▶ Manufacturer advises monitor blood counts, urinalysis,
hepatic and renal function periodically in all patients;
monitor leucocyte count regularly in patients receiving
long-term vancomycin or if given concurrently with other
drugs that may cause neutropenia or agranulocytosis.
▶ Manufacturer advises monitor vestibular and auditory
function during and after treatment in the elderly; avoid
concurrent or sequential use of other ototoxic drugs.
▶ Manufacturer advises serial tests of auditory function may
be helpful to minimise the risk of ototoxicity in patients
with an underlying hearing loss, or who are receiving
concomitant therapy with other ototoxic drugs.
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use Avoid rapid infusion (risk of
anaphylactoid reactions) and rotate infusion sites.
For intravenous infusion, give intermittently in Glucose 5%
or Sodium chloride 0.9%; reconstitute each 500 mg with
10 mL water for injections and dilute with infusion fluid to
a concentration of up to 5 mg/mL (10 mg/mL in fluid
restriction but increased risk of infusion-related effects);
give over at least 60 minutes (rate not to exceed
10 mg/minute for doses over 500 mg); use continuous
infusion only if intermittent not feasible.
▶ With oral use Injection can be used to prepare solution for
oral administration—consult product literature.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
solution, solution for injection, infusion
Powder for solution for infusion
▶ Vancomycin (Non-proprietary)
Vancomycin (as Vancomycin hydrochloride) 500 mg Vancomycin
500mg powder for solution for infusion vials | 1 vial P £7.25 DT =
£5.49 | 10 vial P £62.50 DT = £62.50
Vancomycin 500mg powder for concentrate for solution for infusion
Vancomycin (as Vancomycin hydrochloride) 1 gram Vancomycin
1g powder for solution for infusion vials | 1 vial P £14.50 DT =
£11.25 | 10 vial P £125.00 DT = £125.00
Vancomycin 1g powder for concentrate for solution for infusion vials
Vancomycin (as Vancomycin hydrochloride) 500 mg Vancocin
500mg powder for solution for infusion vials | 1 vial P £6.25 DT =
Vancomycin (as Vancomycin hydrochloride) 1 gram Vancocin 1g
powder for solution for infusion vials | 1 vial P £12.50 DT =
CAUTIONARY AND ADVISORY LABELS 9
▶ Vancomycin (Non-proprietary)
Vancomycin (as Vancomycin hydrochloride) 125 mg Vancomycin
125mg capsules | 28 capsule P £132.47 DT = £132.47
Vancomycin (as Vancomycin hydrochloride) 250 mg Vancomycin
250mg capsules | 28 capsule P £146.38 DT = £146.34
▶ Vancocin Matrigel (Flynn Pharma Ltd)
Vancomycin (as Vancomycin hydrochloride) 125 mg Vancocin
Matrigel 125mg capsules | 28 capsule P £88.31 DT = £132.47
l DRUG ACTION Clindamycin is active against Gram-positive
cocci, including streptococci and penicillin-resistant
staphylococci, and also against many anaerobes, especially
Bacteroides fragilis. It is well concentrated in bone and
Staphylococcal bone and joint infections such as
osteomyelitis | Peritonitis | Intra-abdominal sepsis |
Meticillin-resistant Staphylococcus aureus (MRSA) in
bronchiectasis, bone and joint infections, and skin and
soft-tissue infections | Erysipelas or cellulitis in
penicillin-allergic patients (alternative to macrolides)
▶ Child: 3–6 mg/kg 4 times a day (max. per dose 450 mg)
▶ Adult: 150–300 mg every 6 hours; increased if
necessary up to 450 mg every 6 hours if required,
increased dose used in severe infection
▶ BY DEEP INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
▶ Adult: 0.6–2.7 g daily in 2–4 divided doses; increased if
administered by intravenous infusion only, single
doses by intravenous infusion not to exceed 1.2 g
Treatment of mild to moderate pneumocystis pneumonia
(in combination with primaquine)
Treatment of falciparum malaria (to be given with or
▶ Child: 7–13 mg/kg every 8 hours (max. per dose
▶ Adult: 450 mg every 8 hours for 7 days
l UNLICENSED USE Not licensed for treatment of mild to
moderate pneumocystis infection. Not licensed for
treatment of falciparum malaria.
l CONTRA-INDICATIONS Diarrhoeal states
(antibiotic-associated colitis more common)
l INTERACTIONS → Appendix 1: clindamycin
▶ Common or very common Skin reactions
▶ With oral use Abdominal pain . antibiotic associated colitis . diarrhoea (discontinue)
▶ With oral use Nausea . vomiting
SIDE-EFFECTS, FURTHER INFORMATION Antibioticassociated colitis Clindamycin has been associated with
antibiotic-associated colitis, which may be fatal. Although
antibiotic-associated colitis can occur with most
antibacterials, it occurs more frequently with clindamycin.
If C difficile infection is suspected or confirmed,
discontinue the antibiotic if appropriate. Seek specialist
advice if the antibiotic cannot be stopped and the
BNF 78 Bacterial infection 535
l PREGNANCY Manufacturer advises not known to be
harmful in the second and third trimesters; use with
caution in the first trimester—limited data.
l BREAST FEEDING g Specialist sources indicate use with
caution—present in milk. Monitor infant for effects on the
gastrointestinal flora such as diarrhoea, candidiasis, or
rarely, blood in the stool indicating possible antibioticassociated colitis. k
l MONITORING REQUIREMENTS Monitor liver and renal
function if treatment exceeds 10 days.
