BNF for Children 2011-2012

BNFC 2011–2012 5.4.1 Antimalarials 337estimated glomerular filtration rate 10–20 mL/minute/1.73m 2 . Use one-quarter normal dose onceweekly if estimated glomerular filtration rate less than10 mL/minute/1.73 m 2 ; increased risk of haematologicaltoxicity.Pregnancy benefit of prophylaxis in malaria outweighsrisk; adequate folate supplements should be given tomother; see also p. 332Breast-feeding amount in milk probably too small tobe harmful when used for malaria prophylaxis; seealso p. 332Side-effects mild gastric intolerance, diarrhoea, andconstipation; occasionally mouth ulcers and stomatitis;very rarely cholestasis, vasculitis, skin reactionsand hair lossIndication and doseProphylaxis of malaria preferably started 1 weekbefore entering endemic area and continued for 4weeks after leaving (see notes above). By mouthChild up to 12 weeks, body-weight under 6 kg25 mg once dailyChild 12 weeks–1 year, body-weight 6–10 kg50 mg once dailyChild 1–4 years, body-weight 10–16 kg 75 mgonce dailyChild 4–8 years, body-weight 16–25 kg 100 mgonce dailyChild 8–13 years, body-weight 25–45 kg150 mg once dailyChild over 13 years, body-weight over 45 kg200 mg once dailyCounselling Warn travellers and carers of children travellingabout importance of avoiding mosquito bites,importance of taking prophylaxis regularly, and importanceof immediate visit to doctor if ill within 1 year andespecially within 3 months of return. For details, seenotes aboveNote Proguanil doses in BNFC may differ from those inproduct literatureAdministration Tablets may be crushed and mixedwith food such as milk, jam or honey just beforeadministration1Paludrine c (AstraZeneca)Tablets, scored, proguanil hydrochloride 100 mg. Netprice 98-tab pack = £7.43. Label: 21, counselling,prophylaxis, see aboveWith chloroquineSee under ChloroquinePROGUANIL HYDROCHLORIDE WITHATOVAQUONECautions diarrhoea or vomiting (reduced absorptionof atovaquone); efficacy not evaluated in cerebral orcomplicated malaria (including hyperparasitaemia,pulmonary oedema or renal failure); interactions: seeAppendix 1 (proguanil, atovaquone)Renal impairment avoid for malaria prophylaxis and,if possible, for treatment if estimated glomerular filtrationrate less than 30 mL/minute/1.73 m 21. Can be sold to the public provided it is licensed andlabelled for the prophylaxis of malaria. Drugs for malariaprophylaxis not prescribable on the NHS; health authoritiesmay investigate circumstances under which antimalarialsare prescribedPregnancy manufacturer advises avoid unless essentialBreast-feeding use only if no suitable alternativeavailable; see also Breast-feeding, p. 332Side-effects abdominal pain, nausea, vomiting, diarrhoea;cough; headache, dizziness, insomnia, abnormaldreams, depression, anorexia, fever; rash, pruritus;less frequently stomatitis, palpitation, anxiety, blooddisorders, hyponatraemia, and hair loss; also reportedhepatitis, cholestasis, tachycardia, hallucinations, seizures,vasculitis, mouth ulcers, and Stevens-JohnsonsyndromeIndication and doseSee preparationsCounselling Warn travellers about importance of avoidingmosquito bites, importance of taking prophylaxis regularly,and importance of immediate visit to doctor if ill within 1year and especially within 3 months of return. For details,see notes above2Malarone c (GSK) ATablets (‘standard’), pink, f/c, proguanil hydrochloride100 mg, atovaquone 250 mg. Net price 12-tabpack = £25.21. Label: 21, counselling, prophylaxis, seeaboveDoseProphylaxis of malaria started 1–2 days before enteringendemic area and continued for 1 week after leaving. By mouthChild body-weight over 40 kg 1 tablet dailyTreatment of malaria. By mouthChild body-weight 11–21 kg 1 tablet daily for 3 daysChild body-weight 21–31 kg 2 tablets once daily for 3daysChild body-weight 31–40 kg 3 tablets once daily for 3daysChild body-weight over 40 kg 4 tablets once daily for 3days2Malarone c Paediatric (GSK) APaediatric tablets, pink, f/c proguanil hydrochloride25 mg, atovaquone 62.5 mg, net price 12-tab pack =£6.26. Label: 21, counselling, prophylaxis, see aboveDoseProphylaxis of malaria started 1–2 days before enteringendemic area and continued for 1 week after leaving. By mouthChild body-weight 11–21 kg 1 tablet once dailyChild body-weight 21–31 kg 2 tablets once dailyChild body-weight 31–40 kg 3 tablets once dailyChild body-weight over 40 kg use Malarone c (‘standard’)tablets, see aboveTreatment of malaria. By mouthChild body-weight 5–9 kg 2 tablets once daily for 3daysChild body-weight 9–11 kg 3 tablets once daily for 3daysChild body-weight 11 kg and over use Malarone c(‘standard’) tablets, see aboveAdministration tablets may be crushed and mixed with food ormilky drink just before administration2. Drugs for malaria prophylaxis not prescribable on theNHS; health authorities may investigate circumstancesunder which antimalarials prescribed5 Infections