BNF for Children 2011-2012

BNFC 2011–2012 5.3 Antiviral drugs 309Tinea capitis caused by Trichophyton tonsurans. By mouthChild 1 month–12 years 15–20 mg/kg (max. 1 g)once daily or in divided dosesChild 12–18 years 1 g once daily or in divideddosesGriseofulvin (Non-proprietary) ATablets, griseofulvin 125 mg, net price 100 = £34.86;500 mg, 100 = £90.34. Label: 9, 21, counselling, skilledtasksFulsovin c (Kappin) AOral suspension, griseofulvin 125 mg/5 mL, netprice 100 mL (peppermint-flavoured) = £59.90.Label: 9, 21, counselling, skilled tasksTERBINAFINECautions psoriasis (risk of exacerbation); autoimmmunedisease (risk of lupus-erythematosus-like effect)interactions: Appendix 1 (terbinafine)Hepatic impairment manufacturer advises avoid—elimination reducedRenal impairment use half normal dose if estimatedglomerular filtration rate less than 50 mL/minute/1.73 m 2 and no suitable alternative availablePregnancy manufacturer advises use only if benefitoutweighs risk—no information availableBreast-feeding avoid—present in milkSide-effects abdominal discomfort, anorexia, nausea,diarrhoea; headache; rash and urticaria occasionallywith arthralgia or myalgia; less commonly taste disturbance;rarely liver toxicity (including jaundice,cholestasis and hepatitis)—discontinue treatment,angioedema, dizziness, malaise, paraesthesia,hypoaesthesia, photosensitivity, serious skin reactions(including Stevens-Johnson syndrome and toxic epidermalnecrolysis)—discontinue treatment if progressiveskin rash; very rarely psychiatric disturbances,blood disorders (including incidence ofleucopenia higher and thrombocytopenia), lupuserythematosus-like effect, and exacerbation of psoriasisLicensed use not licensed for use in childrenIndication and doseDermatophyte infections of the nails, ringworminfections (including tinea pedis, cruris, corporis,and capitis) where oral therapy appropriate(due to site, severity or extent). By mouthChild over 1 year; body-weight 10–20 kg62.5 mg once dailyChild body-weight 20–40 kg 125 mg once dailyChild body-weight over 40 kg 250 mg once dailyNote treatment usually for 4 weeks in tinea capitis, 2–6weeks in tinea pedis, 2–4 weeks in tinea cruris, 4 weeks intinea corporis, 6 weeks–3 months in nail infections(occasionally longer in toenail infections)Fungal skin infections section 13.10.2Terbinafine (Non-proprietary) ATablets, terbinafine (as hydrochloride) 250 mg, netprice 14-tab pack = £2.33, 28-tab pack = £3.02.Label: 9Lamisil c (Novartis) ATablets, off-white, scored, terbinafine (as hydrochloride)250 mg, net price 14-tab pack = £21.30, 28-tab pack = £41.09. Label: 95.3 Antiviral drugs5.3.1 HIV infection5.3.2 Herpesvirus infections5.3.3 Viral hepatitis5.3.4 Influenza5.3.5 Respiratory syncytial virusThe majority of virus infections resolve spontaneouslyin immunocompetent subjects. A number of specifictreatments for viral infections are available, particularlyfor the immunocompromised. This section includesnotes on herpes simplex and varicella-zoster, humanimmunodeficiency virus, cytomegalovirus, respiratorysyncytial virus, viral hepatitis and influenza.5.3.1 HIV infectionThere is no cure for infection caused by the humanimmunodeficiency virus (HIV) but a number of drugsslow or halt disease progression. Drugs for HIV infection(antiretrovirals) may be associated with seriousside-effects. Although antiretrovirals increase life expectancyconsiderably and decrease the risk of complicationsassociated with premature ageing, mortality andmorbidity remain slightly higher than in uninfectedindividuals.The natural progression of HIV disease is different inchildren compared to adults; drug treatment shouldonly be undertaken by specialists within a formal paediatricHIV clinical network. Guidelines and dose regimensare under constant review and for this reasonsome dose recommendations have not been included inBNF for Children.Further information on the management of childrenwith HIV can be obtained from the Children’s HIVAssociation (CHIVA) www.chiva.org.uk; and furtherinformation on antiretroviral use and toxicity can beobtained from the Paediatric European Network forTreatment of AIDS (PENTA) websitewww.pentatrials.org.Principles of treatment Treatment is aimed atsuppressing viral replication for as long as possible; itshould be started before the immune system is irreversiblydamaged. The need for early drug treatmentshould, however, be balanced against the risk of toxicity.Commitment to treatment and strict adherence overmany years are required; the regimen chosen shouldtake into account convenience and the child’s toleranceof treatment. The development of drug resistance isreduced by using a combination of drugs; such combinationsshould have synergistic or additive activity whileensuring that their toxicity is not additive. It is recommendedthat viral sensitivity to antiretroviral drugs is5 Infections