▶ In children Monitor liver and renal function in neonates
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use Avoid rapid intravenous
For intravenous infusion (Dalacin ® C Phosphate), give
continuously or intermittently in Glucose 5% or Sodium
Chloride 0.9%; dilute to not more than 18 mg/mL and give
over 10–60 minutes at a rate not exceeding 30 mg/minute
(1.2 g over at least 60 minutes; higher doses by continuous
l PATIENT AND CARER ADVICE Patients and their carers
should be advised to discontinue and contact a doctor
immediately if severe, prolonged or bloody diarrhoea
▶ With oral use Capsules should be swallowed with a glass of
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
▶ With oral use Clindamycin capsules may be prescribed.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension, oral
EXCIPIENTS: May contain Benzyl alcohol
▶ Clindamycin (Non-proprietary)
Clindamycin (as Clindamycin phosphate) 150 mg per
Clindamycin (as Clindamycin phosphate) 150 mg per 1 ml Dalacin
C Phosphate 300mg/2ml solution for injection ampoules | 5 ampoule P £31.01 (Hospital only)
Dalacin C Phosphate 600mg/4ml solution for injection ampoules | 5 ampoule P £61.75 (Hospital only)
CAUTIONARY AND ADVISORY LABELS 9, 27
▶ Clindamycin (Non-proprietary)
Clindamycin (as Clindamycin hydrochloride) 75 mg Clindamycin
75mg capsules | 24 capsule P £7.45 DT = £7.45
Clindamycin (as Clindamycin hydrochloride) 150 mg Clindamycin
150mg capsules | 24 capsule P £13.72 DT = £3.08 |
Clindamycin (as Clindamycin hydrochloride) 300 mg Clindamycin
300mg capsules | 30 capsule P £42.00 DT = £38.26
Clindamycin (as Clindamycin hydrochloride) 75 mg Dalacin C
75mg capsules | 24 capsule P £7.45 DT = £7.45
Clindamycin (as Clindamycin hydrochloride) 150 mg Dalacin C
150mg capsules | 24 capsule P £13.72 DT = £3.08 | 100 capsule P £55.08
The macrolides have an antibacterial spectrum that is similar
but not identical to that of penicillin; they are thus an
alternative in penicillin-allergic patients. They are active
against many-penicillin-resistant staphylococci, but some
are now also resistant to the macrolides.
Indications for the macrolides include campylobacter
enteritis, respiratory infections (including pneumonia,
whooping cough, Legionella, chlamydia, and mycoplasma
infection), and skin infections.
Erythromycin p. 539 is also used in the treatment of early
syphilis, uncomplicated genital chlamydial infection, and
non-gonococcal urethritis. Erythromycin has poor activity
against Haemophilus influenzae. Erythromycin causes nausea,
vomiting, and diarrhoea in some patients; in mild to
moderate infections this can be avoided by giving a lower
dose, but if a more serious infection, such as Legionella
pneumonia, is suspected higher doses are needed.
Azithromycin below is a macrolide with slightly less
activity than erythromycin against Gram-positive bacteria,
but enhanced activity against some Gram-negative
organisms including H. influenzae. Plasma concentrations
are very low, but tissue concentrations are much higher. It
has a long tissue half-life and once daily dosage is
recommended. Azithromycin is also used in the treatment of
uncomplicated genital chlamydial infection, non-gonococcal
urethritis, uncomplicated gonorrhoea, typhoid [unlicensed
indication], trachoma [unlicensed indication], and Lyme
disease [unlicensed indication].
Clarithromycin p. 538 is an erythromycin derivative with
slightly greater activity than the parent compound. Tissue
concentrations are higher than with erythromycin.
Clarithromycin is also used in regimens for Helicobacter
Spiramycin is also a macrolide which is used for the
▶ With intravenous use or oral use electrolyte disturbances
(predisposition to QT interval prolongation). may
aggravate myasthenia gravis . predisposition to QT interval
altered . vasodilation . vision disorders . vomiting
▶ Uncommon Angioedema . anxiety . arrhythmias . candida
adverse reactions (SCARs).tinnitus . vertigo
▶ Rare or very rare Antibiotic associated colitis . myasthenia
gravis . nephritis tubulointerstitial
Prevention of secondary case of invasive group A
streptococcal infection in patients who are allergic to
▶ Child 6 months–11 years: 12 mg/kg once daily (max. per
▶ Child 12–17 years: 500 mg once daily for 5 days
▶ Adult: 500 mg once daily for 5 days
536 Bacterial infection BNF 78
Respiratory-tract infections, otitis media, skin and softtissue infections
▶ Child 6 months–17 years: 10 mg/kg once daily (max. per
▶ Child 6 months–17 years (body-weight 15–25 kg): 200 mg
▶ Child 6 months–17 years (body-weight 26–35 kg): 300 mg
▶ Child 6 months–17 years (body-weight 36–45 kg): 400 mg
▶ Child 6 months–17 years (body-weight 46 kg and above):
▶ Adult: 500 mg once daily for 3 days, alternatively
initially 500 mg once daily for 1 day, then 250 mg once
Uncomplicated genital chlamydial infections | Nongonococcal urethritis
▶ Child 12–17 years: 1 g for 1 dose
Lyme disease [erythema migrans and/or non-focal
▶ Adult: 500 mg daily for 17 days
Mild to moderate typhoid due to multiple-antibacterial
▶ Adult: 500 mg once daily for 7 days
Community-acquired pneumonia, low to moderate
▶ Adult: 500 mg once daily for 3 days, alternatively
initially 500 mg once daily for 1 day, then 250 mg once
Community-acquired pneumonia, high severity
▶ INITIALLY BY INTRAVENOUS INFUSION
▶ Adult: Initially 500 mg once daily for at least 2 days,
then (by mouth) 500 mg once daily for a total duration
Antibacterial prophylaxis for insertion of intra-uterine
▶ In children Not licensed for prevention of group A
▶ With oral use in adults Azithromycin may be used as detailed
below, although these situations are considered outside
. prevention of group A streptococcal infection;
. mild to moderate typhoid due to multiple-antibacterial
. community-acquired pneumonia (high severity) when
oral treatment continues for more than 3 days.
