BNF for Children 2011-2012

BNFC 2011–2012 5.1.2 Cephalosporins, carbapenems, and other beta-lactams 273Child 3 months–18 yearsBody-weight under 40 kg 15 mg/kg (max.500 mg) every 6 hoursBody-weight over 40 kg 250–500 mg every 6hours; less sensitive organisms up to 12.5 mg/kg(max. 1 g) every 6 hours; total daily dose mayalternatively be given in 3 divided dosesCystic fibrosis. By intravenous infusionChild 1 month–18 yearsBody-weight under 40 kg 22.5 mg/kg every 6hoursBody-weight over 40 kg 1 g every 6–8 hoursAdministration for intermittent intravenous infusiondilute to a concentration of 5 mg (as imipenem)/mL insodium chloride 0.9% or sodium chloride and glucose;give up to 500 mg over 20–30 minutes; give 1 g over40–60 minutesPrimaxin c (MSD) AIntravenous infusion, powder for reconstitution,imipenem (as monohydrate) 500 mg with cilastatin (assodium salt) 500 mg, net price per vial = £12.00Electrolytes Na + 1.72 mmol/vialMEROPENEMCautions hypersensitivity to beta-lactam antibacterials(avoid if history of immediate hypersensitivityreaction, see also p. 257); interactions: Appendix 1(meropenem)Hepatic impairment monitor liver functionRenal impairment use normal dose every 12 hours ifestimated glomerular filtration rate 26–50 mL/minute/1.73m 2 ; use half normal dose every 12 hours ifestimated glomerular filtration rate 10–25 mL/minute/1.73m 2 ; use half normal dose every 24 hours ifestimated glomerular filtration rate less than 10 mL/minute/1.73 m 2Pregnancy manufacturer advises use only if potentialbenefit outweighs risk—no information availableBreast-feeding unlikely to be absorbed (but manufactureradvises avoid unless potential benefit outweighsrisk)Side-effects nausea, vomiting, diarrhoea (antibioticassociatedcolitis reported), abdominal pain, disturbancesin liver function tests, headache, thrombocythaemia,rash, pruritus; less commonly paraesthesia,eosinophilia, thrombocytopenia, leucopenia;rarely convulsions; also reported haemolytic anaemia,positive Coombs’ test, Stevens-Johnson syndrome,toxic epidermal necrolysisLicensed use not licensed for use in children under 3monthsIndication and doseAerobic and anaerobic Gram-positive andGram-negative infections (see notes above),hospital-acquired septicaemia Table 1, section5.1. By intravenous injection over 5 minutes or byintravenous infusionNeonate under 7 days 20 mg/kg every 12 hours,dose doubled in severe infectionNeonate 7–28 days 20 mg/kg every 8 hours;dose doubled in severe infectionChild 1 month–12 yearsBody-weight under 50 kg 10–20 mg/kg every 8hoursBody-weight over 50 kg dose as for child 12–18yearsChild 12–18 years 0.5–1 g every 8 hoursMeningitis. By intravenous infusionNeonate under 7 days 40 mg/kg every 12 hoursNeonate 7–28 days 40 mg/kg every 8 hoursChild 1 month–12 yearsBody-weight under 50 kg 40 mg/kg every 8hoursBody-weight over 50 kg dose as for child 12–18yearsChild 12–18 years 2 g every 8 hoursExacerbations of chronic lower respiratory-tractinfections in cystic fibrosis. By intravenous infusionChild 1 month–12 yearsBody-weight under 50 kg 40 mg/kg every 8hoursBody-weight over 50 kg dose as for child 12–18yearsChild 12–18 years 2 g every 8 hoursAdministration displacement value may be significantwhen reconstituting injection, consult local guidelines.For intravenous infusion, dilute reconstitutedsolution further to a concentration of 1–20 mg/mL inGlucose 5% or Sodium Chloride 0.9%; give over 15–30 minutesMeronem c (AstraZeneca) AInjection, powder for reconstitution, meropenem (astrihydrate), net price 500-mg vial = £8.60; 1-g vial =£17.19Electrolytes Na + 3.9 mmol/g5.1.2.3 Other beta-lactam antibioticsAztreonam is a monocyclic beta-lactam (‘monobactam’)antibiotic with an antibacterial spectrum limitedto Gram-negative aerobic bacteria including Pseudomonasaeruginosa, Neisseria meningitidis, and Haemophilusinfluenzae; it should not be used alone for ‘blind’treatment since it is not active against Gram-positiveorganisms. Aztreonam is also effective against Neisseriagonorrhoeae (but not against concurrent chlamydialinfection). Side-effects are similar to those of the otherbeta-lactams although aztreonam may be less likely tocause hypersensitivity in penicillin-sensitive patients.AZTREONAMCautions hypersensitivity to beta-lactam antibiotics;interactions: Appendix 1 (aztreonam)Contra-indications aztreonam hypersensitivityHepatic impairment use with caution and monitorliver functionRenal impairment usual initial dose, then half normaldose if estimated glomerular filtration rate 10–30 mL/5 Infections