BNF for Children 2011-2012

BNFC 2011–2012 7.2.2 Vaginal and vulval infections 395Pessary, clotrimazole 500 mg, net price 1 pessarywith applicator = £2.00Excipients none as listed in section 13.1.3Condoms damages latex condoms and diaphragmsDoseInsert 1 pessary at night as a single dose; may berepeated once if necessaryCombi, clotrimazole 500-mg pessary and cream(topical) 2%, net price 1 pessary and 10-g cream =£5.21Condoms damages latex condoms and diaphragmsDoseSee under individual componentsGyno-Daktarin c (Janssen) AOvule (= vaginal capsule) (Gyno-Daktarin 1 c ),miconazole nitrate 1.2 g in a fatty basis, net price 1ovule = £2.94Excipients include hydroxybenzoates (parabens)Condoms damages latex condoms and diaphragmsDoseInsert 1 ovule at night as a single dose; can be repeatedonce if necessaryGyno-Pevaryl c (Janssen) APessaries, econazole nitrate 150 mg, net price 3pessaries = £2.78Excipients none as listed in section 13.1.3Condoms damages latex condoms and diaphragmsDoseInsert 1 pessary for 3 nights; course can be repeated onceif necessaryPessary (Gyno-Pevaryl 1 c ), econazole nitrate150 mg, formulated for single-dose therapy, net price1 pessary with applicator = £2.95Excipients none as listed in section 13.1.3Condoms damages latex condoms and diaphragmsDoseInsert 1 pessary at night as a single dose; can be repeatedonce if necessaryGynoxin c (Recordati) AIntravaginal cream, fenticonazole nitrate 2%, netprice 30 g with applicator = £3.74Excipients include cetyl alcohol, hydrogenated wool fat, propyleneglycolCondoms damages latex condoms and diaphragmsDoseInsert 5-g applicatorful intravaginally twice daily for 3daysVaginal capsule, fenticonazole nitrate 200 mg, netprice 3 vaginal capsules = £2.42Excipients include hydroxybenzoates (parabens)Condoms damages latex condoms and diaphragmsDoseInsert 1 vaginal capsule at night for 3 nightsVaginal capsule, fenticonazole nitrate 600 mg, netprice 1 vaginal capsule = £2.62Excipients include hydroxybenzoates (parabens)Condoms damages latex condoms and diaphragmsDoseInsert 1 vaginal capsule at night as a single doseNizoral c (Janssen) ACream (topical), ketoconazole 2%, net price 30 g =£3.40Excipients include polysorbates, propylene glycol, stearyl alcoholCondoms effect on latex condoms and diaphragms not yet knownDoseApply to anogenital area once or twice dailyOther infectionsTrichomonal infections commonly involve the lowerurinary tract as well as the genital system and needsystemic treatment with metronidazole (section 5.1.11)or tinidazole (section 5.4.2).Bacterial infections with Gram-negative organisms areparticularly common in association with gynaecologicaloperations and trauma. Metronidazole is effectiveagainst certain Gram-negative organisms, especiallyBacteroides spp. and can be used prophylactically ingynaecological surgery.Clindamycin cream and metronidazole gel are indicatedfor bacterial vaginosis.The antiviral drugs aciclovir, famciclovir, and valaciclovircan be used in the treatment of genital infection dueto herpes simplex virus, the HSV type 2 being a majorcause of genital ulceration. They have a beneficial effecton virus shedding and healing, generally giving relieffrom pain and other symptoms. See section 5.3 forsystemic preparations, and section 13.10.3 for topicalpreparations.PREPARATIONS FOR OTHERVAGINAL INFECTIONSCautions avoid intravaginal preparations (particularlythose that require the use of an applicator) in younggirls who are not sexually active, unless there is noalternative.Dalacin c (Pharmacia) ACream, clindamycin 2% (as phosphate), net price 40-gpack with 7 applicators = £10.86Excipients include benzyl alcohol, cetostearyl alcohol, polysorbates,propylene glycolCondoms damages latex condoms and diaphragmsSide-effects irritation, cervicitis and vaginitis; poorly absorbedinto the blood—low risk of systemic effects, see section 5.1.6Licensed use not licensed for use in children under 12 yearsDoseBacterial vaginosisInsert 5-g applicatorful at night for 3–7 nightsZidoval c (Meda) AVaginal gel, metronidazole 0.75%, net price 40-g packwith 5 applicators = £4.31Excipients include disodium edetate, hydroxybenzoates (parabens),propylene glycolSide-effects local effects including irritation, candidiasis, abnormaldischarge, pelvic discomfortLicensed use not licensed for use in children under 18 yearsNote Not recommended during menstruation; someabsorption may occur, see section 5.1.11 for systemic effectsDoseBacterial vaginosisInsert 5-g applicatorful at night for 5 nights7 Obstetrics, gynaecology, and urinary-tract disorders