BNF for Children 2011-2012

BNFC 2011–2012 5.4.2 Amoebicides 339Hepatic impairment section 5.1.3Renal impairment section 5.1.3Pregnancy section 5.1.3Breast-feeding section 5.1.3Side-effects section 5.1.3Licensed use not licensed for use in children under12 yearsIndication and doseProphylaxis of malaria preferably started 1–2 daysbefore entering endemic area and continued for 4weeks after leaving (see notes above). By mouthChild over 12 years 100 mg once dailyTreatment of falciparum malaria see p. 330PreparationsSection 5.1.35.4.2 AmoebicidesMetronidazole is the drug of choice for acute invasiveamoebic dysentery since it is very effective againstvegetative forms of Entamoeba histolytica which cancause ulceration of the large intestine. Tinidazole is alsoeffective. Metronidazole and tinidazole are also activeagainst amoebae which may have migrated to the liver.Treatment with metronidazole (or tinidazole) is followedby a 10-day course of diloxanide furoate.Diloxanide furoate is the drug of choice for asymptomaticpatients with E. histolytica cysts in the faeces;metronidazole and tinidazole are relatively ineffective.Diloxanide furoate is relatively free from toxic effectsand the usual course is of 10 days, given alone forchronic infections or following metronidazole or tinidazoletreatment.For amoebic abscesses of the liver metronidazole iseffective; tinidazole is an alternative. Aspiration of theabscess is indicated where it is suspected that it mayrupture or where there is no improvement after 72 hoursof metronidazole; the aspiration may need to berepeated. Aspiration aids penetration of metronidazoleand, for abscesses with large volume of pus, if carriedout in conjunction with drug therapy, may reduce theperiod of disability.Diloxanide furoate is not effective against hepaticamoebiasis, but a 10-day course should be given atthe completion of metronidazole or tinidazole treatmentto destroy any amoebae in the gut.DILOXANIDE FUROATEPregnancy manufacturer advises avoid—no informationavailableBreast-feeding manufacturer advises avoidSide-effects flatulence, vomiting, urticaria, pruritusLicensed use not licensed for use in children under25 kg body-weightIndication and doseChronic amoebiasis and as adjunct to metronidazoleor tinidazole in acute amoebiasis. By mouthChild 1 month–12 years 6.6 mg/kg 3 times dailyfor 10 daysChild 12–18 years 500 mg 3 times daily for 10daysDiloxanide (Sovereign) ATablets, diloxanide furoate 500 mg, net price 30-tabpack = £93.50. Label: 9Extemporaneous formulations available seeExtemporaneous Preparations, p. 6METRONIDAZOLECautions section 5.1.11Hepatic impairment section 5.1.11Pregnancy section 5.1.11Breast-feeding section 5.1.11Side-effects section 5.1.11Indication and doseAnaerobic infections section 5.1.11Invasive intestinal amoebiasis, extra-intestinalamoebiasis (including liver abscess). By mouthChild 1–3 years 200 mg 3 times daily for 5 days inintestinal infection (for 5–10 days in extra-intestinalinfection)Child 3–7 years 200 mg 4 times daily for 5 days inintestinal infection (for 5–10 days in extra-intestinalinfection)Child 7–10 years 400 mg 3 times daily for 5 daysin intestinal infection (for 5–10 days in extraintestinalinfection)Child 10–18 years 800 mg 3 times daily for 5 daysin intestinal infection (for 5–10 days in extraintestinalinfection)Urogenital trichomoniasis. By mouthChild 1–3 years 50 mg 3 times daily for 7 daysChild 3–7 years 100 mg twice daily for 7 daysChild 7–10 years 100 mg 3 times daily for 7 daysChild 10–18 years 200 mg 3 times daily for 7 daysor 400–500 mg twice daily for 5–7 days, or 2 g as asingle doseGiardiasis. By mouthChild 1–3 years 500 mg once daily for 3 daysChild 3–7 years 600–800 mg once daily for 3 daysChild 7–10 years 1 g once daily for 3 daysChild 10–18 years 2 g once daily for 3 days or400 mg 3 times daily for 5 days or 500 mg twicedaily for 7–10 daysPreparationsSection 5.1.115 Infections