l INTERACTIONS → Appendix 1: macrolides
▶ With oral use Numbness . oedema . photosensitivity
▶ With parenteral use Numbness . oedema . photosensitivity
▶ With oral use Acute kidney injury . aggression . akathisia . haemolytic anaemia . syncope
▶ With parenteral use Acute kidney injury . aggression . akathisia . haemolytic anaemia . syncope
l PREGNANCY Manufacturers advise use only if adequate
l BREAST FEEDING Present in milk; use only if no suitable
l HEPATIC IMPAIRMENT Manufacturer advises caution;
consider avoiding in severe impairment (no information
▶ In adults Use with caution if eGFR less than
▶ With oral use in children Use with caution if estimated
glomerular filtration rate less than 10 mL/minute/1.73 m2
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use in adults For intravenous infusion
(Zedbac ®), give intermittently in Glucose 5% or Sodium
Chloride 0.9%. Reconstitute 500 mg with 4.8 mL water for
injections to produce a 100 mg/mL solution, then dilute
5 mL of solution with infusion fluid to a final
concentration of 1 or 2 mg/mL; give the 1 mg/mL solution
over 3 hours or give the 2 mg/mL solution over 1 hour.
l PRESCRIBING AND DISPENSING INFORMATION
▶ With oral use See Lyme disease p. 577 for place in therapy
and further information on treatment. Flavours of oral
liquid formulations may include cherry or banana.
Medicines for Children leaflet: Azithromycin for bacterial infections
www.medicinesforchildren.org.uk/azithromycin-bacterialinfections-0
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
▶ With oral use Azithromycin Capsules may be prescribed.
Azithromycin Tablets may be prescribed.
Azithromycin Oral Suspension 200 mg/5 mL may be
l EXCEPTIONS TO LEGAL CATEGORY
▶ With oral use Azithromycin tablets can be sold to the public
for the treatment of confirmed, asymptomatic Chlamydia
trachomatis genital infection in those over 16 years of age,
and for the epidemiological treatment of their sexual
partners, subject to maximum single dose of 1 g, maximum
daily dose 1 g, and a pack size of 1 g.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: oral suspension
CAUTIONARY AND ADVISORY LABELS 5, 9
▶ Azithromycin (Non-proprietary)
Azithromycin 500 mg Azithromycin 500mg tablets | 3 tablet P £9.80 DT = £1.09
CAUTIONARY AND ADVISORY LABELS 5, 9
▶ Azithromycin (Non-proprietary)
Azithromycin 40 mg per 1 ml Azithromycin 200mg/5ml oral
suspension | 15 ml P £6.18 DT = £4.06 | 30 ml P £11.04 DT =
Azithromycin 40 mg per 1 ml Zithromax 200mg/5ml oral
suspension | 15 ml P £4.06 DT = £4.06 | 22.5 ml P £6.10 DT =
£6.10 | 30 ml P £11.04 DT = £11.04
Powder for solution for infusion
ELECTROLYTES: May contain Sodium
Azithromycin (as Azithromycin dihydrate) 500 mg Zedbac 500mg
powder for solution for infusion vials | 1 vial P £9.50 (Hospital
BNF 78 Bacterial infection 537
CAUTIONARY AND ADVISORY LABELS 5, 9, 23
▶ Azithromycin (Non-proprietary)
Azithromycin (as Azithromycin dihydrate) 250 mg Azithromycin
250mg capsules | 4 capsule P £2.44–£10.10 | 6 capsule P £15.15 DT = £3.02
Azithromycin (as Azithromycin dihydrate) 250 mg Zithromax
250mg capsules | 4 capsule P £7.16 | 6 capsule P £10.74 DT
Respiratory-tract infections | Mild to moderate skin and
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 1 month–11 years (body-weight up to 8 kg): 7.5 mg/kg
▶ Child 1 month–11 years (body-weight 8–11 kg): 62.5 mg
▶ Child 1 month–11 years (body-weight 12–19 kg): 125 mg
▶ Child 1 month–11 years (body-weight 20–29 kg): 187.5 mg
▶ Child 1 month–11 years (body-weight 30–40 kg): 250 mg
▶ Child 12–17 years: 250 mg twice daily usually for
7–14 days, increased to 500 mg twice daily, if required
in severe infections (e.g. pneumonia)
▶ Adult: 250 mg twice daily usually for 7–14 days,
