BNF for Children 2011-2012

BNFC 2011–2012 5.1.6 Clindamycin 283Erythromycin (Non-proprietary) ACapsules, enclosing e/c microgranules, erythromycin250 mg, net price 28-cap pack = £15.00. Label: 5, 9, 25Brands include Tiloryth cTablets, e/c, erythromycin 250 mg, net price 28 =£1.54. Label: 5, 9, 25Dental prescribing on NHS Erythromycin Tablets e/c maybe prescribedErythromycin Ethyl Succinate (Non-proprietary) AOral suspension, erythromycin (as ethyl succinate)for reconstitution with water 125 mg/5 mL, net price100 mL = £1.99; 250 mg/5 mL, 100 mL = £2.64;500 mg/5 mL, 100 mL = £4.31. Label: 9Note Sugar-free versions are available and can be ordered byspecifying ‘sugar-free’ on the prescriptionBrands include Primacine cDental prescribing on NHS Erythromycin Ethyl SuccinateOral Suspension may be prescribedErythromycin Lactobionate (Non-proprietary) AIntravenous infusion, powder for reconstitution,erythromycin (as lactobionate), net price 1-g vial =£9.98Erymax c (Cephalon) ACapsules, opaque orange/clear orange, enclosingorange and white e/c pellets, erythromycin 250 mg,net price 28-cap pack = £5.61, 112-cap pack = £22.44.Label: 5, 9, 25Erythrocin c (Amdipharm) ATablets, both f/c, erythromycin (as stearate), 250 mg,net price 100–tab pack = £18.20; 500 mg, 100–tabpack = £36.40. Label: 9Dental prescribing on NHS May be prescribed as ErythromycinStearate TabletsErythroped c (Amdipharm) ASuspension SF, sugar-free, banana-flavoured,erythromycin (as ethyl succinate) for reconstitutionwith water, 125 mg/5 mL (Suspension PI SF), netprice 140 mL = £3.06; 250 mg/5 mL, 140 mL = £5.95;500 mg/5 mL (Suspension SF Forte), 140 mL =£10.56. Label: 9Erythroped A c (Amdipharm) ATablets, yellow, f/c, erythromycin 500 mg (as ethylsuccinate). Net price 28-tab pack = £10.78. Label: 9Dental prescribing on NHS May be prescribed as ErythromycinEthyl Succinate Tablets5.1.6 ClindamycinClindamycin is active against Gram-positive cocci,including streptococci and penicillin-resistant staphylococci,and also against many anaerobes, especially Bacteroidesfragilis. It is well concentrated in bone andexcreted in bile and urine.Clindamycin is recommended for staphylococcal jointand bone infections such as osteomyelitis, and intraabdominalsepsis; it is an alternative to macrolides forerysipelas or cellulitis in penicillin-allergic patients. It isalso used in combination with other antibacterials forcellulitis in immunocompromised children. Clindamycincan also be used for infections associated with meticillin-resistantStaphylococcus aureus (MRSA) in boneand joint infections, and skin and soft-tissue infections.Clindamycin has been associated with antibiotic-associatedcolitis (section 1.5), which may be fatal. Althoughit can occur with most antibacterials, antibiotic-associatedcolitis occurs more frequently with clindamycin.Children should therefore discontinue treatment immediatelyif diarrhoea develops.Oral infections Clindamycin should not be usedroutinely for the treatment of oral infections because itmay be no more effective than penicillins against anaerobesand there may be cross-resistance with erythromycin-resistantbacteria. Clindamycin can be used forthe treatment of dentoalveolar abscess that has notresponded to penicillin or to metronidazole.CLINDAMYCINCautions discontinue immediately if diarrhoea or colitisdevelops; monitor liver and renal function iftreatment exceeds 10 days, and in neonates andinfants; avoid rapid intravenous administration; avoidin acute porphyria (section 9.8.2); interactions:Appendix 1 (clindamycin)Contra-indications diarrhoeal states; avoid injectionscontaining benzyl alcohol in neonates (see underpreparations below)Pregnancy not known to be harmfulBreast-feeding amount probably too small to beharmful; bloody diarrhoea reported in 1 infantSide-effects diarrhoea (discontinue treatment),abdominal discomfort, oesophagitis, oesophagealulcers, taste disturbances, nausea, vomiting, antibiotic-associatedcolitis; jaundice; leucopenia, eosinophilia,and thrombocytopenia reported; polyarthritisreported; rash, pruritus, urticaria, anaphylactoidreactions, Stevens-Johnson syndrome, toxic epidermalnecrolysis, exfoliative and vesiculobullousdermatitis reported; pain, induration, and abscessafter intramuscular injection; thrombophlebitis afterintravenous injectionIndication and doseStaphylococcal bone and joint infections, peritonitissee notes above. By mouthNeonate under 14 days 3–6 mg/kg 3 times dailyNeonate 14–28 days 3–6 mg/kg 4 times dailyChild 1 month–12 years 3–6 mg/kg 4 times daily(body-weight under 10 kg, minimum dose 37.5 mg3 times daily)Child 12–18 years 150–300 mg 4 times daily; insevere infections 450 mg 4 times daily. By deep intramuscular injection or by intravenousinfusionChild 1 month–12 years 3.75–6.25 mg/kg 4times daily; increased up to 10 mg/kg 4 times dailyin severe infections; total daily dose may alternativelybe given in 3 divided dosesChild 12–18 years 150–675 mg 4 times daily;total daily dose may alternatively be given in 2–3divided doses; in life-threatening infection up to1.2 g 4 times daily; single doses above 600 mg byintravenous infusion only; single doses by intravenousinfusion not to exceed 1.2 g5 Infections