BNF for Children 2011-2012

BNFC 2011–2012 1.4.1 Adsorbents and bulk-forming drugs 47mended for use in children under 12 years. Fluid andelectrolyte replacement (section 9.2.1.2) are of primeimportance in the treatment of acute diarrhoea.Antispasmodics (section 1.2) are occasionally of valuein treating abdominal cramp associated with diarrhoeabut they should not be used for primary treatment.Antispasmodics and antiemetics should be avoided inyoung children with gastro-enteritis since they are rarelyeffective and have troublesome side-effects.Antibacterial drugs are generally unnecessary in simplegastro-enteritis because the complaint usually resolvesquickly without such treatment, and infective diarrhoeasin the UK often have a viral cause. Systemic bacterialinfection does, however, need appropriate systemictreatment; for drugs used in campylobacter enteritis,shigellosis, and salmonellosis, see p. 244Colestyramine (section 1.9.2) binds unabsorbed bilesalts and provides symptomatic relief of diarrhoea followingileal disease or resection.1.4.1 Adsorbents and bulkformingdrugsAdsorbents such as kaolin are not recommended foracute diarrhoeas. Bulk-forming drugs, such as ispaghula,methylcellulose, and sterculia (section 1.6.1)are rarely effective in controlling faecal consistency inileostomy and colostomy.1.4.2 Antimotility drugsAntimotility drugs have a role in the management ofuncomplicated acute diarrhoea in adults but not inchildren under 12 years; see also section 1.4. However,in the case of dehydration, fluid and electrolyte replacement(section 9.2.1.2) are of primary importance.For comments on their role in chronic bowel disorderssee section 1.5. Antimotility drugs are also used inchildren with stoma (section 1.8).CODEINE PHOSPHATECautions see section 4.7.2; tolerance and dependencemay occur with prolonged use; interactions: Appendix1 (opioid analgesics)Contra-indications see section 4.7.2; also conditionswhere inhibition of peristalsis should be avoided,where abdominal distension develops, or in acutediarrhoeal conditions such as acute ulcerative colitisor antibiotic-associated colitisHepatic impairment section 4.7.2Renal impairment section 4.7.2Pregnancy section 4.7.2Breast-feeding section 4.7.2Side-effects section 4.7.2Indication and doseDiarrhoea (but see notes above). By mouthChild 12–18 years 30 mg (range 15–60 mg) 3–4times dailyPain section 4.7.2PreparationsSection 4.7.2CO-PHENOTROPEA mixture of diphenoxylate hydrochloride and atropinesulphate in the mass proportions 100 parts to 1part respectivelyCautions section 4.7.2; also young children are particularlysusceptible to overdosage and symptoms maybe delayed and observation is needed for at least 48hours after ingestion; presence of subclinical doses ofatropine may give rise to atropine side-effects insusceptible individuals or in overdosage (section 1.2);interactions: Appendix 1 (antimuscarinics, opioidanalgesics)Contra-indications section 4.7.2 and also see underAntimuscarinics (section 1.2)Hepatic impairment section 4.7.2; also avoid injaundiceRenal impairment section 4.7.2Pregnancy section 4.7.2Breast-feeding may be present in milkSide-effects section 4.7.2 and also see under Antimuscarinics(section 1.2); also abdominal pain, anorexia,feverLicensed use not licensed for use in children under 4yearsIndication and doseSee preparationsAdministration for administration by mouth tabletsmay be crushedCo-phenotrope (Non-proprietary) ATablets, co-phenotrope 2.5/0.025 (diphenoxylatehydrochloride 2.5 mg, atropine sulphate 25 micrograms),net price 100 = £8.95Brands include Lomotil cDoseControl of faecal consistency after colostomy orileostomy, adjunct to rehydration in acute diarrhoea(but see notes above). By mouthChild 2–4 years half tablet 3 times dailyChild 4–9 years 1 tablet 3 times dailyChild 9–12 years 1 tablet 4 times dailyChild 12–16 years 2 tablets 3 times dailyChild 16–18 years initially 4 tablets then 2 tablets 4times dailyNote Co-phenotrope 2.5/0.025 can be sold to the public forchildren over 16 years (provided packs do not contain morethan 20 tablets) as an adjunct to rehydration in acute diarrhoea(max. daily dose 10 tablets)LOPERAMIDE HYDROCHLORIDECautions see notes above; interactions: Appendix 1(loperamide)Contra-indications conditions where inhibition ofperistalsis should be avoided, where abdominal distensiondevelops, or in conditions such as activeulcerative colitis or antibiotic-associated colitisHepatic impairment risk of accumulation—manufactureradvises cautionPregnancy manufacturer advises avoid—no informationavailableBreast-feeding amount probably too small to beharmful1 Gastro-intestinal system