BNF for Children
An editor has been appointed to lead the editorial work on BNFC. The BNFC editor reports to the Executive Editor of the national formulary publications and is supported by BNF staff editors (whose numbers have increased in order to absorb the extra workload). As with the BNF, BNFC is constructed with the guidance of clinical experts including paediatricians, paediatric and neonatal pharmacy specialists and general practitioners with a special interest in paediatrics.
A particular challenge is the construction of notes on drug treatment of childhood ailments and on the selection of appropriate medicines. The BNF already covers many topics of paediatric relevance (e.g. constipation in children, use of pulmonary surfactants in neonates, management of childhood asthma, acute treatment of croup and anaphylaxis, and prevention of haemorrhagic disease of the newborn), but these topics may have to be expanded for a paediatric formulary and many new ones added. Paediatric experts play a key role in the construction of clinical advice.
Clinical expertise and experience is also required for interpreting new data—whether the data come from product information or from reviews and studies in the literature. BNFC is best able to advise on everyday clinical needs if it is guided by expert practitioners.
A panel of about 40 paediatric experts will provide advice to BNFC on a regular basis. Like the BNF, ad hoc advice will also be sought from other clinical advisers. The Committee or BNFC's regular advisers identify individuals with special expertise on specific topics.
The model developed for the BNF is used to construct the notes; as far as possible BNF editors draft the text and this is sent to paediatric experts for validation. In-house construction of text reduces the workload of clinical experts and takes on board editorial conventions and is sensitive to the scope and perspective of the publication.
The BNF already includes many unlicensed uses of medicines. Clearly, for BNFC, there will be a far greater proportion of 'off-label' and unlicensed medicines. This may require the introduction of a specific and formal protocol for validating information on unlicensed use. Criteria used for weighing evidence could easily be adapted for this use. Evidence to support unlicensed use is first sought from systematic reviews and large randomised trials and editors then work down the 'evidence ladder'. If formal evidence is not available, editors have to resort to seeking the views of clinical experts and building a consensus of such views. Authoritative texts, hospital protocols, clinical guidelines, local formularies, and of course Medicines for Children are used as appropriate.
Editorial content of BNFC is constructed in tandem with that for the BNF. This has many advantages:
Editorial processes on the BNF have evolved over very many years. These processes have been established on the back of long experience of producing authoritative works such as the British Pharmaceutical Codex, Martindale, and of course the BNF. In constructing the BNF text, editors focus principally on accuracy, safety and clinical relevance. However, as with any authoritative work, editors are also painstaking about scientific and editorial conventions as well as UK legislation and official standards. It is important that these skills, evolved over several decades, are applied to BNFC.
BNF editors have not only gained considerable editorial expertise but they also possess a deep insight into the clinical content for which they are responsible. This knowledge is amassed through constant dialogue with expert clinicians and being in touch with the clinical literature. Since the editors continually process information about medicinal products (whether they are new or old), they are very familiar with the licensed uses (through the summaries of product characteristics) and unlicensed uses (through the literature). Involvement of BNF editors on BNFC can therefore support BNFC very substantially.
The BNF has built up procedures to ensure that information throughout the volume remains up to date. This involves keeping in constant touch with the 350-plus manufacturers (it is the primary function of an editorial assistant on the BNF to maintain close contact with named individuals of all marketing authorisation holders). The BNF has built up a reliable tracking system for new and updated summaries of product characteristics. The revision of each edition also involves maintaining consistency of advice and looking out for repercussions of a change in one part of the publication on the rest of the publication.
The BNF boasts strong links with national and international organisations. These include NICE, SIGN, Drug and Therapeutics Bulletin, Clinical Evidence (the BNF editors receive—and comment on—drafts of the advice these organisations produce). Since the BNF also produces the World Health Organization's Model Formulary, it has easy access to international experts on a number of diseases. Through the membership of individual editors on committees and working groups of the British Pharmacopoeia Commission and the Committee on Safety of Medicines, the BNF has developed close links that enable a very productive exchange of information between the organisations. Integration of the BNFC work into BNF activities benefits BNFC.
