BNF for Children 2011-2012

290 5.1.9 Antituberculosis drugs BNFC 2011–20125 Infections1 ampoule (5 mL) to 125 mL, 2 ampoules (10 mL) to250 mL or 3 ampoules (15 mL) to 500 mL; suggestedduration of infusion 60–90 minutes (but may beadjusted according to fluid requirements); if fluidrestriction necessary, 1 ampoule (5 mL) may bediluted with 75 mL glucose 5% and the required doseinfused over max. 60 minutes; check container forhaze or precipitant during administration. In severefluid restriction may be given undiluted via a centralvenous lineCo-trimoxazole (Non-proprietary) ATablets, co-trimoxazole 480 mg, net price 28-tab pack= £18.99; 960 mg, 100 = £23.46. Label: 9Brands include Fectrim c , Fectrim c FortePaediatric oral suspension, co-trimoxazole 240 mg/5 mL, net price 100 mL = £1.12. Label: 9Oral suspension, co-trimoxazole 480 mg/5 mL. Netprice 100 mL = £4.41. Label: 9Septrin c (Aspen) ATablets, co-trimoxazole 480 mg, net price 100-tabpack = £15.52. Label: 9Forte tablets, scored, co-trimoxazole 960 mg, netprice 100-tab pack = £23.46. Label: 9Adult suspension, co-trimoxazole 480 mg/5 mL, netprice 100 mL (vanilla-flavoured) = £4.41. Label: 9Paediatric suspension, sugar-free, co-trimoxazole240 mg/5 mL. Net price 100 mL (banana- and vanillaflavoured)= £2.45. Label: 9Intravenous infusion, co-trimoxazole 96 mg/mL. Tobe diluted before use. Net price 5-mL amp = £1.78Electrolytes Na + 1.7 mmol/5 mLExcipients include alcohol 13.2%, propylene glycol, sulphitesTRIMETHOPRIMCautions predisposition to folate deficiency; manufacturerrecommends blood counts on long-termtherapy (but evidence of practical value unsatisfactory);neonates (specialist supervision required); acuteporphyria (section 9.8.2); interactions: Appendix 1(trimethoprim)Blood disorders On long-term treatment, patients and theircarers should be told how to recognise signs of blooddisorders and advised to seek immediate medical attention ifsymptoms such as fever, sore throat, rash, mouth ulcers,purpura, bruising or bleeding developContra-indications blood dyscrasiasRenal impairment use half normal dose after 3 days ifestimated glomerular filtration rate 15–30 mL/minute/1.73m 2 ; use half normal dose if estimated glomerularfiltration rate less than 15 mL/minute/1.73 m 2(monitor plasma-trimethoprim concentration if estimatedglomerular filtration rate less than 10 mL/minute/1.73 m 2 )Pregnancy teratogenic risk in first trimester (folateantagonist); manufacturers advise avoidBreast-feeding present in milk—short-term use notknown to be harmfulSide-effects gastro-intestinal disturbances includingnausea and vomiting, pruritus, rashes, hyperkalaemia,depression of haematopoiesis; rarely erythema multiforme,toxic epidermal necrolysis, photosensitivityand other allergic reactions including angioedemaand anaphylaxis; aseptic meningitis reportedLicensed use not licensed for use in children under 6weeksIndication and doseUrinary-tract infections; respiratory-tractinfections. By mouthNeonate initially 3 mg/kg as a single dose then 1–2 mg/kg twice dailyChild 1 month–12 years 4 mg/kg (max. 200 mg)twice dailyorChild 6 weeks–6 months 25 mg twice dailyChild 6 months–6 years 50 mg twice dailyChild 6–12 years 100 mg twice dailyChild 12–18 years 200 mg twice dailyProphylaxis of urinary-tract infectionTable 2, section 5.1Pneumocystis pneumonia see p. 342Trimethoprim (Non-proprietary) ATablets, trimethoprim 100 mg, net price 28 = 94p;200 mg, 14-tab pack = 91p. Label: 9Brands include Trimopan cSuspension, trimethoprim 50 mg/5 mL, net price100 mL = £2.37. Label: 95.1.9 Antituberculosis drugsTuberculosis is treated in two phases—an initial phaseusing 4 drugs and a continuation phase using two drugsin fully sensitive cases. Treatment requires specialisedknowledge, particularly where the disease involvesresistant organisms or non-respiratory organs.The regimens given below are recommended for thetreatment of tuberculosis in the UK; variations occur inother countries. Either the unsupervised regimen or thesupervised regimen described below should be used; thetwo regimens should not be used concurrently. Compliancewith therapy is a major determinant of itssuccess. Treatment needs to be carefully monitored infamilies in whom concordance may be problematic.Initial phase The concurrent use of 4 drugs during theinitial phase is designed to reduce the bacterial populationas rapidly as possible and to prevent the emergenceof drug-resistant bacteria. The drugs are best given ascombination preparations, provided the respective doseof each drug is appropriate, unless the child is unable toswallow the tablets or one of the components cannot begiven because of resistance or intolerance. The treatmentof choice for the initial phase is the daily use ofisoniazid, rifampicin, pyrazinamide and ethambutol.However, care is needed in young children receivingethambutol because of the difficulty in testing eyesightand in obtaining reports of visual symptoms (see below).Treatment should be started without waiting for cultureresults if clinical features or histology results are consistentwith tuberculosis; treatment should be continuedeven if initial culture results are negative. The initialphase drugs should be continued for 2 months. Where apositive culture for M. tuberculosis has been obtained,but susceptibility results are not available after 2months, treatment with rifampicin, isoniazid, pyrazin-