BNF for Children 2011-2012

270 5.1.2 Cephalosporins, carbapenems, and other beta-lactams BNFC 2011–20125 InfectionsBreast-feeding present in milk in low concentration,considered compatible with breast-feedingSide-effects see under CefaclorLicensed use nebulised route unlicensedIndication and doseInfections due to sensitive Gram-positive andGram-negative bacteria but see notes above. By intravenous injection or infusionNeonate under 7 days 25 mg/kg every 24 hours;dose doubled in severe infection and meningitisNeonate 7–21 days 25 mg/kg every 12 hours;dose doubled in severe infection and meningitisNeonate 21–28 days 25 mg/kg every 8 hours;dose doubled in severe infection and meningitisChild 1 month–18 years 25 mg/kg every 8 hours;dose doubled in severe infection, febrile neutropeniaand meningitis (max. 6 g daily)Pseudomonal lung infection in cystic fibrosis. By intravenous injection or infusion or by deepintramuscular injectionChild 1 month–18 years 50 mg/kg every 8 hours(max. 9 g daily)Chronic Burkholderia cepacia infection in cysticfibrosis. By inhalation of nebulised solutionChild 1 month–18 years 1 g twice dailyAdministration For parenteral administration, intravenousroute recommended in children. Displacementvalue may be significant, consult local guidelines.For intermittent intravenous infusion dilutereconstituted solution further to a concentration ofnot more than 40 mg/mL in Glucose 5% or Glucose10% or Sodium chloride 0.9%; give over 20–30 minutesFor nebulisation, dissolve dose in 3 mL of water forinjectionCeftazidime (Non-proprietary) AInjection, powder for reconstitution, ceftazidime (aspentahydrate), with sodium carbonate, net price 1-gvial = £8.50; 2-g vial = £17.90Fortum c (GSK) AInjection, powder for reconstitution, ceftazidime (aspentahydrate), with sodium carbonate, net price 500-mg vial = £4.40, 1-g vial = £8.79, 2-g vial = £17.59, 3-gvial = £25.76Electrolytes Na + 2.3 mmol/gKefadim c (Flynn) AInjection, powder for reconstitution, ceftazidime (aspentahydrate), with sodium carbonate, net price 1-gvial = £7.92; 2-g vial = £15.84Electrolytes Na + 2.3 mmol/gCEFTRIAXONECautions see under Cefaclor; neonates; may displacebilirubin from serum albumin, administer over 60minutes in neonates (see also Contra-indications);treatment longer than 14 days, renal failure, dehydration—riskof ceftriaxone precipitation in gallbladder; interactions: Appendix 1 (cephalosporins)Contra-indications see under Cefaclor; neonates lessthan 41 weeks postmenstrual age; neonates over 41weeks postmenstrual age with jaundice, hypoalbuminaemia,or acidosis; concomitant treatment withintravenous calcium (including total parenteral nutritioncontaining calcium) in neonates over 41 weekspostmenstrual age—risk of precipitation in urine andlungsHepatic impairment if hepatic impairment is accompaniedby severe renal impairment, reduce dose andmonitor plasma concentrationRenal impairment max. 50 mg/kg daily (max. 2 gdaily) in severe renal impairment; also monitorplasma concentration if hepatic impairment accompaniedby severe renal impairmentPregnancy not known to be harmfulBreast-feeding present in milk in low concentration,considered compatible with breast-feedingSide-effects see under Cefaclor; calcium ceftriaxoneprecipitates in urine (particularly in very young,dehydrated or those who are immobilised) or in gallbladder—consider discontinuation if symptomatic;rarely prolongation of prothrombin time, pancreatitisLicensed use not licensed for congenital gonococcalconjunctivitis or early syphilis; not licensed for usein children under 12 years of age for uncomplicatedgonorrhoea or pelvic inflammatory diseaseIndication and doseInfections due to sensitive Gram-positive andGram-negative bacteria. By intravenous infusion over 60 minutesNeonate 20–50 mg/kg once daily. By deep intramuscular injection, or by intravenousinjection over 2–4 minutes, or byintravenous infusionChild 1 month–12 yearsBody-weight under 50 kg 50 mg/kg once daily;up to 80 mg/kg daily in severe infections andmeningitis; doses of 50 mg/kg and over by intravenousinfusion onlyBody-weight 50 kg and over dose as for child 12–18 yearsChild 12–18 years 1 g daily; 2–4 g daily in severeinfections and meningitis; intramuscular dosesover 1 g divided between more than one site; singleintravenous doses above 1 g by intravenous infusiononlyCongenital gonococcal conjunctivitis. By intravenous infusion over 60 minutes or bydeep intramuscular injectionNeonate 25–50 mg/kg (max.125 mg) as a singledoseUncomplicated gonorrhoea, pelvic inflammatorydisease (Table 1, section 5.1). By deep intramuscular injectionChild under 12 yearsBody-weight under 45 kg 125 mg as a single doseBody-weight over 45 kg 250 mg as a single doseChild 12–18 years 250 mg as a single dose