BNF for Children 2011-2012

586 13.10.1 Antibacterial preparations BNFC 2011–201213 Skin(p. 3) has advised (March 2008) that retapamulin(Altargo c ) is not recommended for use within NHSScotland for the treatment of superficial skin infections.Silver sulfadiazine is licensed for the prevention andtreatment of infection in burns but the use of appropriatedressings may be more effective. Systemic effectsmay occur following extensive application of silversulfadiazine; its use is not recommended in neonates.13.10.1.1 Antibacterial preparations onlyused topicallyMUPIROCINRenal impairment manufacturer advises cautionwhen Bactroban c ointment used in moderate orsevere impairment because it contains macrogols(polyethylene glycols)Pregnancy manufacturer advises avoid unless potentialbenefit outweighs risk—no information availableBreast-feeding no information availableSide-effects local reactions including urticaria, pruritus,burning sensation, rashLicensed use Bactroban c ointment licensed for usein children (age range not specified by manufacturer);Bactroban c cream not recommended foruse in children under 1 yearIndication and doseBacterial skin infections (see also notes above)Child 1 month–18 years apply up to 3 times dailyfor up to 10 daysBactroban c (GSK) ACream, mupirocin (as mupirocin calcium) 2%, netprice 15 g = £4.38Excipients include benzyl alcohol, cetyl alcohol, stearyl alcoholOintment, mupirocin 2%, net price 15 g = £4.38Excipients none as listed in section 13.1.3Nasal ointment—section 12.2.3NEOMYCIN SULPHATECautions large areas—if large areas of skin are beingtreated ototoxicity may be a hazard in children, particularlyin those with renal impairmentContra-indications neonatesRenal impairment see Cautions aboveSide-effects sensitisation (see also notes above)Licensed use Neomycin Cream BPC—no informationavailableIndication and doseBacterial skin infections see under preparationNeomycin Cream BPC AUCream, neomycin sulphate 0.5%, cetomacrogolemulsifying ointment 30%, chlorocresol 0.1%,disodium edetate 0.01%, in freshly boiled and cooledpurified water, net price 15 g = £2.17Excipients include cetostearyl alcohol, edetic acid (EDTA)DoseApply up to 3 times daily (short-term use)POLYMYXINSCautions large areas—if large areas of skin are beingtreated nephrotoxicity and neurotoxicity may be ahazard, particularly in children with renal impairmentRenal impairment see Cautions aboveSide-effects sensitisation (see also notes above)Licensed use licensed for use in children (age rangenot specified by manufacturer)Indication and doseBacterial skin infections see under preparationPolyfax c (TEVA UK) AOintment, polymyxin B sulphate 10 000 units, bacitracinzinc 500 units/g, net price 4 g = £3.26, 20 g =£4.62Excipients none as listed in section 13.1.3DoseApply twice daily or more frequently if requiredRETAPAMULINContra-indications contact with eyes and mucousmembranesSide-effects local reactions including irritation,erythema, pain, contact dermatitis, and pruritusIndication and doseSuperficial bacterial skin infections (but see alsonotes above)Child 9 months–18 years apply thinly twice dailyfor 5 days; max. area of skin treated 2% of bodysurface area; review treatment if no responsewithin 2–3 daysAltargo c (GSK) TAOintment, retapamulin 1%, net price 5 g = £7.89.Label: 28Excipients include butylated hydroxytolueneSILVER SULFADIAZINE(Silver sulphadiazine)Cautions G6PD deficiency; may inactivate enzymaticdebriding agents—concomitant use may be inappropriate;interactions: Appendix 1 (sulfonamides)Large areas Plasma-sulfadiazine concentrations mayapproach therapeutic levels with side-effects and interactionsas for sulfonamides (see section 5.1.8) if large areas of skinare treated. Owing to the association of sulfonamides withsevere blood and skin disorders, treatment should bestopped immediately if blood disorders or rashes develop—but leucopenia developing 2–3 days after starting treatmentof burns patients is reported usually to be self-limiting andsilver sulfadiazine need not usually be discontinued providedblood counts are monitored carefully to ensure return tobaseline within a few days. Argyria may also occur if largeareas of skin are treated (or if application is prolonged).Contra-indications sensitivity to sulfonamides; notrecommended for neonatesHepatic impairment manufacturer advises caution ifsignificant impairment; see also Large areas, aboveRenal impairment manufacturer advises caution ifsignificant impairment; see also Large areas, abovePregnancy risk of neonatal haemolysis andmethaemoglobinaemia in third trimesterBreast-feeding small risk of kernicterus in jaundicedinfants and of haemolysis in G6PD deficient infantsSide-effects allergic reactions including burning,itching and rashes; argyria reported following pro-