BNF for Children 2011-2012

344 5.5 Anthelmintics BNFC 2011–20125 InfectionsCutaneous leishmaniasis. By deep intramuscular injectionChild 1–18 years 3–4 mg/kg once or twiceweekly until condition resolves (but see also section5.4.5)Trypanosomiasis. By deep intramuscular injection or intravenousinfusionChild 1–18 years 4 mg/kg daily or on alternatedays to total of 7–10 injectionsAdministration Direct intravenous injection should beavoided whenever possible and never given rapidly;intramuscular injections should be deep and preferablygiven into the buttock.For intravenous infusion, reconstitute 300 mg with 3–5 mL Water for Injections (displacement value may besignificant), then dilute required dose with 50–250 mLGlucose 5% or Sodium Chloride 0.9%; give over atleast 60 minutesPentacarinat c (Sanofi-Aventis) AInjection, powder for reconstitution, pentamidineisetionate, net price 300-mg vial = £30.45Caution in handling Pentamidine isetionate is toxic andpersonnel should be adequately protected during handlingand administration—consult product literatureNote Pentacarinat c Injection (dissolved in water forinjection) may be used for nebulisation5.5.1 Drugs for threadworms(pinworms, Enterobius vermicularis)Anthelmintics are effective in threadworm infections,but their use needs to be combined with hygienicmeasures to break the cycle of auto-infection. All membersof the family require treatment.Adult threadworms do not live for longer than 6 weeksand for development of fresh worms, ova must beswallowed and exposed to the action of digestive juicesin the upper intestinal tract. Direct multiplication ofworms does not take place in the large bowel. Adultfemale worms lay ova on the perianal skin which causespruritus; scratching the area then leads to ova beingtransmitted on fingers to the mouth, often via food eatenwith unwashed hands. Washing hands and scrubbingnails before each meal and after each visit to the toilet isessential. A bath taken immediately after rising willremove ova laid during the night.Mebendazole is the drug of choice for treating threadworminfection in children over 6 months. It is given as asingle dose; as reinfection is very common, a seconddose may be given after 2 weeks.Piperazine is available in combination with sennosidesas a single-dose preparation.5.5 Anthelmintics5.5.1 Drugs for threadworms5.5.2 Ascaricides5.5.3 Drugs for tapeworm infections5.5.4 Drugs for hookworms5.5.5 Schistosomicides5.5.6 Filaricides5.5.7 Drugs for cutaneous larva migrans5.5.8 Drugs for strongyloidiasisAdvice on prophylaxis and treatment of helminth infectionsis available from the following specialist centres:Birmingham (0121) 424 0357Scottish Centre for Infection andEnvironmental Health (registeredusers of Travax only)(0141) 300 1100(weekdays 2–4 p.m.only)Liverpool (0151) 708 9393London (020) 7387 9300(treatment adviceonly)MEBENDAZOLECautions interactions: Appendix 1 (mebendazole)Note The patient information leaflet in the Vermox c packincludes the statement that it is not suitable for womenknown to be pregnant or for children under 2 yearsPregnancy manufacturer advises avoid—toxicity inanimal studiesBreast-feeding amount present in milk too small tobe harmful but manufacturer advises avoidSide-effects abdominal pain; less commonly diarrhoea,flatulence, rash; very rarely hepatitis, convulsions,neutropenia, urticaria, alopecia, Stevens-Johnson syndrome, toxic epidermal necrolysisLicensed use not licensed for use in children under 2yearsIndication and doseThreadworms. By mouthChild 6 months—18 years 100 mg as a singledose; if reinfection occurs second dose may beneeded after 2 weeksWhipworms, hookworms (section 5.5.4). By mouthChild 1—18 years 100 mg twice daily for 3 daysRoundworms (section 5.5.2). By mouthChild 1—2 years 100 mg twice daily for 3 daysChild 2—18 years 100 mg twice daily for 3 days or500 mg as a single dose