BNF for Children 2011-2012

286 5.1.7 Some other antibacterials BNFC 2011–20125 InfectionsSide-effects after parenteral administration: nephrotoxicityincluding renal failure and interstitial nephritis;ototoxicity (discontinue if tinnitus occurs); blooddisorders including neutropenia (usually after 1 weekor high cumulative dose), rarely agranulocytosis andthrombocytopenia; nausea; chills, fever; eosinophilia,anaphylaxis, rashes (including exfoliative dermatitis,Stevens-Johnson syndrome, toxic epidermal necrolysis,and vasculitis); phlebitis (irritant to tissue); onrapid infusion, severe hypotension (including shockand cardiac arrest), wheezing, dyspnoea, urticaria,pruritus, flushing of the upper body (‘red man’syndrome), pain and muscle spasm of back and chestPharmacokinetics plasma concentration monitoringrequired; pre-dose (‘trough’) concentration shouldbe 10–15 mg/litre (15–20 mg/litre for less sensitivestrains of meticillin-resistant Staphylococcus aureus)Licensed use not licensed for intraventricular useIndication and doseInfections due to Gram-positive bacteriaincluding osteomyelitis, septicaemia and softtissueinfections see notes above. By intravenous infusionNeonate less than 29 weeks postmenstrual age15 mg/kg every 24 hours, adjusted according toplasma concentrationNeonate 29–35 weeks postmenstrual age15 mg/kg every 12 hours, adjusted according toplasma concentrationNeonate over 35 weeks postmenstrual age15 mg/kg every 8 hours, adjusted according toplasma concentrationChild 1 month–18 years 15 mg/kg every 8 hours(maximum daily dose 2 g), adjusted according toplasma concentrationClostridium difficile infection (see also notesabove). By mouthChild 1 month–5 years 5 mg/kg 4 times daily for10–14 days (increased up to 10 mg/kg 4 timesdaily if infection fails to respond or is life-threatening)Child 5–12 years 62.5 mg 4 times daily for 10–14days (increased up to 250 mg 4 times daily ifinfection fails to respond or is life-threatening)Child 12–18 years 125 mg 4 times daily for 10–14days (increased up to 500 mg 4 times daily ifinfection fails to respond or is life-threatening)CNS infection e.g. ventriculitis. By intraventricular administration, seek specialistadviceNeonate 10 mg once every 24 hoursChild 1 month–18 years 10 mg once every 24hoursNote for all children reduce to 5 mg daily if ventricularsize reduced or increase to 15–20 mg once daily ifventricular size increased. Adjust dose according to CSFconcentration after 3-4 days; aim for pre-dose (‘trough’)concentration less than 10 mg/litre. If CSF not drainingfreely reduce dose frequency to once every 2–3 daysPeritonitis associated with peritoneal dialysisAdd to each bag of dialysis fluid to achieve a concentrationof 20–25 mg/litreNote Vancomycin doses in BNF for Children may differ fromthose in product literatureAdministration Displacement value may be significant,consult product literature and local guidelines.For intermittent intravenous infusion, the reconstitutedpreparation should be further diluted in sodiumchloride 0.9% or glucose 5% to a concentration of upto 5 mg/mL; give over at least 60 minutes (rate not toexceed 10 mg/minute for doses over 500 mg); usecontinuous infusion only if intermittent not available(limited evidence); 10 mg/mL can be used if infusedvia a central venous line over at least 1 hourInjection may be given orally; flavouring syrups maybe added to the solution at the time of administration.Safe PracticeFor intraventricular administration, seek specialistadviceVancomycin (Non-proprietary) ACapsules, vancomycin (as hydrochloride) 125 mg, netprice 28-cap pack = £132.47; 250 mg, 28-cap pack =£132.47. Label: 9Injection, powder for reconstitution, vancomycin (ashydrochloride), for use as an infusion, net price 500-mg vial = £7.25; 1-g vial = £14.50Note Can be used to prepare solution for oral administrationVancocin c (Flynn) AMatrigel capsules, vancomycin (as hydrochloride)125 mg, net price 28-cap pack = £88.31. Label: 9Injection, powder for reconstitution, vancomycin (ashydrochloride), for use as an infusion, net price 500-mg vial = £8.05; 1-g vial = £16.11Note Can be used to prepare solution for oral administrationTEICOPLANINCautions vancomycin sensitivity; blood counts andliver and kidney function tests required—monitorrenal and auditory function on prolonged administrationduring renal impairment or if other nephrotoxicor neurotoxic drugs given; monitor plasmateicoplaninconcentration if severe sepsis or burns,deep-seated staphylococcal infection (including boneand joint infection), endocarditis, renal impairment,and in intravenous drug abusers; interactions:Appendix 1 (teicoplanin)Renal impairment reduce dose on day 4: use halfnormal dose if estimated glomerular filtration rate 40–60 mL/minute/1.73 m 2 and use one-third normaldose if estimated glomerular filtration rate less than40 mL/minute/1.73 m 2 ; see also Cautions abovePregnancy manufacturer advises use only if potentialbenefit outweighs riskBreast-feeding no information availableSide-effects rash, pruritus; less commonly nausea,vomiting, diarrhoea, bronchospasm, dizziness, headache,fever, leucopenia, thrombocytopenia, eosinophilia,tinnitus, mild hearing loss, vestibular disorders,thrombophlebitis; also reported renal failure, exfoliativedermatitis, Stevens-Johnson syndrome, toxicepidermal necrolysisPharmacokinetics plasma-teicoplanin concentrationis not measured routinely because there is no