increased to 500 mg twice daily, if required in severe
▶ BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶ Child 12–17 years: 500 mg once daily usually for
7–14 days, increased to 1 g once daily, if required in
severe infections (e.g. pneumonia)
▶ Adult: 500 mg once daily usually for 7–14 days,
increased to 1 g once daily, if required in severe
▶ Adult: 500 mg every 12 hours maximum duration
5 days, switch to oral route when appropriate, to be
administered into a large proximal vein
Acute exacerbation of chronic obstructive pulmonary
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Adult: 500 mg twice daily for 5 days
▶ Adult: 500 mg every 12 hours, to be administered into a
Acute exacerbation of bronchiectasis
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 1 month–11 years (body-weight up to 8 kg): 7.5 mg/kg
▶ Child 1 month–11 years (body-weight 8–11 kg): 62.5 mg
▶ Child 1 month–11 years (body-weight 12–19 kg): 125 mg
▶ Child 1 month–11 years (body-weight 20–29 kg): 187.5 mg
▶ Child 1 month–11 years (body-weight 30–40 kg): 250 mg
▶ Child 12–17 years: 250–500 mg twice daily for 7–14 days
▶ Adult: 500 mg twice daily for 7–14 days
Acute cough [if systemically very unwell or at higher risk
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 1 month–11 years (body-weight up to 8 kg): 7.5 mg/kg
▶ Child 1 month–11 years (body-weight 8–11 kg): 62.5 mg
▶ Child 1 month–11 years (body-weight 12–19 kg): 125 mg
▶ Child 1 month–11 years (body-weight 20–29 kg): 187.5 mg
▶ Child 1 month–11 years (body-weight 30–40 kg): 250 mg
▶ Child 12–17 years: 250–500 mg twice daily for 5 days
▶ Adult: 250–500 mg twice daily for 5 days
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 1 month–11 years (body-weight up to 8 kg): 7.5 mg/kg
▶ Child 1 month–11 years (body-weight 8–11 kg): 62.5 mg
▶ Child 1 month–11 years (body-weight 12–19 kg): 125 mg
▶ Child 1 month–11 years (body-weight 20–29 kg): 187.5 mg
▶ Child 1 month–11 years (body-weight 30–40 kg): 250 mg
▶ Child 12–17 years: 250–500 mg twice daily for 5–7 days
▶ Adult: 250 mg twice daily usually for 7–14 days,
increased to 500 mg twice daily, if required in severe
▶ Adult: 500 mg every 12 hours maximum duration
5 days, switch to oral route when appropriate, to be
administered into a large proximal vein
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 1 month–11 years (body-weight up to 8 kg): 7.5 mg/kg
▶ Child 1 month–11 years (body-weight 8–11 kg): 62.5 mg
▶ Child 1 month–11 years (body-weight 12–19 kg): 125 mg
▶ Child 1 month–11 years (body-weight 20–29 kg): 187.5 mg
▶ Child 1 month–11 years (body-weight 30–40 kg): 250 mg
▶ Child 12–17 years: 500 mg twice daily for 7 days
▶ Adult: 500 mg twice daily for 7 days
Helicobacter pylori eradication in combination with a
proton pump inhibitor and amoxicillin
Helicobacter pylori eradication in combination with a
proton pump inhibitor and metronidazole
▶ BY MOUTH USING IMMEDIATE-RELEASE MEDICINES
▶ Child 1 month–11 years (body-weight up to 8 kg): 7.5 mg/kg
▶ Child 1 month–11 years (body-weight 8–11 kg): 62.5 mg
▶ Child 1 month–11 years (body-weight 12–19 kg): 125 mg
▶ Child 1 month–11 years (body-weight 20–29 kg): 187.5 mg
▶ Child 1 month–11 years (body-weight 30–40 kg): 250 mg
▶ Child 12–17 years: 250 mg twice daily for 5 days,
alternatively 500 mg twice daily for 5 days
▶ Adult: 500 mg twice daily for 5 days
l UNLICENSED USE g Duration of treatment for acute
sinusitis differs from product literature and adheres to
538 Bacterial infection BNF 78
national guidelines. hSee Sinusitis (acute) p. 1203 for
▶ With oral use in children g Duration of treatment for
acute otitis media differs from product literature and
adheres to national guidelines. hSee Ear infections,
antibacterial therapy p. 511 for further information.
