BNF for Children 2011-2012

542 12.2.3 Nasal preparations for infection BNFC 2011–201212 Ear, nose, and oropharynx1Ephedrine (Non-proprietary)Nasal drops, ephedrine hydrochloride 0.5%, net price10 mL = £1.39; 1%, 10 mL = £1.63Note The BP directs that if no strength is specified 0.5%drops should be suppliedDental prescribing on NHS Ephedrine nasal drops may beprescribed1. Can be sold to the public provided no more than 180 mg ofephedrine base (or salts) are supplied at one time, andpseudoephedrine salts are not supplied at the same time; forconditions that apply to supplies made at the request of apatient, see Medicines, Ethics and Practice, London,Pharmaceutical Press (always consult latest edition)XYLOMETAZOLINE HYDROCHLORIDECautions see under Ephedrine Hydrochloride andnotes above; also avoid excessive or prolonged usePregnancy avoidSide-effects see under Ephedrine Hydrochloride andnotes above; in small children, also restlessness, sleepdisturbances, and hallucinations (discontinue treatment)Indication and doseNasal congestion for dose, see under preparationsXylometazoline (Non-proprietary)Nasal drops, xylometazoline hydrochloride 0.1%, netprice 10 mL = £1.91DoseChild 12–18 years instil 2–3 drops into each nostril 2–3times daily when required; max. duration 7 daysBrands include Otradrops c , Otrivine c DPaediatric nasal drops, xylometazoline hydrochloride0.05%, net price 10 mL = £1.59DoseChild 6–12 years instil 1–2 drops into each nostril 1–2times daily when required; max. duration 5 daysBrands include Otradrops c , Otrivine c DNasal spray, xylometazoline hydrochloride 0.1%, netprice 10 mL = £1.91DoseChild 12–18 years apply 1 spray into each nostril 1–3times daily when required; max. duration 7 daysBrands include Otrivine c DAntimuscarinicIPRATROPIUM BROMIDECautions see section 3.1.2; avoid spraying near eyesSide-effects epistaxis, nasal dryness, and irritation;less frequently nausea, headache, and pharyngitis;very rarely antimuscarinic effects such as gastrointestinalmotility disturbances, palpitations, andurinary retentionIndication and doseRhinorrhoea associated with allergic and nonallergicrhinitisChild 12–18 years apply 42 micrograms (2sprays) into each nostril 2–3 times dailyAsthma and reversible airways obstructionsection 3.1.2Rinatec c (Boehringer Ingelheim) ANasal spray 0.03%, ipratropium bromide 21 micrograms/meteredspray. Net price 180-dose unit =£3.99Excipients include benzalkonium chloride, disodium edetate12.2.3 Nasal preparations forinfectionThere is no evidence that topical anti-infective nasalpreparations have any therapeutic value in rhinitis orsinusitis; for elimination of nasal staphylococci, seebelow. Acute complications such as periorbital cellulitisrequire hospital treatment. For systemic treatment ofsinusitis, see Table 1, section 5.1.Betnesol-N c (UCB Pharma) AUDrops (for ear, eye, or nose), betamethasone sodiumphosphate 0.1%, neomycin sulphate 0.5%. Net price10 mL = £2.30Excipients include benzalkonium chloride, disodium edetateDosenose, instil 2–3 drops into each nostril 2–3 times dailyNote Betnesol-N c licensed for use in children (age range notspecified by manufacturer)Nasal staphylococciElimination of organisms such as staphylococci from thenasal vestibule can be achieved by the use of a creamcontaining chlorhexidine and neomycin (Naseptin c ),but re-colonisation frequently occurs. Coagulase-positivestaphylococci are present in the noses of 40% of thepopulation. A nasal ointment containing mupirocin isalso available; it should probably be held in reserve forresistant infections. In hospitals or in care establishments,mupirocin nasal ointment should be reserved forthe eradication (in both patients and staff) of nasalcarriage of meticillin-resistant Staphylococcus aureus(MRSA). The ointment should be applied 3 times dailyfor 5 days and a sample taken 2 days after treatment toconfirm eradication. The course may be repeated if thesample is positive (and the throat is not colonised). Toavoid the development of resistance, the treatmentcourse should not exceed 7 days and the course shouldnot be repeated on more than one occasion. If theMRSA strain is mupirocin-resistant or does not respondafter 2 courses, consider alternative products such aschlorhexidine and neomycin cream. For eradication ofMRSA also consult local infection control policy. Seesection 13.10.1 for treatment of MRSA-infected openwounds. See section 5.1.1.2 for treatment of childrenwith MRSA-positive throat swabs or systemic MRSAinfection.Bactroban Nasal c (GSK) ANasal ointment, mupirocin 2% (as calcium salt) inwhite soft paraffin basis. Net price 3 g = £5.80DoseFor eradication of nasal carriage of staphylococci,including meticillin-resistant Staphylococcus aureus(MRSA)Apply 2–3 times daily to the inner surface of each nostril(see notes above)