BNF for Children 2011-2012

BNFC 2011–2012 5.1.5 Macrolides 281mia, insterstitial nephritis, acute renal failure, photosensitivity,tooth and tongue discolorationLicensed use not licensed for typhoid fever, Lymedisease, chronic Pseudomonas aeruginosa infectionin cystic fibrosis, or prophylaxis of group A streptococcalinfectionIndication and doseRespiratory-tract infections, otitis media, skinand soft-tissue infections. By mouthChild over 6 months 10 mg/kg once daily (max.500 mg once daily) for 3 daysorBody-weight 15–25 kg 200 mg once daily for 3daysBody-weight 26–35 kg 300 mg once daily for 3daysBody-weight 36–45 kg 400 mg once daily for 3daysBody-weight over 45 kg 500 mg once daily for 3daysInfection in cystic fibrosis. By mouthChild 6 months–18 years 10 mg/kg once daily(max. 500 mg once daily) for 3 days; courserepeated after 1 week, then repeat as necessaryChronic Pseudomonas aeruginosa infection incystic fibrosis. By mouthChild 6–18 yearsBody-weight 25–40 kg 250 mg 3 times a weekBody-weight over 40 kg 500 mg 3 times a weekUncomplicated genital chlamydial infectionsand non-gonococcal urethritis. By mouthChild 12–18 years 1 g as a single doseLyme disease (see also section 5.1.1.3), mild tomoderate typhoid due to multiple-antibacterialresistant organisms. By mouthChild 6 months–18 years 10 mg/kg once daily(max. 500 mg) for 7–10 days (for 7 days in typhoid)Prevention of group A streptococcal infectionTable 2, section 5.1Azithromycin (Non-proprietary) ACapsules, azithromycin (as dihydrate) 250 mg, netprice 4-cap pack = £9.82, 6-cap pack = £14.73.Label: 5, 9, 23Tablets, azithromycin (as monohydrate hemi-ethanolate)250 mg, net price 4-tab pack = £9.83; 500 mg,3-tab pack = £6.75. Label: 5, 9Note Azithromycin tablets can be sold to the public for thetreatment of confirmed, asymptomatic Chlamydia trachomatisgenital infection in those over 16 years of age, and forthe epidemiological treatment of their sexual partners, subjectto max. single dose of 1 g, max. daily dose 1 g, and a packsize of 1 gOral suspensio, azithromycin (as monohydrate)200 mg/5 mL when reconstituted with water, netprice 15-mL pack = £5.81, 30-mL pack = £11.04.Label: 5, 9Dental prescribing on NHS May be prescribed as AzithromycinOral Suspension 200 mg/5 mLZithromax c (Pfizer) ACapsules, azithromycin (as dihydrate) 250 mg, netprice 4-cap pack = £7.16, 6-cap pack = £10.74.Label: 5, 9, 23Oral suspension, cherry/banana-flavoured, azithromycin(as dihydrate) 200 mg/5 mL when reconstitutedwith water. Net price 15-mL pack = £4.06, 22.5-mL pack = £6.10, 30-mL pack = £11.04. Label: 5, 9CLARITHROMYCINCautions see notes above; interactions: Appendix 1(macrolides)Hepatic impairment hepatic dysfunction includingjaundice reportedRenal impairment use half normal dose if estimatedglomerular filtration rate less than 30 mL/minute/1.73 m 2 ; avoid Klaricid XL c if estimated glomerularfiltration rate less than 30 mL/minute/1.73 m 2Pregnancy manufacturer advises avoid unless potentialbenefit outweighs riskBreast-feeding manufacturer advises avoid unlesspotential benefit outweighs risk—present in milkSide-effects see notes above; also dyspepsia, toothand tongue discoloration, smell and taste disturbances,stomatitis, glossitis, and headache; less commonlyarthralgia and myalgia; rarely tinnitus; veryrarely dizziness, insomnia, nightmares, anxiety, confusion,psychosis, paraesthesia, convulsions, hypoglycaemia,renal failure, interstitial nephritis, leucopenia,and thrombocytopeniaLicensed use tablets and intravenous infusion notlicensed for use in children under 12 yearsIndication and doseRespiratory-tract infections, mild to moderateskin and soft-tissue infections, otitis media(see also Table 1, section 5.1). By mouthNeonate 7.5 mg/kg twice dailyChild 1 month–12 yearsBody-weight under 8 kg 7.5 mg/kg twice dailyBody-weight 8–11 kg 62.5 mg twice dailyBody-weight 12–19 kg 125 mg twice dailyBody-weight 20–29 kg 187.5 mg twice dailyBody-weight 30–40 kg 250 mg twice dailyChild 12–18 years 250 mg twice daily for 7 days,increased if necessary in severe infections to500 mg every 12 hours for up to 14 days. By intravenous infusion into large proximalveinChild 1 month–12 years 7.5 mg/kg every 12hoursChild 12–18 years 500 mg every 12 hours5 Infections