Tablets not licensed for use in children under 12 years; oral
suspension not licensed for use in infants under 6 months.
l INTERACTIONS → Appendix 1: macrolides
▶ Uncommon Burping . dry mouth . muscle complaints . oral
disorders .thrombocytosis .tremor
l PREGNANCY Manufacturer advises avoid, particularly in
the first trimester, unless potential benefit outweighs risk.
l BREAST FEEDING Manufacturer advises avoid unless
potential benefit outweighs risk—present in milk.
l HEPATIC IMPAIRMENT Manufacturer advises caution in
mild-to-moderate impairment; avoid in severe failure if
renal impairment also present.
l RENAL IMPAIRMENT Avoid if severe hepatic impairment
▶ With oral use in adults Avoid Klaricid XL ® or clarithromycin
m/r preparations if eGFR less than 30 mL/minute/1.73 m2
▶ With oral use in children Avoid Klaricid XL ® or clarithromyin
m/r preparations if estimated glomerular filtration rate
less than 30 mL/minute/1.73 m2
Dose adjustments ▶ In adults Use half normal dose if eGFR
less than 30 mL/minute/1.73 m2
▶ In children Use half normal dose if estimated glomerular
filtration rate less than 30 mL/minute/1.73 m2
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use in adults For intravenous infusion
(Klaricid ® I.V.), give intermittently in Glucose 5% or
Sodium Chloride 0.9%; dissolve initially in water for
injections (500 mg in 10 mL) then dilute to a concentration
of 2 mg/mL; give over 60 minutes.
Medicines for Children leaflet: Clarithromycin for bacterial
infections www.medicinesforchildren.org.uk/clarithromycinbacterial-infections
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
Clarithromycin Tablets may be prescribed.
Clarithromycin Oral Suspension may be prescribed.
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug. Forms available
from special-order manufacturers include: infusion
CAUTIONARY AND ADVISORY LABELS 9, 21, 25
Clarithromycin 500 mg Clarie XL 500mg tablets | 7 tablet P £6.72 DT = £6.72 | 14 tablet P £13.23
Clarithromycin 500 mg Klaricid XL 500mg tablets | 7 tablet P £6.72 DT = £6.72 | 14 tablet P £13.23
▶ Xetinin XL (Morningside Healthcare Ltd)
Clarithromycin 500 mg Xetinin XL 500mg tablets | 7 tablet P £6.72 DT = £6.72 | 14 tablet P £13.23
CAUTIONARY AND ADVISORY LABELS 9, 13
Clarithromycin 250 mg Klaricid Adult 250mg granules sachets | 14 sachet P £11.68
CAUTIONARY AND ADVISORY LABELS 9
▶ Clarithromycin (Non-proprietary)
Clarithromycin 250 mg Clarithromycin 250mg tablets | 14 tablet P £10.50 DT = £1.29
Clarithromycin 500 mg Clarithromycin 500mg tablets | 14 tablet P £21.50 DT = £2.10
CAUTIONARY AND ADVISORY LABELS 9
▶ Clarithromycin (Non-proprietary)
Clarithromycin 25 mg per 1 ml Clarithromycin 125mg/5ml oral
suspension | 70 ml P £3.75 DT = £3.36
Clarithromycin 50 mg per 1 ml Clarithromycin 250mg/5ml oral
suspension | 70 ml P £5.25 DT = £4.46
Clarithromycin 25 mg per 1 ml Klaricid Paediatric 125mg/5ml oral
suspension | 70 ml P £5.26 DT = £3.36 | 100 ml P £9.04
Clarithromycin 50 mg per 1 ml Klaricid Paediatric 250mg/5ml oral
suspension | 70 ml P £10.51 DT = £4.46
Powder for solution for infusion
ELECTROLYTES: May contain Sodium
▶ Clarithromycin (Non-proprietary)
Clarithromycin 500 mg Clarithromycin 500mg powder for solution
for infusion vials | 1 vial P £11.25 DT = £9.45 (Hospital only)
Clarithromycin 500mg powder for concentrate for solution for infusion
vials | 1 vial P £11.15 DT = £9.45 | 10 vial P £111.50
Clarithromycin 500 mg Klaricid IV 500mg powder for solution for
infusion vials | 1 vial P £9.45 DT = £9.45
Susceptible infections in patients with penicillin
hypersensitivity (e.g. respiratory-tract infections
(including Legionella infection), skin and oral infections,
▶ Child 1–23 months: 125 mg 4 times a day, total daily dose
may alternatively be given in two divided doses,
increased to 250 mg 4 times a day, dose increase may
▶ Child 2–7 years: 250 mg 4 times a day, total daily dose
may alternatively be given in two divided doses,
increased to 500 mg 4 times a day, dose increase may
▶ Child 8–17 years: 250–500 mg 4 times a day, total daily
dose may alternatively be given in two divided doses,
increased to 500–1000 mg 4 times a day, dose increase
may be used in severe infections
▶ Adult: 250–500 mg 4 times a day, total daily dose may
alternatively be given in two divided doses, increased
to 500–1000 mg 4 times a day, dose increase may be
▶ Child: 12.5 mg/kg every 6 hours (max. per dose 1 g)
▶ Adult: 6.25 mg/kg every 6 hours, for mild infections
when oral treatment not possible, increased to
