BNF for Children 2011-2012

BNFC 2011–2012 5.1.7 Some other antibacterials 285caused by penicillin-resistant staphylococci, especiallyosteomyelitis, as they are well concentrated in bone;they are also used for staphylococcal endocarditis. Asecond antistaphylococcal antibiotic is usually requiredto prevent emergence of resistance during treatment.SODIUM FUSIDATECautions monitor liver function with high doses or onprolonged therapy; elimination may be reduced inhepatic impairment or biliary disease or biliaryobstruction; interactions: Appendix 1 (fusidic acid)Hepatic impairment impaired biliary excretion, avoidor reduce dose; possibly increased risk of hepatotoxicity,monitor liver functionPregnancy not known to be harmful; manufactureradvises use only if potential benefit outweighs riskBreast-feeding present in milk; manufacturer advisescautionSide-effects nausea, vomiting, reversible jaundice,especially after high dosage or rapid infusion (withdrawtherapy if persistent); rarely hypersensitivityreactions, acute renal failure (usually with jaundice),blood disordersIndication and dosePenicillin-resistant staphylococcal infectionincluding osteomyelitis, staphylococcal endocarditisin combination with other antibacterialssee under Preparations, belowSodium fusidate (LEO) AIntravenous infusion, powder for reconstitution,sodium fusidate 500 mg (= fusidic acid 480 mg), withbuffer, net price per vial (with diluent) = £70.04Electrolytes Na + 3.1 mmol/vial when reconstituted with bufferDoseAs sodium fusidate. By intravenous infusionNeonate 10 mg/kg every 12 hoursChild 1 month–18 years 6–7 mg/kg (max. 500 mg)every 8 hoursAdministration reconstitute with buffer solution provided;further dilute to 1 mg/mL with Sodium chloride 0.9% or Glucose5% intravenous infusion (but see below); infuse over at least 6hours via a superficial vein or 2 hours via a central venous line;incompatible in solution of pH less than 7.4Fucidin c (LEO) ATablets, f/c, sodium fusidate 250 mg, net price 10-tabpack = £6.02. Label: 9DoseAs sodium fusidate. By mouthChild 12–18 years 500 mg every 8 hours, dose doubledfor severe infectionsSkin infection as sodium fusidate. By mouthChild 12–18 years 250 mg every 12 hours for 5–10 daysSuspension, off-white, banana- and orange-flavoured,fusidic acid 250 mg/5 mL, net price 50 mL =£6.73. Label: 9, 21DoseAs fusidic acid. By mouthNeonate 15 mg/kg 3 times dailyChild 1 month–1 year 15 mg/kg 3 times dailyChild 1–5 years 250 mg 3 times dailyChild 5–12 years 500 mg 3 times dailyChild 12–18 years 750 mg 3 times dailyNote Fusidic acid is incompletely absorbed and dosesrecommended for suspension are proportionately higherthan those for sodium fusidate tabletsVancomycin and teicoplaninThe glycopeptide antibiotics vancomycin and teicoplaninhave bactericidal activity against aerobic andanaerobic Gram-positive bacteria including multi-resistantStaphylococci. However, there are reports of Staphylococcusaureus with reduced susceptibility to glycopeptides.There are increasing reports ofglycopeptide-resistant Enterococci.Vancomycin is used by the intravenous route in theprophylaxis and treatment of serious infections causedby Gram-positive cocci. Vancomycin is principallyexcreted via the kidney and dose reduction is necessaryin renal impairment.Penetration in to cerebrospinal fluid is poor; vancomycinmay be administered by the intrathecal or intraventricularroute for treatment of meningitis [unlicensed].Vancomycin (added to dialysis fluid) is alsoused in the treatment of peritonitis associated withperitoneal dialysis [unlicensed route] (Table 1 section5.1).Vancomycin given by mouth for 10–14 days is effectivein the treatment of Clostridium difficile infection (seealso section 1.5); low doses are considered adequate(higher dose may be considered if the infection fails torespond or if it is life-threatening). Vancomycin shouldnot be given by mouth for systemic infections since it isnot significantly absorbed.Teicoplanin is similar to vancomycin but has a significantlylonger duration of action allowing once-dailyadministration. Plasma concentration monitoring isnot usually necessary, but may help optimise therapy.Unlike vancomycin, teicoplanin can be given by intramuscularas well as by intravenous injection; it is notgiven by mouth.VANCOMYCINCautions avoid rapid infusion (risk of anaphylactoidreactions, see Side-effects); rotate infusion sites; avoidif history of deafness; all patients require plasmavancomycinmeasurement (after 3 or 4 doses if renalfunction normal, earlier if renal impairment), bloodcounts, urinalysis, and renal function tests; monitorauditory function in renal impairment; teicoplaninsensitivity; systemic absorption may follow oraladministration especially in inflammatory bowel disordersor following multiple doses; interactions:Appendix 1 (vancomycin)Renal impairment reduce dose—monitor plasmavancomycinconcentration and renal function regularly;see also Cautions abovePregnancy manufacturer advises use only if potentialbenefit outweighs risk—plasma-vancomycin concentrationmonitoring essential to reduce risk of fetaltoxicityBreast-feeding present in milk—significant absorptionfollowing oral administration unlikely5 Infections