Cryptococcal meningitis (adjunct to amphotericin)
▶BY INTRAVENOUS INFUSION, OR BY MOUTH
▶Neonate: 50 mg/kg every 12 hours.▶Child: 25 mg/kg every 6 hours for 2 weekslUNLICENSED USETablets not licensed.
lCAUTIONSBlood disorders
lINTERACTIONS→Appendix 1 :flucytosine
lSIDE-EFFECTSAgranulocytosis.aplastic anaemia.blood
disorder.cardiotoxicity.confusion.diarrhoea.
hallucination.headache.hepatic disorders.leucopenia.
nausea.rash.sedation.seizure.thrombocytopenia.toxic
epidermal necrolysis.ventricular dysfunction.vertigo.
vomiting
lPREGNANCYTeratogenic inanimalstudies; manufacturer
advises use only if potential benefit outweighs risk.
lBREAST FEEDINGManufacturer advises avoid.
lRENAL IMPAIRMENT
Dose adjustmentsUse normal dose every 12 hours if
creatinine clearance 20 – 40 mL/minute; use normal dose
every 24 hours if creatinine clearance 10 – 20 mL/minute;
use initial normal dose if creatinine clearance less than
10 mL/minute and then adjust dose according to plasma-
flucytosine concentration.
MonitoringIn renal impairment liver- and kidney-function
tests and blood counts required weekly.
lMONITORING REQUIREMENTS
▶For plasma concentration monitoring, blood should be
taken shortly before starting the next infusion; plasma
concentration for optimum response 25 – 50 mg/litre
( 200 – 400 micromol/litre)—should not be allowed to
exceed 80 mg/litre ( 620 micromol/litre).
▶Liver- and kidney-function tests and blood counts
required (weekly in blood disorders).
lDIRECTIONS FOR ADMINISTRATIONForintravenous
infusion, give over 20 – 40 minutes.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral solution
Solution for infusion
ELECTROLYTES:May contain Sodium
▶Ancotil(Meda Pharmaceuticals Ltd)
Flucytosine 10 mg per 1 mlAncotil 2. 5 g/ 250 ml solution for infusion
bottles| 5 bottleP£ 151. 67 (Hospital only)
Tablet
▶Ancotil(ICN Pharmaceuticals France S.A.)
Flucytosine 500 mgAncotil 500 mg tablets| 100 tabletPs
Griseofulvin
lINDICATIONS AND DOSE
Dermatophyte infections of the skin, scalp, hair and nails
where topical therapy has failed or is inappropriate
▶BY MOUTH
▶Child 1 month–11 years:Usual dose 10 mg/kg daily (max.
per dose 500 mg), increased if necessary to 20 mg/kg
daily (max. per dose 1 g), for severe infections; reduce
dose when response occurs, daily dose may be taken
once daily or in divided doses
▶Child 12–17 years: 500 mg daily, increased if necessary to
1 g daily, for severe infections; reduce dose when
response occurs, daily dose may be taken once daily or
in divided dosesTinea capitis caused byTrichophyton tonsurans
▶BY MOUTH
▶Child 1 month–11 years: 15 – 20 mg/kg once daily (max.
per dose 1 g), alternatively 15 – 20 mg/kg daily in
divided doses (max. per dose 1 g)
▶Child 12–17 years: 1 g once daily, alternatively 1 g daily
in divided doseslUNLICENSED USELicensed for use in children (age range
not specified by manufacturer).
lCONTRA-INDICATIONSAcute porphyrias p. 603 .systemic
lupus erythematosus (risk of exacerbation)
lINTERACTIONS→Appendix 1 : griseofulvin
lSIDE-EFFECTS
▶Common or very commonDiarrhoea.epigastric discomfort
.headache.nausea.vomiting
▶UncommonAppetite decreased.confusion.coordination
abnormal.dizziness.drowsiness.insomnia.irritability.
peripheral neuropathy.photosensitivity reaction.skin
reactions.taste altered.toxic epidermal necrolysis
▶Rare or very rareAnaemia.hepatic disorders.leucopenia.
neutropenia.systemic lupus erythematosus (SLE)
lCONCEPTION AND CONTRACEPTIONEffective
contraception required during and for at least 1 month
after administration to women (important: effectiveness of
oral contraceptives may be reduced, additional
contraceptive precautions e.g. barrier method, required).
Men should avoid fathering a child during and for at least
6 months after administration
lPREGNANCYAvoid (fetotoxicity and teratogenicity in
animals).
lBREAST FEEDINGAvoid—no information available.
lHEPATIC IMPAIRMENTAvoid in severe liver disease.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Griseofulvin for fungal
infectionswww.medicinesforchildren.org.uk/griseofulvin-for-
fungal-infections
Driving and skilled tasksMay impair performance of skilled
tasks (e.g. driving); effects of alcohol enhanced.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension
Tablet
CAUTIONARY AND ADVISORY LABELS9, 21
▶Griseofulvin (Non-proprietary)
Griseofulvin 125 mgGriseofulvin 125 mg tablets| 100 tabletP
£ 96. 67 DT = £ 96. 67
Griseofulvin 500 mgGriseofulvin 500 mg tablets| 90 tabletP
£ 85. 73 | 100 tabletP£ 90. 34 DT = £ 92. 803.1 Pneumocystis pneumonia
Pneumocystis pneumonia
Overview
Pneumonia caused byPneumocystis jirovecii(Pneumocystis
carinii) occurs in immunosuppressed patients; it is a
common cause of pneumonia in AIDS. Pneumocystis
pneumonia should generally be treated by those experienced
in its management. Blood gas measurement is used to assess
disease severity.Treatment
The recommended duration of treatment is generally
14 – 21 days.BNFC 2018 – 2019 Pneumocystis pneumonia 379
Infection5