Quinine sulfate 300 mgQuinine sulfate 300 mg tablets|
28 tabletP£ 2. 83 DT = £ 1. 965.3 Toxoplasmosis
ANTIBACTERIALS›MACROLIDES
Spiramycin
lINDICATIONS AND DOSE
Toxoplasmosis in pregnancy
▶BY MOUTH
▶Child 12–17 years: 1. 5 g twice daily until delivery
Chemoprophylaxis of congenital toxoplasmosis
▶BY MOUTH
▶Neonate: 50 mg/kg twice daily.DOSE EQUIVALENCE AND CONVERSION
▶ 3000 units: 1 mg spiramycin.lUNLICENSED USENot licensed.
lCAUTIONSArrhythmias.cardiac disease.predisposition to
QT interval prolongation
lSIDE-EFFECTS
▶Rare or very rareQT interval prolongation.
thrombocytopenia.vasculitis
▶Frequency not knownDiarrhoea.dizziness.
gastrointestinal disorder.headache.hepatotoxicity.
nausea.rash.vomiting
lALLERGY AND CROSS-SENSITIVITYSensitivity to other
macrolides.
lBREAST FEEDINGPresent in breast milk.
lHEPATIC IMPAIRMENTUse with caution.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Powder for solution for infusion
▶Rovamycine (Imported (France))
Spiramycin (as Spiramycin adipate) 1.5 mega uRovamycine
- 5 million unit powder for solution for infusion vials| 1 vialPs
Tablet
▶Rovamycine (Imported (France))
Spiramycin 1.5 mega uRovamycine 1. 5 million unit tablets|
16 tabletPs
Spiramycin 3 mega uRovamycine 3 million unit tablets|
10 tabletPs
ANTIPROTOZOALS
Pyrimethamine
lINDICATIONS AND DOSE
Toxoplasmosis in pregnancy (in combination with
sulfadiazine and folinic acid)
▶BY MOUTH
▶Child 12–17 years: 50 mg once daily until delivery
Congenital toxoplasmosis (in combination with
sulfadiazine and folinic acid)
▶BY MOUTH
▶Neonate: 1 mg/kg twice daily for 2 days, then 1 mg/kg
once daily for 6 months, then 1 mg/kg 3 times a week for
6 months.lUNLICENSED USENot licensed for use in children under
5 years.
lCAUTIONSHistory of seizures—avoid large loading doses.
predisposition to folate deficiency
lINTERACTIONS→Appendix 1 : antimalarials
lSIDE-EFFECTS
▶Common or very commonAnaemia.diarrhoea.dizziness.
headache.leucopenia.nausea.skin reactions.
thrombocytopenia.vomiting
▶UncommonFever
▶Rare or very rareAbdominal pain.oral ulceration.
pancytopenia.pneumonia eosinophilic.seizure
lPREGNANCYTheoretical teratogenic risk infirst trimester
(folate antagonist). Adequate folate supplements should
be given to the mother.
lBREAST FEEDINGSignificant amount in milk—avoid
administration of other folate antagonists to infant. Avoid
breast-feeding during toxoplasmosis treatment.
lHEPATIC IMPAIRMENTManufacturer advises caution.
lRENAL IMPAIRMENTManufacturer advises caution.
lMONITORING REQUIREMENTSBlood counts required with
prolonged treatment.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
▶Daraprim(GlaxoSmithKline UK Ltd)
Pyrimethamine 25 mgDaraprim 25 mg tablets| 30 tabletP
£ 13. 006 Viral infection
6.1 Hepatitis
Hepatitis
Overview
Treatment for viral hepatitis should be initiated by a
specialist in hepatology or infectious diseases. The
management of uncomplicated acute viral hepatitis is largely
symptomatic. Hepatitis B and hepatitis C viruses are major
causes of chronic hepatitis. Active or passive immunisation
against hepatitis A and B infections can be given.Chronic hepatitis B
Interferon alfa p. 557 ,peginterferon alfa- 2 a, lamivudine
p. 420 , adefovir dipivoxil, entecavir, and tenofovir disoproxil
p. 421 have a role in the treatment of chronic hepatitis B in
adults, but their role in children has not been well
established. Specialist supervision is required for the
management of chronic hepatitis B.
Tenofovir disoproxil, or a combination of tenofovir
disoproxil with either emtricitabine p. 418 or lamivudine,
may be used with other antiretrovirals, as part of‘highly
active antiretroviral therapy’in children who require
treatment for both HIV and chronic hepatitis B. If children
infected with both HIV and chronic hepatitis B only require
treatment for chronic hepatitis B, they should receive
antivirals that are not active against HIV. Management of
these children should be co-ordinated between HIV and
hepatology specialists.Chronic hepatitis C
Treatment should be considered for children with moderate
or severe liver disease. Specialist supervision is required and
the regimen is chosen according to the genotype of the
infecting virus and the viral load. A combination of ribavirin
p. 400 with either interferon alfa orpeginterferon alfa- 2 bis
licensed for use in children over 3 years with chronic
hepatitis C. A combination of peginterferon alfa p. 402 and
ribavirin is preferred.BNFC 2018 – 2019 Hepatitis 399
Infection5