12.5 mg/kg every 6 hours, dose increase may be used in
Acute cough [if systemically very unwell or at higher risk
▶ Child 1–23 months: 125 mg 4 times a day for 5 days,
alternatively 250 mg twice daily for 5 days
▶ Child 2–7 years: 250 mg 4 times a day for 5 days,
alternatively 500 mg twice daily for 5 days continued→
BNF 78 Bacterial infection 539
▶ Child 8–17 years: 250–500 mg 4 times a day for 5 days,
alternatively 500–1000 mg twice daily for 5 days
▶ Adult: 250–500 mg 4 times a day for 5 days,
alternatively 500–1000 mg twice daily for 5 days
▶ Child 1–23 months: 125 mg 4 times a day for 5–7 days,
alternatively 250 mg twice daily for 5–7 days
▶ Child 2–7 years: 250 mg 4 times a day for 5–7 days,
alternatively 500 mg twice daily for 5–7 days
▶ Child 8–17 years: 250–500 mg 4 times a day for
5–7 days, alternatively 500–1000 mg twice daily for
▶ Adult: 500 mg 4 times a day for 14 days
Uncomplicated genital chlamydia | Non-gonococcal
▶ Adult: 500 mg twice daily for 14 days
▶ Adult: 250–500 mg 4 times a day, total daily dose may
alternatively be given in two divided doses, increased
to 4 g daily in divided doses, dose increase may be used
▶ Adult: 6.25 mg/kg every 6 hours, for mild infections
when oral treatment is not possible, increased to
12.5 mg/kg every 6 hours, dose increase may be used in
Prevention and treatment of pertussis
▶ Child 1–23 months: 125 mg 4 times a day, total daily dose
may alternatively be given in two divided doses,
increased to 250 mg 4 times a day, dose increase may
▶ Child 2–7 years: 250 mg 4 times a day, total daily dose
may alternatively be given in two divided doses,
increased to 500 mg 4 times a day, dose increase may
▶ Child 8–17 years: 250–500 mg 4 times a day, total daily
dose may alternatively be given in two divided doses,
increased to 500–1000 mg 4 times a day, dose increase
may be used in severe infections
▶ Adult: (consult local protocol)
Prevention of secondary case of diphtheria in nonimmune patient
▶ Adult: 500 mg every 6 hours for 7 days, treat for further
10 days if nasopharyngeal swabs positive after first
Prevention of secondary case of invasive group A
streptococcal infection in penicillin allergic patients
▶ Adult: 250–500 mg every 6 hours for 10 days
Prevention of pneumococcal infection in asplenia or in
patients with sickle-cell disease (if penicillin-allergic)
▶ Adult: 500 mg twice daily, antibiotic prophylaxis is not
fully reliable. It may be discontinued in those with
sickle-cell disease who have received pneumococcal
immunisation and who do not have a history of severe
▶ Adult: 500 mg twice daily courses usually last
6–12 weeks and are repeated intermittently
▶ Adult: 250–500 mg 3 times a day for up to 4 weeks, to
▶ Adult: 3 mg/kg 3 times a day
l UNLICENSED USE g Duration of treatment for acute
otitis media differs from product literature and adheres to
national guidelines. hSee Ear infections, antibacterial
therapy p. 511 for further information.
▶ In adults g Erythromycin may be used for gastrointestinal stasis, lbut it is not licensed for this
l CAUTIONS Avoid in Acute porphyrias p. 1058
l INTERACTIONS → Appendix 1: macrolides
▶ Rare or very rare Hearing loss (can occur after large doses)
▶ With oral use Cerebral impairment
▶ With parenteral use Atrioventricular block
l PREGNANCY Not known to be harmful.
l BREAST FEEDING Only small amounts in milk—not known
l HEPATIC IMPAIRMENT May cause idiosyncratic
Dose adjustments ▶ In adults Max. 1.5 g daily in severe
renal impairment (ototoxicity).
▶ In children Reduce dose in severe renal impairment
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use in children Dilute reconstituted solution
further in glucose 5% (neutralised with Sodium
bicarbonate) or sodium chloride 0.9% to a concentration of
1–5 mg/mL; give over 20–60 minutes. Concentration of up
to 10 mg/mL may be used in fluid-restriction if
administered via a central venous catheter.
▶ With intravenous use in adults For intravenous infusion (as
lactobionate), give intermittently in Glucose 5%
(neutralised with sodium bicarbonate) or Sodium chloride
0.9%; dissolve initially in water for injections (1 g in 20 mL)
then dilute to a concentration of 1–5 mg/mL; give over
l PRESCRIBING AND DISPENSING INFORMATION Flavours of
oral liquid formulations may include banana.
Medicines for Children leaflet: Erythromycin for bacterial infections
www.medicinesforchildren.org.uk/erythromycin-bacterialinfections
l PROFESSION SPECIFIC INFORMATION
Dental practitioners’ formulary
▶ With oral use Erythromycin tablets e/c may be prescribed.
