BNF for Children 2011-2012

BNFC 2011–2012 12.3 Drugs acting on the oropharynx 543Naseptin c (Alliance) ACream, chlorhexidine hydrochloride 0.1%, neomycinsulphate 0.5%, net price 15 g = £1.90Excipients include arachis (peanut) oil, cetostearyl alcoholDoseFor eradication of nasal carriage of staphylococciApply to nostrils 4 times daily for 10 daysFor preventing nasal carriage of staphylococciApply to nostrils twice daily12.3 Drugs acting on theoropharynx12.3.1 Drugs for oral ulceration andinflammation12.3.2 Oropharyngeal anti-infective drugs12.3.3 Lozenges and sprays12.3.4 Mouthwashes and gargles12.3.5 Treatment of dry mouth12.3.1 Drugs for oral ulcerationand inflammationUlceration of the oral mucosa may be caused by trauma(physical or chemical), recurrent aphthous ulcers, infections,carcinoma, dermatological disorders, nutritionaldeficiencies, gastro-intestinal disease, haematopoieticdisorders, and drug therapy. It is important to establishthe diagnosis in each case as the majority of theselesions require specific management in addition tolocal treatment. Local treatment aims to protect theulcerated area, to relieve pain, to reduce inflammation,or to control secondary infection. Children with anunexplained mouth ulcer of more than 3 weeks’ durationrequire urgent referral to hospital to exclude secondarycauses such as leukaemia.Simple mouthwashes A saline mouthwash (section12.3.4) may relieve the pain of traumatic ulceration. Themouthwash is made up with warm water and used atfrequent intervals until the discomfort and swellingsubsides.Antiseptic mouthwashes Secondary bacterial infectionmay be a feature of any mucosal ulceration; it canincrease discomfort and delay healing. Use of chlorhexidinemouthwash (section 12.3.4) is often beneficialand may accelerate healing of recurrent aphthousulcers.Corticosteroids Topical corticosteroid therapy maybe used for some forms of oral ulceration; for aphthousulcers it is most effective if applied in the ‘prodromal’phase. Thrush or other types of candidiasis are recognisedcomplications of corticosteroid treatment.Hydrocortisone oromucosal tablets are useful inrecurrent aphthous ulcers and erosive lichenoid lesions.Beclometasone dipropionate inhaler (p. 147) 50–100 micrograms sprayed twice daily on the oral mucosais used to manage oral ulceration [unlicensed indication].Alternatively, betamethasone soluble tablets dissolvedin water, can be used as a mouthwash to treatoral ulceration.Systemic corticosteroid therapy (section 6.3.2) isreserved for severe conditions such as pemphigus vulgaris.Local analgesics Local analgesics have a limited rolein the management of oral ulceration. When appliedtopically their action is of a relatively short duration andanalgesia cannot be maintained continuously throughoutthe day. When local anaesthetics are used in themouth, care must be taken not to produce anaesthesiaof the pharynx before meals as this might lead tochoking.Benzydamine mouthwash or spray may be useful inreducing the discomfort associated with a variety ofulcerative conditions. It has also been found to beeffective in reducing the discomfort of tonsillectomyand post-irradiation mucositis. Some children find thefull-strength mouthwash causes some stinging and, forthem, it should be diluted with an equal volume of water.Flurbiprofen lozenges are licensed for the relief of sorethroat in adolescents.Choline salicylate dental gel has some analgesic actionand may provide relief for recurrent aphthous ulcers inchildren over 16 years of age.Periodontitis Low-dose doxycycline (Periostat c ) islicensed as an adjunct to scaling and root planing for thetreatment of periodontitis in children over 12 years; alow dose of doxycycline reduces collagenase activitywithout inhibiting bacteria associated with periodontitis.For anti-infectives used in the treatment of destructive(refractory) forms of periodontal disease, see section12.3.2 and Table 1, section 5.1. For mouthwashes usedfor oral hygiene and plaque inhibition, see section12.3.4.BENZYDAMINE HYDROCHLORIDESide-effects occasional numbness or stinging; rarelyhypersensitivity reactionsLicensed use Difflam c Spray licensed for use inchildren (age range not specified by manufacturer)Indication and dosePainful inflammatory conditions of oropharynxfor dose, see under preparationsDifflam c (3M)Oral rinse, green, benzydamine hydrochloride 0.15%,net price 200 mL (Difflam c Sore Throat Rinse) =£2.50; 300 mL = £4.01DoseChild 12–18 years rinse or gargle, using 15 mL (dilutewith an equal volume of water if stinging occurs) every1½–3 hours as required, usually for not more than 7 daysDental prescribing on NHS May be prescribed as BenzydamineMouthwash 0.15%12 Ear, nose, and oropharynx