BNF for Children 2011-2012

302 5.2.1 Triazole antifungals BNFC 2011–20125 InfectionsPregnancy manufacturer advises avoid—multiplecongenital abnormalities reported with long-termhigh dosesBreast-feeding present in milk but amount probablytoo small to be harmfulSide-effects nausea, abdominal discomfort, diarrhoea,flatulence, headache, rash (discontinue treatmentor monitor closely if infection invasive or systemic);less frequently dyspepsia, vomiting, tastedisturbance, hepatic disorders, angioedema, anaphylaxis,dizziness, seizures, alopecia, pruritus, toxic epidermalnecrolysis, Stevens-Johnson syndrome(severe cutaneous reactions more likely in AIDSpatients), hyperlipidaemia, leucopenia, thrombocytopenia,and hypokalaemia reportedLicensed use not licensed for tinea infections inchildren, or for vaginal candidiasis in girls under 16years, or for prevention of relapse of cryptococcalmeningitis after completion of primary therapy inchildren with AIDSIndication and doseMucosal candidiasis (except genital). By mouth or by intravenous infusionNeonate under 2 weeks 3–6 mg/kg on first daythen 3 mg/kg every 72 hoursNeonate 2–4 weeks 3–6 mg/kg on first day then3 mg/kg every 48 hoursChild 1 month–12 years 3–6 mg/kg on first daythen 3 mg/kg (max. 100 mg) daily for 7–14 days inoropharyngeal candidiasis (max. 14 days except inseverely immunocompromised patients); for 14–30days in other mucosal infections (e.g. oesophagitis,candiduria, non-invasive bronchopulmonaryinfections)Child 12–18 years 50 mg daily (100 mg daily inunusually difficult infections) given for 7–14 daysin oropharyngeal candidiasis (max. 14 days exceptin severely immunocompromised patients); for 14–30 days in other mucosal infections (e.g. oesophagitis,candiduria, non-invasive bronchopulmonaryinfections)Vaginal candidiasis (see also Recurrent VulvovaginalCandidiasis, section 7.2.2). By mouthChild under 16 years (post-puberty) a singledose of 150 mgChild 16–18 years a single dose of 150 mgCandidal balanitis. By mouthChild 16–18 years a single dose of 150 mgTinea pedis, corporis, cruris, pityriasis versicolor,and dermal candidiasis. By mouthChild 1 month–18 years 3 mg/kg (max. 50 mg)daily for 2–4 weeks (for up to 6 weeks in tineapedis); max. duration of treatment 6 weeksTinea capitis. By mouthChild 1–18 years 6 mg/kg (max. 300 mg) daily for2–4 weeksInvasive candidal infections (including candidaemiaand disseminated candidiasis) andcryptococcal infections (including meningitis). By mouth or by intravenous infusionNeonate under 2 weeks 6–12 mg/kg every 72hours, treatment continued according to response(at least 8 weeks for cryptococcal meningitis)Neonate 2–4 weeks 6–12 mg/kg every 48 hours,treatment continued according to response (atleast 8 weeks for cryptococcal meningitis)Child 1 month–18 years 6–12 mg/kg (max.800 mg) daily, treatment continued according toresponse (at least 8 weeks for cryptococcalmeningitis)Prevention of relapse of cryptococcal meningitisin HIV-infected patients after completion ofprimary therapy. By mouth or by intravenous infusionChild 1 month–18 years 6 mg/kg (max. 200 mg)dailyPrevention of fungal infections in immunocompromisedpatients. By mouth or by intravenous infusionNeonate under 2 weeks according to extent andduration of neutropenia, 3–12 mg/kg every 72hoursNeonate 2–4 weeks according to extent andduration of neutropenia, 3–12 mg/kg every 48hoursChild 1 month–18 years according to extent andduration of neutropenia, 3–12 mg/kg (max.400 mg) daily; 12 mg/kg (max. 400 mg) daily ifhigh risk of systemic infections e.g. following bonemarrowtransplantation; commence treatmentbefore anticipated onset of neutropenia and continuefor 7 days after neutrophil count in desirablerangeAdministration for intravenous infusion, give over10–30 minutes; do not exceed an infusion rate of 5–10 mL/minuteFluconazole (Non-proprietary) A1Capsules, fluconazole 50 mg, net price 7-cap pack =£1.14; 150 mg, single-capsule pack = 98p; 200 mg, 7-cap pack = £5.04. Label: 9, (50 and 200 mg)Dental prescribing on NHS Fluconazole Capsules 50 mgmay be prescribedIntravenous infusion, fluconazole 2 mg/mL, netprice 25-mL bottle = £7.31; 100-mL bottle = £29.27;100-mL infusion bag = £3.89; 50-mL infusion bag =£2.70Diflucan c (Pfizer) A1Capsules, fluconazole 50 mg (blue/white), net price7-cap pack = £16.61; 150 mg (blue), single-capsulepack = £7.12; 200 mg (purple/white), 7-cap pack =£66.42. Label: 9, (50 and 200 mg)Oral suspension, orange-flavoured, fluconazole forreconstitution with water, 50 mg/5 mL, net price1. Capsules can be sold to the public for vaginal candidiasisand associated candidal balanitis in those aged 16–18years, in a container or packaging containing not morethan 150 mg and labelled to show a max. dose of 150 mg