BNF for Children 2011-2012

298 5.1.12 Quinolones BNFC 2011–20125 InfectionsContra-indications Quinolone hypersensitivity.Pregnancy Quinolones should be avoided inpregnancy because they have been shown to causearthropathy in animal studies; safer alternatives areavailable.Side-effects Side-effects of the quinolones includenausea, vomiting, dyspepsia, abdominal pain, diarrhoea(rarely antibiotic-associated colitis), headache, dizziness,rash (very rarely Stevens-Johnson syndrome andtoxic epidermal necrolysis). Less frequent side-effectsinclude anorexia, sleep disturbances, asthenia, confusion,anxiety, depression, hallucinations, tremor, blooddisorders (including eosinophilia, leucopenia, thrombocytopenia),arthralgia, myalgia, disturbances in visionand taste. Other side-effects reported rarely or veryrarely include hepatic dysfunction (including jaundiceand hepatitis), hypotension, vasculitis, dyspnoea, convulsions,psychoses, paraesthesia, renal failure, interstitialnephritis, tendon inflammation and damage (seealso Tendon Damage above), photosensitivity, disturbancesin hearing and smell. The drug should be discontinuedif psychiatric, neurological or hypersensitivityreactions (including severe rash) occur.CIPROFLOXACINCautions see notes above; avoid excessive alkalinity ofurine and ensure adequate fluid intake (risk of crystalluria);interactions: Appendix 1 (quinolones)Skilled tasks May impair performance of skilled tasks (e.g.driving)Contra-indications see notes aboveRenal impairment reduce dose if estimated glomerularfiltration rate less than 30 mL/minute/1.73 m 2 —consult product literaturePregnancy see notes aboveBreast-feeding amount probably too small to beharmful but manufacturer advises avoidSide-effects see notes above; also flatulence, pain andphlebitis at injection site; rarely dysphagia, pancreatitis,chest pain, tachycardia, syncope, oedema, hotflushes, abnormal dreams, sweating, hyperglycaemia,and erythema nodosum; very rarely movement disorders,tinnitus, vasculitis, and tenosynovitisLicensed use licensed for use in children over 1 yearfor complicated urinary-tract infections, for pseudomonallower respiratory-tract infections in cysticfibrosis, for prophylaxis and treatment of inhalationalanthrax; licensed for use in children over 1year for other infections where the benefit is consideredto outweigh the potential risks; not licensedfor use in children for gastro-intestinal anthrax; notlicensed for use in children for prophylaxis ofmeningococcal meningitis; not licensed for use inchildren under 1 year of ageIndication and doseComplicated urinary-tract infections. By mouthNeonate 10 mg/kg twice dailyChild 1 month–18 years 10 mg/kg twice daily;dose doubled in severe infection (max. 750 mgtwice daily). By intravenous infusion over 60 minutesNeonate 6 mg/kg every 12 hoursChild 1 month–18 years 6 mg/kg every 8 hours;increased to 10 mg/kg every 8 hours in severeinfection (max. 400 mg every 8 hours)Severe respiratory-tract infections, gastrointestinalinfections; see notes above. By mouthNeonate 15 mg/kg twice dailyChild 1 month–18 years 20 mg/kg (max. 750 mg)twice daily. By intravenous infusion over 60 minutesNeonate 10 mg/kg every 12 hoursChild 1 month–18 years 10 mg/kg (max. 400 mg)every 8 hoursPseudomonal lower respiratory-tract infectionin cystic fibrosis. By mouthChild 1 month–18 years 20 mg/kg (max. 750 mg)twice daily. By intravenous infusion over 60 minutesChild 1 month–18 years 10 mg/kg (max. 400 mg)every 8 hoursGonorrhoea. By mouthChild 12–18 years 500 mg as a single doseAnthrax (treatment and post-exposure prophylaxis,see notes above). By mouthChild 1 month–18 years 15 mg/kg (max. 500 mg)twice daily. By intravenous infusion over 60 minutesChild 1 month–18 years 10 mg/kg (max. 400 mg)every 12 hoursEye infections section 11.3.1Prophylaxis of meningococcal meningitis Table2, section 5.1Ciprofloxacin (Non-proprietary) ATablets, ciprofloxacin (as hydrochloride) 100 mg, netprice 6-tab pack = £1.42; 250 mg, 10-tab pack = 96p,20-tab pack = £1.09; 500 mg, 10-tab pack = £1.06, 20-tab pack = £1.22; 750 mg, 10-tab pack = £6.15.Label: 7, 9, 25, counselling, drivingIntravenous infusion, ciprofloxacin (as lactate)2 mg/mL, net price 50-mL bottle = £8.00, 100-mLbottle = £15.00, 200-mL bottle = £22.00Ciproxin c (Bayer Schering) ATablets, all f/c, ciprofloxacin (as hydrochloride)250 mg (scored), net price 10-tab pack = £6.59;500 mg (scored), 10-tab pack = £12.49; 750 mg, 10-tabpack = £17.78. Label: 7, 9, 25, counselling, drivingSuspension, strawberry-flavoured, ciprofloxacin forreconstitution with diluent provided, 250 mg/5 mL,net price 100 mL = £16.83. Label: 7, 9, 25, counselling,driving