BNF for Children 2011-2012

BNFC 2011–2012 1.7.4 Management of anal fissures 67Proctofoam HC c (Meda) AFoam in aerosol pack, hydrocortisone acetate 1%,pramocaine hydrochloride 1%. Net price 21.2-g pack(approx. 40 applications) with applicator = £5.06DosePain and irritation associated with local, non-infectedanal or perianal conditions. By rectumChild 12–18 years 1 applicatorful (4–6 mg hydrocortisoneacetate, 4–6 mg pramocaine hydrochloride) byrectum 2–3 times daily and after a bowel movement(max. 4 times daily); do not use for longer than 7 daysProctosedyl c (Sanofi-Aventis) AOintment, cinchocaine (dibucaine) hydrochloride0.5%, hydrocortisone 0.5%, net price 30 g = £10.34(with cannula)DoseHaemorrhoids, pruritus ani. By rectumChild 1 month–18 years apply morning and night andafter a bowel movement, externally or by rectum; do notuse for longer than 7 daysSuppositories, cinchocaine (dibucaine) hydrochloride5 mg, hydrocortisone 5 mg, net price 12 =£4.66DoseHaemorrhoids, pruritus ani. By rectumChild 12–18 years insert 1 suppository night andmorning and after a bowel movement; do not use forlonger than 7 daysScheriproct c (Bayer Schering) AOintment, cinchocaine (dibucaine) hydrochloride0.5%, prednisolone hexanoate 0.19%, net price 30 g =£2.94DoseHaemorrhoids, pruritus ani. By rectumChild 1 month–18 years apply twice daily for 5–7 days(3–4 times daily on 1st day if necessary), then once dailyfor a few days after symptoms have clearedSuppositories, cinchocaine (dibucaine) hydrochloride1 mg, prednisolone hexanoate 1.3 mg, netprice 12 = £1.38DoseHaemorrhoids, pruritus ani. By rectumChild 12–18 years insert 1 suppository daily after abowel movement, for 5–7 days (in severe cases initially2–3 times daily)Ultraproct c (Meadow) AOintment, cinchocaine (dibucaine) hydrochloride0.5%, fluocortolone caproate 0.095%, fluocortolonepivalate 0.092%, net price 30 g (with rectal nozzle) =£4.57DoseHaemorrhoids, pruritus aniChild 1 month–18 years apply twice daily for 5–7 days(3–4 times daily on 1st day if necessary), then once dailyfor a few days after symptoms have clearedSuppositories, cinchocaine (dibucaine) hydrochloride1 mg, fluocortolone caproate 630 micrograms,fluocortolone pivalate 610 micrograms, netprice 12 = £2.15DoseHaemorrhoids, pruritus ani. By rectumChild 12–18 years insert 1 suppository daily after abowel movement, for 5–7 days (in severe cases initially2–3 times daily) then 1 suppository every other day for 1weekUniroid-HC c (Chemidex) AOintment, cinchocaine (dibucaine) hydrochloride0.5%, hydrocortisone 0.5%, net price 30 g (withapplicator) = £4.23DoseHaemorrhoids, pruritus ani. By rectumChild 1 month–18 years apply twice daily and after abowel movement, externally or by rectum; do not use forlonger than 7 days (child under 12 years, on medicaladvice only)Suppositories, cinchocaine (dibucaine) hydrochloride5 mg, hydrocortisone 5 mg, net price 12 =£1.91DoseHaemorrhoids, pruritus ani. By rectumChild 12–18 years insert 1 suppository twice daily andafter a bowel movement; do not use for longer than 7daysXyloproct c (AstraZeneca) AOintment (water-miscible), aluminium acetate 3.5%,hydrocortisone acetate 0.275%, lidocaine 5%, zincoxide 18%, net price 20 g (with applicator) = £2.26DoseHaemorrhoids, pruritus ani. By rectumChild 1 month–18 years apply several times daily;short-term use only1.7.3 Rectal sclerosantsClassification not used in BNF for Children.1.7.4 Management of analfissuresThe management of anal fissures includes stool softening(section 1.6) and the short-term use of a topicalpreparation containing a local anaesthetic (section1.7.1). If these measures are inadequate, children withchronic anal fissures should be referred for specialisttreatment in hospital. Topical glyceryl trinitrate, 0.05%or 0.1% ointment, may be used in children to relax theanal sphincter, relieve pain and aid healing of analfissures. Excessive application of topical nitrates causesside-effects such as headache, flushing, dizziness, andpostural hypotension.Before considering surgery, diltiazem 2% ointment maybe used in children with chronic anal fissures resistant totopical nitrates.1 Gastro-intestinal system