BNF for Children (BNFC) 2018-2019

NSAID treatment who areH. pyloripositive and have

dyspepsia or a history of gastric or duodenal ulcer,

eradication ofH. pylorimay reduce the overall risk of

ulceration.

If the NSAID can bediscontinuedin a child who has

developed an ulcer, a proton pump inhibitor usually

produces the most rapid healing; alternatively the ulcer can

be treated with an H 2 -receptor antagonist.

IfNSAID treatment needs to continue, the ulcer is treated

with a proton pump inhibitor.

GASTROPROTECTIVE COMPLEXES AND

CHELATORS

Chelates and complexes

Sucralfate

Sucralfate below is a complex of aluminium hydroxide and

sulfated sucrose that appears to act by protecting the

mucosa from acid-pepsin attack; it has minimal antacid

properties.

Sucralfate

lINDICATIONS AND DOSE

Benign gastric ulceration|Benign duodenal ulceration

▶BY MOUTH

▶Child 1 month–1 year: 250 mg 4 – 6 times a day

▶Child 2–11 years: 500 mg 4 – 6 times a day

▶Child 12–14 years: 1 g 4 – 6 times a day

▶Child 15–17 years: 2 g twice daily, dose to be taken on

rising and at bedtime, alternatively 1 g 4 times a day for

4 – 6 weeks, or in resistant cases up to 12 weeks, dose to

be taken 1 hour before meals and at bedtime;

maximum 8 g per day

Prophylaxis of stress ulceration in child under intensive

care

▶BY MOUTH

▶Child 1 month–1 year: 250 mg 4 – 6 times a day

▶Child 2–11 years: 500 mg 4 – 6 times a day

▶Child 12–14 years: 1 g 4 – 6 times a day

▶Child 15–17 years: 1 g 6 times a day; maximum 8 g per

day

lUNLICENSED USENot licensed for use in children under

15 years. Tablets not licensed for prophylaxis of stress

ulceration.

lCAUTIONSPatients under intensive care (Important:

reports of bezoar formation)

CAUTIONS, FURTHER INFORMATION

▶Bezoar formationFollowing reports of bezoar formation

associated with sucralfate, caution is advised in seriously

ill patients, especially those receiving concomitant enteral

feeds or those with predisposing conditions such as

delayed gastric emptying.

lINTERACTIONS→Appendix 1 : sucralfate

lSIDE-EFFECTS

▶Common or very commonConstipation

▶UncommonDry mouth.nausea

▶Rare or very rareBezoar.rash

▶Frequency not knownBack pain.bone disorders.diarrhoea

.dizziness.drowsiness.encephalopathy.flatulence.

headache.vertigo

lPREGNANCYNo evidence of harm; absorption from gastro-

intestinal tract negligible.

lBREAST FEEDINGAmount probably too small to be

harmful.

lRENAL IMPAIRMENTUse with caution; aluminium is

absorbed and may accumulate.

lDIRECTIONS FOR ADMINISTRATIONAdministration of

sucralfate and enteral feeds should be separated by 1 hour

and for administration bymouth, sucralfate should be

given^1 hour before meals.Oral suspensionblocksfine-

bore feeding tubes. Crushedtabletsmay be dispersed in

water.

lPRESCRIBING AND DISPENSING INFORMATIONFlavours of

oral liquid formulations may include aniseed and caramel.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines

containing the same drug. Forms available from special-order

manufacturers include: tablet, oral suspension

Tablet

CAUTIONARY AND ADVISORY LABELS 5

▶Sucralfate (Non-proprietary)

Sucralfate 1 gramSulcrate 1 g tablets| 100 tablets

H 2 -RECEPTOR ANTAGONISTS

H 2 -receptor antagonists

Overview

Histamine H 2 -receptor antagonistshealgastric and

duodenal ulcersby reducing gastric acid output as a result of

histamine H 2 -receptor blockade; they are also used to relieve

symptoms ofdyspepsiaandgastro-oesophageal reflux disease.

H 2 -receptor antagonists should not normally be used for

Zollinger–Ellison syndromebecause proton pump inhibitors

are more effective.

Maintenance treatment with low doses has largely been

replaced inHelicobacter pyloripositive children by

eradication regimens.

H 2 -receptor antagonist therapy can promote healing of

NSAID-associated ulcers.

Treatment with a H 2 -receptor antagonist has not been

shown to be beneficial in haematemesis and melaena, but

prophylactic use reduces the frequency of bleeding from

gastroduodenal erosions in hepatic coma, and possibly in other

conditions requiring intensive care. Treatment also reduces

the risk ofacid aspirationin obstetric patients at delivery

(Mendelson’s syndrome).

H 2 -receptor antagonists are also used to reduce the

degradation of pancreatic enzyme supplements in children

with cysticfibrosis.

H 2 -receptor antagonists f

lSIDE-EFFECTS

▶Common or very commonConstipation.diarrhoea.

dizziness.fatigue.headache.myalgia.skin reactions

▶UncommonConfusion.depression.erectile dysfunction.

gynaecomastia.hallucination.hepatic disorders.

leucopenia.nausea.tachycardia

▶Rare or very rareAgranulocytosis.alopecia.arthralgia.

atrioventricular block.fever.galactorrhoea.pancytopenia

.thrombocytopenia.vasculitis

eiiiiFabove

Ranitidine

lINDICATIONS AND DOSE

Benign gastric ulceration|Duodenal ulceration

▶BY MOUTH

▶Neonate: 2 mg/kg 3 times a day (max. per dose 3 mg/kg

3 times a day), oral absorption is unreliable.

▶Child 1–5 months: 1 mg/kg 3 times a day (max. per dose

3 mg/kg 3 times a day)

▶Child 6 months–2 years: 2 – 4 mg/kg twice daily

54 Disorders of gastric acid and ulceration BNFC 2018 – 2019

Gastro-intestinal system

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