Erythromycin ethyl succinate oral suspension may be
prescribed. Erythromycin stearate tablets may be
prescribed. Erythromycin ethyl succinate tablets may be
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
CAUTIONARY AND ADVISORY LABELS 5, 9, 25
▶ Erythromycin (Non-proprietary)
Erythromycin 250 mg Erythromycin 250mg gastro-resistant tablets
| 28 tablet P £4.59 DT = £1.40 | 500 tablet P £25.00
540 Bacterial infection BNF 78
CAUTIONARY AND ADVISORY LABELS 9
▶ Erythromycin (Non-proprietary)
Erythromycin (as Erythromycin ethyl succinate)
500 mg Erythromycin ethyl succinate 500mg tablets | 28 tablet P £15.95 DT = £10.78
Erythromycin (as Erythromycin stearate) 250 mg Erythrocin
250 tablets | 100 tablet P £18.20 DT = £18.20
Erythromycin (as Erythromycin stearate) 500 mg Erythrocin
500 tablets | 100 tablet P £36.40 DT = £36.40
▶ Erythrolar (Ennogen Pharma Ltd)
Erythromycin (as Erythromycin stearate) 250 mg Erythrolar
250mg tablets | 100 tablet P £22.80 DT = £18.20
Erythromycin (as Erythromycin stearate) 500 mg Erythrolar
500mg tablets | 100 tablet P £45.60 DT = £36.40
▶ Erythroped A (Advanz Pharma)
Erythromycin (as Erythromycin ethyl succinate)
500 mg Erythroped A 500mg tablets | 28 tablet P £10.78 DT =
CAUTIONARY AND ADVISORY LABELS 9
▶ Erythromycin (Non-proprietary)
Erythromycin (as Erythromycin ethyl succinate) 25 mg per
1 ml Erythromycin ethyl succinate 125mg/5ml oral suspension | 100 ml P £4.95 DT = £4.95
Erythromycin ethyl succinate 125mg/5ml oral suspension sugar free
sugar-free | 100 ml P £4.95 DT = £4.88
Erythromycin (as Erythromycin ethyl succinate) 50 mg per
1 ml Erythromycin ethyl succinate 250mg/5ml oral suspension | 100 ml P £8.48 DT = £8.48
Erythromycin ethyl succinate 250mg/5ml oral suspension sugar free
sugar-free | 100 ml P £8.48 DT = £8.35
Erythromycin (as Erythromycin ethyl succinate) 100 mg per
1 ml Erythromycin ethyl succinate 500mg/5ml oral suspension | 100 ml P £14.99 DT = £14.99
Erythromycin ethyl succinate 500mg/5ml oral suspension sugar free
Erythromycin (as Erythromycin ethyl succinate) 25 mg per
1 ml Erythroped PI SF 125mg/5ml oral suspension sugar-free | 140 ml P £3.06
Erythromycin (as Erythromycin ethyl succinate) 50 mg per
1 ml Erythroped SF 250mg/5ml oral suspension sugar-free | 140 ml P £5.95
Erythromycin (as Erythromycin ethyl succinate) 100 mg per
1 ml Erythroped Forte SF 500mg/5ml oral suspension sugar-free |
Powder for solution for infusion
▶ Erythromycin (Non-proprietary)
Erythromycin (as Erythromycin lactobionate)
1 gram Erythromycin 1g powder for solution for infusion vials |
l DRUG ACTION Aztreonam is a monocyclic beta-lactam
(‘monobactam’) antibiotic with an antibacterial spectrum
limited to Gram-negative aerobic bacteria including
Pseudomonas aeruginosa, Neisseria meningitidis, and
Haemophilus influenzae; it should not be used alone for
Neisseria gonorrhoeae (but not against concurrent
Gram-negative infections including Pseudomonas
aeruginosa, Haemophilus influenzae, and Neisseria
▶ BY DEEP INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INFUSION, OR BY INTRAVENOUS INJECTION
▶ Adult: 1 g every 8 hours, alternatively 2 g every
12 hours, single doses over 1 g intravenous route only
Severe gram-negative infections including Pseudomonas
aeruginosa, Haemophilus influenzae, Neisseria
meningitidis, and lung infections in cystic fibrosis
▶ BY INTRAVENOUS INFUSION, OR BY INTRAVENOUS INJECTION
▶ Adult: 1 g for 1 single dose
▶ BY DEEP INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS
INFUSION, OR BY INTRAVENOUS INJECTION
▶ Adult: 0.5–1 g every 8–12 hours
Chronic pulmonary Pseudomonas aeruginosa infection in
▶ BY INHALATION OF NEBULISED SOLUTION
▶ Adult: 75 mg 3 times a day for 28 days, doses to be
administered at least 4 hours apart, subsequent courses
repeated after 28-day interval without aztreonam
▶ When used by inhalation Haemoptysis— risk of further
▶ Common or very common Dyspnoea .respiratory disorders
▶ When used by inhalation Cough . haemoptysis . joint
disorders . laryngeal pain . nasal complaints .rash
epidermal necrolysis . vomiting
l ALLERGY AND CROSS-SENSITIVITY Contra-indicated in
Use with caution in patients with hypersensitivity to
other beta-lactam antibiotics (although aztreonam may be
less likely than other beta-lactams to cause
hypersensitivity in penicillin-sensitive patients).
▶ With systemic use No information available; manufacturer
▶ When used by inhalation No information available;
manufacturer of powder for nebuliser solution advises
l BREAST FEEDING Amount in milk probably too small to be
▶ With systemic use Manufacturer advises caution in chronic
Dose adjustments ▶ With systemic use Manufacturer advises
dose reduction of 20—25% for long term treatment of
patients with chronic impairment with cirrhosis, especially
in alcoholic cirrhosis and concomitant renal impairment.
Dose adjustments ▶ With systemic use If eGFR
, usual initial dose of injection,
then half normal dose. If eGFR less than
, usual initial dose of injection, then
BNF 78 Bacterial infection 541
▶ When used by inhalation Measure lung function before and
after initial dose of aztreonam and monitor for
l DIRECTIONS FOR ADMINISTRATION
▶ With intravenous use For intravenous injection, give over
3–5 minutes. For intravenous infusion (Azactam®), give
intermittently in Glucose 5% or Sodium chloride 0.9%.
