BNF for Children 2011-2012

BNFC 2011–2012 5.1.1 Penicillins 265Indication and doseNote Expressed as a combination of piperacillin andtazobactam (both as sodium salts) in a ratio of 8:1Lower respiratory tract, urinary-tract, intraabdominaland skin infections, and bacterialsepticaemia. By intravenous injection over 3–5 minutes orby intravenous infusionNeonate 90 mg/kg every 8 hoursChild 1 month–12 years 90 mg/kg every 6–8hours; (max 4.5 g every 6 hours)Child 12–18 years 2.25–4.5 g every 6–8 hours,usually 4.5 g every 8 hoursInfections in children with neutropenia in combinationwith an aminoglycoside. By intravenous injection over 3–5 minutes orby intravenous infusionChild 1 month–18 years 90 mg/kg (max. 4.5 g)every 6 hoursComplicated appendicitis. By intravenous injection over 3–5 minutes orby intravenous infusionChild 2–12 years 112.5 mg/kg (max. 4.5 g) every8 hours for 5–14 daysAdministration displacement value may be significantwhen reconstituting injection, consult local guidelines.For intravenous infusion, dilute reconstitutedsolution to a concentration of 15–90 mg/mL withGlucose 5% or Sodium Chloride 0.9%; give over 20–30 minutesPiperacillin with tazobactam (Non-proprietary) AInjection 2.25 g, powder for reconstitution, piperacillin2 g (as sodium salt), tazobactam 250 mg (assodium salt), net price 2.25-g vial = £7.16Injection 4.5 g, powder for reconstitution, piperacillin4 g (as sodium salt), tazobactam 500 mg (as sodiumsalt), net price 4.5-g vial = £14.21Tazocin c (Wyeth) AInjection 2.25 g, powder for reconstitution, piperacillin2 g (as sodium salt), tazobactam 250 mg (assodium salt), net price 2.25-g vial = £7.65Electrolytes Na + 5.58 mmol/2.25-g vialInjection 4.5 g, powder for reconstitution, piperacillin4 g (as sodium salt), tazobactam 500 mg (as sodiumsalt), net price 4.5-g vial = £15.17Electrolytes Na + 11.16 mmol/4.5-g vialTICARCILLIN WITH CLAVULANICACIDCautions see under Benzylpenicillin (section 5.1.1.1);interactions: Appendix 1 (penicillins)Cholestatic Jaundice For a warning on cholestatic jaundicepossibly associated with clavulanic acid, see under CoamoxiclavContra-indications see under Benzylpenicillin (section5.1.1.1)Hepatic impairment manufacturer advises caution insevere impairment; also cholestatic jaundice, seeunder Co-amoxiclavRenal impairment Neonate reduce dose ifestimated glomerular filtration rate less than60 mL/minute/1.73 m 2 . Child 1 month–18 years usenormal dose every 8 hours if estimated glomerularfiltration rate 30–60 mL/minute/1.73 m 2 ; use halfnormal dose every 8 hours if estimated glomerularfiltration rate 10–30 mL/minute/1.73 m 2 ; use halfnormal dose every 12 hours if estimated glomerularfiltration rate less than 10 mL/minute/1.73 m 2Pregnancy not known to be harmfulBreast-feeding trace amounts present in milk—notknown to be harmful, but be alert for hypersensitivityin the infantSide-effects see under Benzylpenicillin (section5.1.1.1); also nausea, vomiting, coagulation disorders,haemorrhagic cystitis (more frequent in children),injection-site reactions, Stevens-Johnson syndrome,toxic epidermal necrolysis, hypokalaemia, eosinophiliaIndication and doseNote Expressed as a combination of ticarcillin (as sodiumsalt) and clavulanic acid (as potassium salt) in a ratio of15:1Infections due to Pseudomonas and Proteusspp. see notes above. By intravenous infusionPreterm neonate body-weight under 2 kg80 mg/kg every 12 hoursPreterm neonate body-weight over 2 kg andneonate 80 mg/kg every 8 hours, increased toevery 6 hours in more severe infectionsChild 1 month–18 years and body-weightunder 40 kg 80 mg/kg every 8 hours, increased toevery 6 hours in more severe infectionsChild under 18 years and body-weight over40 kg 3.2 g every 6–8 hours, increased to every 4hours in more severe infectionsAdministration Displacement value may be important,consult local guidelines. For intermittent infusion,dilute reconstituted solution further to a concentrationof 16–32 mg/mL with glucose 5%; infuseover 30–40 minutes.Timentin c (GSK) AInjection 3.2 g, powder for reconstitution, ticarcillin3 g (as sodium salt), clavulanic acid 200 mg (aspotassium salt). Net price per vial = £5.33Electrolytes Na + 16 mmol, K + 1 mmol /3.2-g vial5.1.1.5 MecillinamsPivmecillinam has significant activity against manyGram-negative bacteria including Escherichia coli, klebsiella,enterobacter, and salmonellae. It is not activeagainst Pseudomonas aeruginosa or enterococci.Pivmecillinam is hydrolysed to mecillinam, which isthe active drug.PIVMECILLINAM HYDROCHLORIDECautions see under Benzylpenicillin (section 5.1.1.1);also liver and renal function tests required in longtermuse; avoid in acute porphyria (section 9.8.2);interactions: Appendix 1 (penicillins)Contra-indications see under Benzylpenicillin (section5.1.1.1); also carnitine deficiency, oesophageal5 Infections