BNF for Children 2011-2012

BNFC 2011–2012 5.3.2 Herpesvirus infections 323Child 12–18 years 5 mg/kg every 8 hours usuallyfor 5 days, doubled to 10 mg/kg every 8 hours ifCNS involvement (given for up to 21 days) or ifimmunocompromisedNote To avoid excessive dose in obese patients parenteraldose should be calculated on the basis of idealweight for heightHerpes simplex prophylaxis in the immunocompromised. By mouthChild 1 month–2 years 100–200 mg 4 times dailyChild 2–18 years 200–400 mg 4 times dailyHerpes simplex suppression. By mouthChild 12–18 years 400 mg twice daily or 200 mg4 times daily; increased to 400 mg 3 times daily ifrecurrences occur on standard suppressive therapyor for suppression of genital herpes during latepregnancy (from 36 weeks gestation); therapyinterrupted every 6–12 months to reassess recurrencefrequency—consider restarting after two ormore recurrencesChickenpox and herpes zoster infection. By mouthChild 1 month–2 years 200 mg 4 times daily for 5daysChild 2–6 years 400 mg 4 times daily for 5 daysChild 6–12 years 800 mg 4 times daily for 5 daysChild 12–18 years 800 mg 5 times daily for 7 days. By intravenous infusionNeonate 10–20 mg/kg every 8 hours for at least 7daysChild 1–3 months 10–20 mg/kg every 8 hours forat least 7 daysChild 3 months–12 years 250 mg/m 2 every 8hours usually for 5 days, dose doubled if immunocompromisedChild 12–18 years 5 mg/kg every 8 hours usuallyfor 5 days, dose doubled if immunocompromisedNote To avoid excessive dose in obese patients parenteraldose should be calculated on the basis of idealweight for heightProphylaxis of chickenpox after delivery (seenotes above). By intravenous infusionNeonate 10 mg/kg every 8 hours; continued untilserological tests confirm absence of virusAttenuation of chickenpox if varicella–zosterimmunoglobulin not indicated. By mouthChild 1 month–18 years 10 mg/kg 4 times dailyfor 7 days starting 1 week after exposureHerpesvirus skin infections section 13.10.3Herpesvirus eye infections section 11.3.3Administration for intravenous infusion, reconstituteto 25 mg/mL with Water for Injections or SodiumChloride 0.9% then dilute to concentration of 5 mg/mL with Sodium Chloride 0.9% or Sodium Chlorideand Glucose and give over 1 hour; alternatively, maybe administered in a concentration of 25 mg/mLusing a suitable infusion pump and central venousaccess and given over 1 hourAciclovir (Non-proprietary) ATablets, aciclovir 200 mg, net price 25-tab pack =£4.45; 400 mg, 56-tab pack = £8.10; 800 mg, 35-tabpack = £10.21. Label: 9Brands include Virovir cDental prescribing on NHS Aciclovir Tablets 200 mg or800 mg may be prescribedDispersible tablets, aciclovir 200 mg, net price 25-tab pack = £2.05; 400 mg, 56-tab pack = £7.24;800 mg, 35-tab pack = £7.02. Label: 9Suspension, aciclovir 200 mg/5 mL, net price125 mL = £38.22; 400 mg/5 mL, 100 mL = £41.55.Label: 9Dental prescribing on NHS Aciclovir Oral Suspension200 mg/5 mL may be prescribedIntravenous infusion, powder for reconstitution,aciclovir (as sodium salt), net price 250-mg vial =£9.13; 500-mg vial = £20.22Electrolytes Na + 1.1 mmol/250-mg vialIntravenous infusion, aciclovir (as sodium salt),25 mg/mL, net price 10-mL (250-mg) vial = £10.37;20-mL (500-mg) vial = £19.21; 40-mL (1-g) vial =£40.44Electrolytes Na + 1.16 mmol/250-mg vialZovirax c (GSK) ATablets, all dispersible, f/c, aciclovir 200 mg, net price25-tab pack = £17.71; 800 mg (scored, ShinglesTreatment Pack), 35-tab pack = £65.80. Label: 9Suspension, both off-white, sugar-free, aciclovir200 mg/5 mL (banana-flavoured), net price 125 mL =£29.53; 400 mg/5 mL (Double Strength Suspension,orange-flavoured), 100 mL = £33.01. Label: 9Intravenous infusion, powder for reconstitution,aciclovir (as sodium salt), net price 250-mg vial =£9.96; 500-mg vial = £17.72Electrolytes Na + 1.1 mmol/250-mg vialVALACICLOVIRNote Valaciclovir is a pro-drug of aciclovirCautions see under AciclovirHepatic impairment manufacturer advises cautionwith high doses used for preventing cytomegalovirusdisease—no information available in childrenRenal impairment maintain adequate hydration; forherpes zoster, 1 g every 12 hours if estimated glomerularfiltration rate 30–50 mL/minute/1.73 m 2 (1 gevery 24 hours if estimated glomerular filtration rate10–30 mL/minute/1.73 m 2 ; 500 mg every 24 hours ifestimated glomerular filtration rate less than 10 mL/minute/1.73 m 2 ); for treatment of herpes simplex,500 mg (1 g in immunocompromised or HIV-positivechildren) every 24 hours if estimated glomerularfiltration rate less than 30 mL/minute/1.73 m 2 ; fortreatment of herpes labialis, if estimated glomerularfiltration rate 30–50 mL/minute/1.73 m 2 , initially 1 g,then 1 g 12 hours after initial dose (if estimatedglomerular filtration rate 10–30 mL/minute/1.73 m 2 ,initally 500 mg, then 500 mg 12 hours after initial5 Infections