BNF for Children 2011-2012

340 5.4.3 Trichomonacides BNFC 2011–20125 InfectionsTINIDAZOLECautions see under Metronidazole (section 5.1.11);avoid in acute porphyria (section 9.8.2); interactions:Appendix 1 (tinidazole)Pregnancy manufacturer advises avoid in first trimesterBreast-feeding present in milk—manufactureradvises avoid breast-feeding during and for 3 daysafter stopping treatmentSide-effects see under Metronidazole (section 5.1.11)Licensed use licensed for use in children (age rangenot specified by manufacturer)Indication and doseIntestinal amoebiasis. By mouthChild 1 month–12 years 50–60 mg/kg (max. 2 g)once daily for 3 daysChild 12–18 years 2 g once daily for 2–3 daysAmoebic involvement of liver. By mouthChild 1 month–12 years 50–60 mg/kg (max. 2 g)once daily for 5 daysChild 12–18 years 1.5–2 g once daily for 3–6 daysUrogenital trichomoniasis and giardiasis. By mouthChild 1 month–12 years single dose of 50–75 mg/kg (max. 2 g) (repeated once if necessary)Child 12–18 years single dose of 2 g (repeatedonce if necessary)Fasigyn c (Pfizer) ATablets, f/c, tinidazole 500 mg, net price 16-tab pack= £11.04. Label: 4, 9, 21, 255.4.3 TrichomonacidesMetronidazole (section 5.4.2) is the treatment of choicefor Trichomonas vaginalis infection. Contact tracing isrecommended and sexual contacts should be treatedsimultaneously. If metronidazole is ineffective, tinidazole(section 5.4.2) may be tried.5.4.4 Antigiardial drugsMetronidazole (section 5.4.2) is the treatment of choicefor Giardia lamblia infections. Tinidazole (section5.4.2) may be used as an alternative to metronidazole.5.4.5 LeishmaniacidesCutaneous leishmaniasis frequently heals spontaneouslybut if skin lesions are extensive or unsightly,treatment is indicated, as it is in visceral leishmaniasis(kala-azar). Leishmaniasis should be treated under specialistsupervision.Sodium stibogluconate, an organic pentavalent antimonycompound, is the treatment of choice for visceralleishmaniasis. The dose is 20 mg/kg daily (max. 850 mg)for at least 20 days by intramuscular or intravenousinjection; the dosage varies with different geographicalregions and expert advice should be obtained. Skinlesions can also be treated with sodium stibogluconate.Amphotericin is used with or after an antimony compoundfor visceral leishmaniasis unresponsive to theantimonial alone; side-effects may be reduced byusing liposomal amphotericin (AmBisome c —section5.2) at a dose of 1–3 mg/kg daily for 10–21 days to acumulative dose of 21–30 mg/kg or at a dose of 3 mg/kg for 5 consecutive days followed by a single dose of3 mg/kg 6 days later. Abelcet c , a lipid formulation ofamphotericin is also likely to be effective but lessinformation is available.Pentamidine isetionate (pentamidine isethionate) (section5.4.8) has been used in antimony-resistant visceralleishmaniasis, but although the initial response is oftengood, the relapse rate is high; it is associated withserious side-effects. Other treatments include paromomycin[unlicensed], available from ‘special-order’ manufacturersor specialist importing companies, see p. 809SODIUM STIBOGLUCONATECautions intravenous injections must be given slowlyover 5 minutes (to reduce risk of local thrombosis)and stopped if coughing or substernal pain; mucocutaneousdisease (see below); monitor ECG before andduring treatment; heart disease (withdraw if conductiondisturbances occur); treat intercurrent infection(e.g. pneumonia)Mucocutaneous disease Successful treatment of mucocutaneousleishmaniasis may induce severe inflammationaround the lesions (may be life-threatening if pharyngeal ortracheal involvement)—may require corticosteroidHepatic impairment use with cautionRenal impairment avoid in significant impairmentPregnancy manufacturer advises use only if potentialbenefit outweighs riskBreast-feeding amount probably too small to beharmfulSide-effects anorexia, nausea, vomiting, abdominalpain; ECG changes; coughing (see Cautions); headache,lethargy, arthralgia, myalgia; rarely jaundice,flushing, bleeding from nose or gum, substernal pain(see Cautions), vertigo, fever, sweating, and rash; alsoreported pancreatitis and anaphylaxis; pain andthrombosis on intravenous administration, intramuscularinjection also painfulLicensed use licensed for use in children (age rangenot specified by manufacturer)Indication and doseLeishmaniasis for dose, see notes aboveAdministration injection should be filtered immediatelybefore administration using a filter of 5 micronsor less; see also Cautions abovePentostam c (GSK) AInjection, sodium stibogluconate equivalent to pentavalentantimony 100 mg/mL. Net price 100-mLbottle = £66.43