BNF for Children 2011-2012

284 5.1.7 Some other antibacterials BNFC 2011–20125 InfectionsStaphylococcal lung infection in cystic fibrosis. By mouthChild 1 month–18 years 5–7 mg/kg (max.600 mg) 4 times dailyTreatment of falciparum malaria, see p. 330Administration for intravenous infusion, dilute to aconcentration of not more than 18 mg/mL with Glucose5% or Sodium Chloride 0.9%; give over 10–60minutes at a max. rate of 20 mg/kg/hourClindamycin (Non-proprietary) ACapsules, clindamycin (as hydrochloride) 150 mg, netprice 24-cap pack = £11.75. Label: 9, 27, counselling,see above (diarrhoea)Dental prescribing on NHS Clindamycin Capsules may beprescribedLiquid, 75 mg/5 mL available from ‘special-order’manufacturers or specialist importing companies, seep. 809Dalacin C c (Pharmacia) ACapsules, clindamycin (as hydrochloride) 75 mg(green/white), net price 24-cap pack = £7.45; 150 mg,(white), 24-cap pack = £13.72. Label: 9, 27, counselling,see above (diarrhoea)Dental prescribing on NHS May be prescribed as ClindamycinCapsulesInjection, clindamycin (as phosphate) 150 mg/mL,net price 2-mL amp = £6.20; 4-mL amp = £12.35Excipients include benzyl alcohol (avoid in neonates, see Excipients,p. 2)5.1.7 Some other antibacterialsAntibacterials discussed in this section include chloramphenicol,fusidic acid, glycopeptide antibiotics(vancomycin and teicoplanin), linezolid, and the polymyxin,colistimethate sodium.ChloramphenicolChloramphenicol is a potent broad-spectrum antibiotic;however, it is associated with serious haematologicalside-effects when given systemically and should thereforebe reserved for the treatment of life-threateninginfections, particularly those caused by Haemophilusinfluenzae, and also for typhoid fever. Chloramphenicolis also used in cystic fibrosis for the treatment of respiratoryBurkholderia cepacia infection resistant to otherantibacterials.Grey baby syndrome may follow excessive doses inneonates with immature hepatic metabolism; monitoringof plasma concentrations is recommended.Chloramphenicol eye drops (section 11.3.1) and chloramphenicolear drops (section 12.1.1) are also available.CHLORAMPHENICOLCautions avoid repeated courses and prolongedtreatment; blood counts required before and periodicallyduring treatment; monitor plasma-chloramphenicolconcentration in neonates (see below);interactions: Appendix 1 (chloramphenicol)Contra-indications acute porphyria (section 9.8.2)Hepatic impairment avoid if possible—increased riskof bone-marrow depression; reduce dose and monitorplasma-chloramphenicol concentrationRenal impairment avoid in severe impairment unlessno alternative; dose-related depression of haematopoiesisPregnancy manufacturer advises avoid; neonatalgrey-baby syndrome if used in third trimesterBreast-feeding manufacturer advises avoid; useanother antibiotic; may cause bone-marrow toxicity ininfant; concentration in milk usually insufficient tocause ‘grey-baby syndrome’Side-effects blood disorders including reversible andirreversible aplastic anaemia (with reports of resultingleukaemia), peripheral neuritis, optic neuritis, headache,depression, urticaria, erythema multiforme,nausea, vomiting, diarrhoea, stomatitis, glossitis, drymouth; nocturnal haemoglobinuria reported; greysyndrome (abdominal distension, pallid cyanosis, circulatorycollapse) may follow excessive doses inneonates with immature hepatic metabolism (seePharmacokinetics below)Pharmacokinetics plasma concentration monitoringrequired in neonates and preferred in those under 4years of age, and in hepatic impairment; recommendedpeak plasma concentration (approx. 2hours after administration by mouth, intravenousinjection or infusion) 10–25 mg/litre; pre-dose(‘trough’) concentration should not exceed 15 mg/litreIndication and doseSee notes above. By intravenous injectionNeonate up to 14 days 12.5 mg/kg twice dailyNeonate 14–28 days 12.5 mg/kg 2–4 times dailyNote Check dosage carefully; overdosage can be fatal(see also pharmacokinetics above). By mouth or by intravenous injection or infusionChild 1 month–18 years 12.5 mg/kg every 6hours; dose may be doubled in severe infectionssuch as septicaemia, meningitis and epiglottitisproviding plasma-chloramphenicol concentrationsare measured and high doses reduced as soon asindicatedAdministration Displacement value may be significantfor injection, consult local guidelines. For intermittentintravenous infusion, dilute reconstitutedsolution further in glucose 5% or sodium chloride0.9%Chloramphenicol (Non-proprietary) ACapsules, chloramphenicol 250 mg. Net price 60 =£377.00Extemporaneous formulations available seeExtemporaneous Preparations, p. 6Kemicetine c (Pharmacia) AInjection, powder for reconstitution, chloramphenicol(as sodium succinate). Net price 1-g vial = £1.39Electrolytes Na + 3.14 mmol/gFusidic acidFusidic acid and its salts are narrow-spectrum antibiotics.The only indication for their use is in infections