Dissolve initially in water for injections (1 g per 3 mL) then
dilute to a concentration of less than 20 mg/mL; to be
▶ When used by inhalation Other inhaled drugs should be
administered before aztreonam; a bronchodilator should
be administered before each dose.
l NATIONAL FUNDING/ACCESS DECISIONS
Scottish Medicines Consortium (SMC) decisions
The Scottish Medicines Consortium has advised (January
2015) that aztreonam powder for nebuliser solution
(Cayston ®) is accepted for restricted use within NHS
Scotland when inhaled colistimethate sodium and inhaled
tobramycin are not tolerated or are not providing
satisfactory therapeutic benefit (measured as 2% decline
in forced expiratory volume in 1 second). This advice is
contingent upon the continuing availability of the Patient
Access Scheme in NHS Scotland or a list price that is
l MEDICINAL FORMS There can be variation in the licensing of
different medicines containing the same drug.
Powder and solvent for nebuliser solution
▶ Cayston (Gilead Sciences International Ltd)
Aztreonam (as Aztreonam lysine) 75 mg Cayston 75mg powder
and solvent for nebuliser solution vials with Altera Nebuliser Handset
| 84 vial P £2,181.53 DT = £2,181.53
Powder for solution for injection
▶ Azactam (Bristol-Myers Squibb Pharmaceuticals Ltd)
Aztreonam 1 gram Azactam 1g powder for solution for injection vials
| 1 vial P £9.40 (Hospital only)
Aztreonam 2 gram Azactam 2g powder for solution for injection vials
| 1 vial P £18.82 (Hospital only)
ANTIBACTERIALS › NITROIMIDAZOLE
l DRUG ACTION Metronidazole is an antimicrobial drug with
high activity against anaerobic bacteria and protozoa.
▶ Child 1 month: 7.5 mg/kg every 12 hours usually treated
for 7 days (for 10–14 days in Clostridium difficile
▶ Child 2 months–11 years: 7.5 mg/kg every 8 hours (max.
per dose 400 mg) usually treated for 7 days (for
10–14 days in Clostridium difficile infection)
▶ Child 12–17 years: 400 mg every 8 hours usually treated
for 7 days (for 10–14 days in Clostridium difficile
▶ Adult: 400 mg every 8 hours, alternatively 500 mg every
8 hours usually treated for 7 days (for 10–14 days in
Clostridium difficile infection)
▶ Child 1–11 months: 125 mg 3 times a day for 3 days, then
125 mg twice daily, for usual total treatment duration
▶ Child 1–4 years: 250 mg 3 times a day for 3 days, then
250 mg twice daily, for usual total treatment duration
▶ Child 5–9 years: 500 mg 3 times a day for 3 days, then
500 mg twice daily, for usual total treatment duration
▶ Child 10–17 years: 1 g 3 times a day for 3 days, then 1 g
twice daily, for usual total treatment duration of 7 days
▶ Adult: 1 g 3 times a day for 3 days, then 1 g twice daily,
for usual total treatment duration of 7 days
▶ Adult: 500 mg every 8 hours usually treated for 7 days
(for 10–14 days in Clostridium difficile infection), to be
Helicobacter pylori eradication; in combination with
clarithromycin and esomeprazole; or in combination
with clarithromycin and lansoprazole; or in combination
with amoxicillin and lansoprazole; or in combination
with clarithromycin and omeprazole; or in combination
with clarithromycin and pantoprazole; or in combination
with clarithromycin and rabeprazole
Helicobacter pylori eradication; in combination with
▶ Adult: 10–20 mg/kg daily in divided doses, usual dose
400–500 mg 3 times a day usually given for 1 month
but no longer than 3 months because of concerns about
▶ Adult: 400 mg every 8 hours for 7 days
Bacterial vaginosis (notably Gardnerella vaginalis
▶ Adult: 400–500 mg twice daily for 5–7 days,
▶ Adult: 1 applicatorful daily for 5 days, dose to be
DOSE EQUIVALENCE AND CONVERSION
▶ 1 applicatorful of vaginal gel delivers a 5 g dose of
▶ Adult: 400 mg twice daily for 14 days
▶ Child 1–2 years: 50 mg every 8 hours for 3 days
▶ Child 3–6 years: 100 mg every 12 hours for 3 days
▶ Child 7–9 years: 100 mg every 8 hours for 3 days
▶ Child 10–17 years: 200–250 mg every 8 hours for 3 days
▶ Adult: 400 mg every 8 hours for 3 days
▶ Child 1–2 years: 50 mg every 8 hours for 3–7 days
▶ Child 3–6 years: 100 mg every 12 hours for 3–7 days
▶ Child 7–9 years: 100 mg every 8 hours for 3–7 days
▶ Child 10–17 years: 200–250 mg every 8 hours for
▶ Adult: 400 mg every 8 hours for 3–7 days
▶ Adult: 400–500 mg, to be administered 2 hours before
surgery, then 400–500 mg every 8 hours if required for
up to 3 doses (in high-risk procedures)
No comments:
Post a Comment
اكتب تعليق حول الموضوع