BNF for Children 2011-2012

300 5.2 Antifungal drugs BNFC 2011–20125 Infectionswith great caution; tetracyclines, methamine, and nitrofurantoinshould be avoided altogether.NITROFURANTOINCautions anaemia; diabetes mellitus; electrolyteimbalance; vitamin B and folate deficiency; pulmonarydisease; on long-term therapy, monitor liverfunction and monitor for pulmonary symptoms (discontinueif deterioration in lung function); susceptibilityto peripheral neuropathy; false positive urinaryglucose (if tested for reducing substances); urine maybe coloured yellow or brown; interactions: Appendix1 (nitrofurantoin)Contra-indications infants less than 3 months old,G6PD deficiency (section 9.1.5), acute porphyria(section 9.8.2)Hepatic impairment use with caution; cholestaticjaundice and chronic active hepatitis reportedRenal impairment avoid if estimated glomerular filtrationrate less than 60 mL/minute/1.73 m 2 ; risk ofperipheral neuropathy; ineffective because of inadequateurine concentrationsPregnancy avoid at term—may produce neonatalhaemolysisBreast-feeding avoid; only small amounts in milk butenough to produce haemolysis in G6PD-deficientinfants (section 9.1.5)Side-effects anorexia, nausea, vomiting, and diarrhoea;acute and chronic pulmonary reactions (pulmonaryfibrosis reported; possible association withlupus erythematosus-like syndrome); peripheralneuropathy; also reported, hypersensitivity reactions(including angioedema, anaphylaxis, sialadenitis,urticaria, rash and pruritus); rarely, cholestatic jaundice,hepatitis, exfoliative dermatitis, erythema multiforme,pancreatitis, arthralgia, blood disorders(including agranulocytosis, thrombocytopenia, andaplastic anaemia), benign intracranial hypertension,and transient alopeciaIndication and doseAcute uncomplicated urinary-tract infection. By mouthChild 3 months–12 years 750 micrograms/kg 4times daily for 3–7 daysChild 12–18 years 50 mg 4 times daily for 3–7days; increased to 100 mg 4 times daily in severechronic recurrent infectionsProphylaxis of urinary-tract infection (but seeCautions above)Table 2, section 5.1Nitrofurantoin (Non-proprietary) ATablets, nitrofurantoin 50 mg, net price 28-tab pack =£1.84; 100 mg, 28-tab pack = £4.43 Label: 9, 14, 21Oral suspension, nitrofurantoin 25 mg/5 mL, netprice 300 mL = £99.05. Label: 9, 14, 21Note Sugar-free versions are available and can be ordered byspecifying ‘sugar-free’ on the prescriptionFuradantin c (Goldshield) ATablets, all yellow, scored, nitrofurantoin 50 mg, netprice 100-tab pack = £9.79; 100 mg, 100-tab pack =£18.11. Label: 9, 14, 21Macrodantin c (Goldshield) ACapsules, yellow/white, nitrofurantoin 50 mg (asmacrocrystals), net price 30-cap pack = £2.49; 100 mg(yellow/white), 30-cap pack = £4.81. Label: 9, 14, 21Modified releaseMacrobid c (Goldshield) ACapsules, m/r, blue/yellow, nitrofurantoin 100 mg(as nitrofurantoin macrocrystals and nitrofurantoinmonohydrate). Net price 14-cap pack = £4.89.Label: 9, 14, 21, 25DoseUncomplicated urinary-tract infectionChild 12–18 years 1 capsule twice daily with foodGenito-urinary surgical prophylaxisChild 12–18 years 1 capsule twice daily on day ofprocedure and for 3 days after5.2 Antifungal drugsTreatment of fungal infectionsThe systemic treatment of common fungal infections isoutlined below; specialist treatment is required in mostforms of systemic or disseminated fungal infections. Forlocal treatment of fungal infections, see section 7.2.2(genital), section 7.4.4 (bladder), section 11.3.2 (eye),section 12.1.1 (ear), section 12.3.2 (oropharynx), andsection 13.10.2 (skin).Aspergillosis Aspergillosis most commonly affectsthe respiratory tract but in severely immunocompromisedpatients, invasive forms can affect the heart,brain, and skin. Voriconazole (section 5.2.1) is thetreatment of choice for aspergillosis; liposomalamphotericin (section 5.2.3) is an alternative first-linetreatment when voriconazole cannot be used. Caspofungin(section 5.2.4) or itraconazole (section 5.2.1)can be used in patients who are refractory to, or intolerantof voriconazole and liposomal amphotericin. Itraconazoleis also used for the treatment of chronic pulmonaryaspergillosis or as an adjunct in the treatment ofallergic bronchopulmonary aspergillosis.Candidiasis Many superficial candidal infections,including infections of the skin (section 13.10.2), aretreated locally. Systemic antifungal treatment is requiredin widespread or intractable infection. Vaginal candidiasiscan be treated with locally acting antifungals(section 7.2.2); alternatively, fluconazole (section5.2.1) can be given by mouth.Oropharyngeal candidiasis generally responds to topicaltherapy (section 12.3.2). Fluconazole is given bymouth for unresponsive infections; it is reliablyabsorbed and is effective. Itraconazole (section 5.2.1)can be used for fluconazole-resistant infections. Topicaltherapy may not be adequate in immunocompromisedchildren and an oral triazole antifungal is preferred.For invasive or disseminated candidiasis, eitheramphotericin (section 5.2.3) by intravenous infusionor an echinocandin (section 5.2.4) can be used. Flu-