BNF for Children 2011-2012

546 12.3.3 Lozenges and sprays BNFC 2011–201212 Ear, nose, and oropharynxBreast-feeding manufacturer advises caution—noinformation availableSide-effects nausea and vomiting, very rarely diarrhoea(usually on long-term treatment), hepatitis, rash,toxic epidermal necrolysis, and Stevens-JohnsonsyndromeLicensed use not licensed for use in children under 4months of age or during first 5–6 months of life of aninfant born pre-termIndication and dosePrevention and treatment of oral and intestinalfungal infections. By mouthNeonate (oral fungal infections only) 1 mL 2–4times daily smeared around the mouth after feedsChild 1 month–2 years 2.5 mL twice dailysmeared around the mouth after foodChild 2–6 years 5 mL twice daily after food; retainnear lesions before swallowingChild 6–12 years 5 mL 4 times daily after food;retain near lesions before swallowingChild 12–18 years 5–10 mL 4 times daily afterfood; retain near lesions before swallowingNote Treatment should be continued for 48 hours afterlesions have healedLocalised lesionsChild 2–18 years smear small amount on affectedarea with clean finger 4 times daily for 5–7 days(orthodontic appliances should be removed atnight and brushed with gel); continue treatment for48 hours after lesions have healed1Daktarin c (Janssen) AOral gel, sugar-free, orange-flavoured, miconazole24 mg/mL (20 mg/g). Net price 15-g tube = £2.85, 80-g tube = £4.38. Label: 9, counselling, hold in mouth,after foodDental prescribing on NHS May be prescribed as MiconazoleOromucosal Gel1. 15-g tube can be sold to the publicNYSTATINSide-effects oral irritation and sensitisation, nauseareportedLicensed use suspension not licensed for use inneonates for the treatment of candidiasisIndication and doseOral and perioral fungal infectionsNeonate 100 000 units 4 times daily after feedsChild 1 month–18 years 100 000 units 4 timesdaily after foodNote Treatment is usually given for 7 days, and continued for48 hours after lesions have healed.Skin infections section 13.10.2Nystan c (Squibb) AOral suspension, yellow, nystatin 100 000 units/mL.Net price 30 mL with pipette = £1.91. Label: 9, counselling,use of pipette, hold in mouth, after foodDental prescribing on NHS May be prescribed as NystatinOral Suspension12.3.3 Lozenges and spraysThere is no convincing evidence that antisepticlozenges and sprays have a beneficial action and theysometimes irritate and cause sore tongue and sore lips.Some preparations also contain local anaestheticswhich relieve pain but may cause sensitisation.12.3.4 Mouthwashes andgarglesSuperficial infections of the mouth are often helped bywarm mouthwashes which have a mechanical cleansingeffect and cause some local hyperaemia. However, to beeffective, they must be used frequently and vigorously.Mouthwashes may not be suitable for children under 7years (risk of the solution being swallowed); themouthwash or dental gel may be applied using a cottonbud.A warm saline mouthwash is ideal for its cleansing effectand can be prepared either by dissolving half a teaspoonfulof salt in a glassful of warm water or by dilutingcompound sodium chloride mouthwash with an equalvolume of warm water. Mouthwash solution-tabletscontaining thymol are used to remove unpleasant tastes.Mouthwashes containing an oxidising agent, such ashydrogen peroxide, may be useful in the treatment ofacute ulcerative gingivitis (Vincent’s infection).Hydrogen peroxide solution has also a mechanicalcleansing effect arising from frothing when in contactwith oral debris, but in concentrations greater than 1.5%may cause ulceration and tissue damage.Chlorhexidine is an effective antiseptic which has theadvantage of inhibiting plaque formation on the teeth. Itdoes not, however, completely control plaque depositionand is not a substitute for effective toothbrushing.Moreover, chlorhexidine preparations do not penetratesignificantly into stagnation areas and are therefore oflittle value in the control of dental caries or of periodontaldisease once pocketing has developed. Chlorhexidinepreparations are of little value in the control ofacute necrotising ulcerative gingivitis. With prolongeduse, chlorhexidine causes reversible brown staining ofteeth and tongue. Chlorhexidine may be incompatiblewith some ingredients in toothpaste, causing an unpleasanttaste in the mouth; allow at least 30 minutesbetween using the mouthwash and toothpaste.Chlorhexidine can be used as a mouthwash, spray or gelfor secondary infection in mucosal ulceration and forcontrolling gingivitis, as an adjunct to other oral hygienemeasures. These preparations may also be used insteadof toothbrushing where there is a painful periodontalcondition (e.g. primary herpetic stomatitis) or if the childhas a haemorrhagic disorder, or is disabled. Chlorhexidinemouthwash is used in the prevention of oral candidiasisin immunocompromised patients. Chlorhexidinemouthwash reduces the incidence of alveolar osteitisfollowing tooth extraction. Chlorhexidine mouthwashshould not be used for the prevention of endocarditisin children undergoing dental procedures.