BNF for Children 2011-2012

BNFC 2011–2012 5.1.7 Some other antibacterials 287clear relationship between plasma-teicoplanin concentrationand toxicity. However, the plasmateicoplaninconcentration can be used to optimisetreatment in some patients (see Cautions). Pre-dose(‘trough’) concentration should be greater than10 mg/litre (greater than 15–20 mg/litre in endocarditis)but less than 60 mg/litreIndication and dosePotentially serious Gram-positive infectionsincluding endocarditis, and serious infectionsdue to Staphylococcus aureus. By intravenous injection or intravenous infusionover 30 minutesNeonate initially 16 mg/kg for one dose followed24 hours later by 8 mg/kg once daily (intravenousinfusion only)Child 1 month–18 years initially 10 mg/kg (max.400 mg) every 12 hours for 3 doses, then 6 mg/kg(max. 400 mg) once daily; in severe infections(including burns, septicaemia, septic arthritis andosteomyelitis) initially 10 mg/kg every 12 hoursfor 3 doses then 10 mg/kg once daily; after first 3doses, subsequent doses can be given by intramuscularinjection if necessary although intravenousroute preferable for childrenAdministration For intermittent intravenous infusion,dilute reconstituted solution further in sodium chloride0.9% or glucose 5%; give over 30 minutes. Intermittentintravenous infusion preferred in neonatesTargocid c (Sanofi-Aventis) AInjection, powder for reconstitution, teicoplanin, netprice 200-mg vial (with diluent) = £3.57; 400-mg vial(with diluent) = £6.10Electrolytes Na + < 0.5 mmol/200- and 400-mg vialLinezolidLinezolid, an oxazolidinone antibacterial, is activeagainst Gram-positive bacteria including meticillinresistantStaphylococcus aureus (MRSA), and glycopeptide-resistantenterococci. Resistance to linezolidcan develop with prolonged treatment or if the dose isless than that recommended. Linezolid should bereserved for infections caused by Gram-positive bacteriawhen the organisms are resistant to other antibacterialsor when patients cannot tolerate other antibacterials.Linezolid is not active against common Gramnegativeorganisms; it must be given in combinationwith other antibacterials for mixed infections that alsoinvolve Gram-negative organisms. There is limitedinformation on use in children and expert advice shouldbe sought. A higher incidence of blood disorders andoptic neuropathy have been reported in patients receivinglinezolid for more than the maximum recommendedduration of 28 days.LINEZOLIDCautions monitor full blood count (including plateletcount) weekly (see also Blood Disorders below);unless close observation and blood-pressure monitoringpossible, avoid in uncontrolled hypertension,phaeochromocytoma, carcinoid tumour, thyrotoxicosis,bipolar depression, schizophrenia, or acute confusionalstates; interactions: Appendix 1 (MAOIs)Blood disordersHaematopoietic disorders (including thrombocytopenia,anaemia, leucopenia, and pancytopenia) havebeen reported in patients receiving linezolid. It isrecommended that full blood counts are monitoredweekly. Close monitoring is recommended in patientswho:. receive treatment for more than 10–14 days;. have pre-existing myelosuppression;. are receiving drugs that may have adverse effects onhaemoglobin, blood counts, or platelet function;. have severe renal impairment.If significant myelosuppression occurs, treatmentshould be stopped unless it is considered essential,in which case intensive monitoring of blood countsand appropriate management should be implemented.CHM advice (optic neuropathy)Severe optic neuropathy may occur rarely, particularlyif linezolid is used for longer than 28 days. The CHMrecommends that:. patients should be warned to report symptoms of visualimpairment (including blurred vision, visual field defect,changes in visual acuity and colour vision) immediately;. patients experiencing new visual symptoms (regardless oftreatment duration) should be evaluated promptly, andreferred to an ophthalmologist if necessary;. visual function should be monitored regularly if treatmentis required for longer than 28 days.Monoamine oxidase inhibition Linezolid is a reversible,non-selective monoamine oxidase inhibitor (MAOI). Patientsshould avoid consuming large amounts of tyramine-richfoods (such as mature cheese, yeast extracts, undistilledalcoholic beverages, and fermented soya bean products). Inaddition, linezolid should not be given with another MAOI orwithin 2 weeks of stopping another MAOI. Unless closeobservation and blood-pressure monitoring is possible, avoidin those receiving SSRIs, 5HT 1 agonists (‘triptans’), tricyclicantidepressants, sympathomimetics, dopaminergics, buspirone,pethidine and possibly other opioid analgesics. For otherinteractions see Appendix 1 (MAOIs)Contra-indications see Monoamine Oxidase InhibitionaboveHepatic impairment no dose adjustment necessarybut in severe hepatic impairment use only if potentialbenefit outweighs riskRenal impairment no dose adjustment necessary butmetabolites may accumulate if estimated glomerularfiltration rate less than 30 mL/minute/1.73 m 2 ; seealso Blood Disorders abovePregnancy manufacturer advises use only if potentialbenefit outweighs risk—no information availableBreast-feeding manufacturer advises avoid—presentin milk in animal studiesSide-effects diarrhoea (antibiotic-associated colitisreported), nausea, vomiting, taste disturbances,headache; less commonly thirst, dry mouth, glossitis,stomatitis, tongue discoloration, abdominal pain,dyspepsia, gastritis, constipation, pancreatitis, hypertension,fever, fatigue, dizziness, insomnia,hypoaesthesia, paraesthesia, tinnitus, polyuria, leucopenia,thrombocytopenia, eosinophilia, electrolytedisturbances, blurred vision, rash, pruritus, diaphoresis,injection-site reactions; rarely tachycardia, transientischaemic attacks, renal failure; also reportedtooth discoloration, convulsions, lactic acidosis, pancytopenia,anaemia, Stevens-Johnson syndrome,toxic epidermal necrolysis; peripheral and opticneuropathy reported on prolonged therapy (see alsoCHM Advice above)5 Infections