BNF for Children 2011-2012

BNFC 2011–2012 5.1.2 Cephalosporins, carbapenems, and other beta-lactams 267which become resistant to penicillin are usually alsoresistant to cephalosporins. This is of importance in thecase of children who have had rheumatic fever and areon long-term penicillin therapy. Cefalexin and cefradinehave been used in the treatment of oral infections.Suspension, cefaclor (as monohydrate) for reconstitutionwith water, 125 mg/5 mL, net price 100 mL =£8.33; 250 mg/5 mL, 100 mL = £6.97. Label: 9Note Sugar-free versions are available and can be ordered byspecifying ‘sugar-free’ on the prescriptionBrands include Keftid cCEFACLORCautions sensitivity to beta-lactam antibacterials(avoid if history of immediate hypersensitivity reaction,see also notes above and p. 257); false positiveurinary glucose (if tested for reducing substances) andfalse positive Coombs’ test; interactions: Appendix 1(cephalosporins)Contra-indications cephalosporin hypersensitivityRenal impairment no dosage adjustment required,manufacturer advises cautionPregnancy not known to be harmfulBreast-feeding present in milk in low concentration,considered compatible with breast-feedingSide-effects diarrhoea (rarely antibiotic-associatedcolitis), nausea and vomiting, abdominal discomfort,headache; allergic reactions including rashes, pruritus,urticaria, serum sickness-like reactions with rashes,fever and arthralgia, and anaphylaxis; Stevens-Johnsonsyndrome, toxic epidermal necrolysis reported;disturbances in liver enzymes, transient hepatitis andcholestatic jaundice; other side-effects reportedinclude eosinophilia and blood disorders (includingthrombocytopenia, leucopenia, agranulocytosis,aplastic anaemia and haemolytic anaemia); reversibleinterstitial nephritis, hyperactivity, nervousness, sleepdisturbances, hallucinations, confusion, hypertonia,and dizzinessIndication and doseInfections due to sensitive Gram-positive andGram-negative bacteria but see notes above. By mouthChild 1 month–12 years 20 mg/kg daily in 3divided doses, doubled for severe infection (usualmax. 1 g daily)orChild 1 month–1 year 62.5 mg 3 times daily; dosedoubled for severe infectionsChild 1–5 years 125 mg 3 times daily; dosedoubled for severe infectionsChild 5–12 years 250 mg 3 times daily; dosedoubled for severe infectionsChild 12–18 years 250 mg 3 times daily; dosedoubled for severe infections (max. 4 g daily)Asymptomatic carriage of Haemophilus influenzaeor mild exacerbations in cystic fibrosis. By mouthChild 1 month–1 year 125 mg every 8 hoursChild 1–7 years 250 mg 3 times dailyChild 7–18 years 500 mg 3 times dailyCefaclor (Non-proprietary) ACapsules, cefaclor (as monohydrate) 250 mg, netprice 21-cap pack = £5.09; 500 mg, 50-cap pack =£31.99. Label: 9Brands include Keftid cDistaclor c (Flynn) ACapsules, cefaclor (as monohydrate) 500 mg (violet/grey), net price 21-cap pack = £18.19. Label: 9Suspension, both pink, cefaclor (as monohydrate) forreconstitution with water, 125 mg/5 mL, net price100 mL = £4.13; 250 mg/5 mL, 100 mL = £8.26.Label: 9Distaclor MR c (Flynn) ATablets, m/r, both blue, cefaclor (as monohydrate)375 mg. Net price 14-tab pack = £8.31. Label: 9, 21, 25DoseSusceptible infectionsChild 12–18 years 375 mg every 12 hours with food,dose doubled for pneumoniaLower urinary-tract infectionsChild 12–18 years 375 mg every 12 hours with foodCEFADROXILCautions see under Cefaclor; interactions: Appendix1 (cephalosporins)Contra-indications see under CefaclorRenal impairment reduce dose if estimated glomerularfiltration rate less than 50 mL/minute/1.73 m 2Pregnancy not known to be harmfulBreast-feeding present in milk in low concentrationsSide-effects see under CefaclorIndication and doseInfections due to sensitive Gram-positive andGram-negative bacteria but see notes above. By mouthChild 6–18 yearsBody-weight under 40 kg 500 mg twice daily;Body-weight over 40 kg 0.5–1 g twice daily (1 gonce daily for skin, soft-tissue and uncomplicatedurinary-tract infections)Cefadroxil (Non-proprietary) ACapsules, cefadroxil (as monohydrate) 500 mg, netprice 20-cap pack = £4.83. Label: 9CEFALEXIN(Cephalexin)Cautions see under Cefaclor; interactions: Appendix1 (cephalosporins)Contra-indications see under CefaclorRenal impairment reduce dose in moderate impairmentPregnancy not known to be harmfulBreast-feeding present in milk in low concentrations,considered compatible with breast-feedingSide-effects see under Cefaclor5 Infections