BNF for Children
Preparations of Controlled Drugs in Schedules 2, 3, 4 (Part I), and 4 (Part II) of the Misuse of Drugs Regulations 2001 (and subsequent amendments) are now identified throughout BNFC 2011–2012 using symbols to indicate the Schedule to which they belong. A key to the new symbols can be found in the Prescribing for Controlled Drugs section in General Guidance.
Guidance on the use of antiepileptic medication in pregnancy has been reviewed and updated in section 4.8.1. All young women with epilepsy who become pregnant, or want to become pregnant, should be referred to a specialist. It is important that young women taking anticonvulsants at the time of becoming pregnant should not discontinue their medication without specialist advice; the risk of harm to the mother and unborn child from seizures outweighs any teratogenic risk.
The concentration of antiepileptic medication in the blood may change during pregnancy, necessitating plasma-drug concentration monitoring; this is especially a concern for phenytoin, lamotrigine, and carbamazepine.
Guidance on the pre-hospital management of bacterial meningitis (Table 1, section 5.1) has been updated to take into account the recommendations of the NICE guideline: Bacterial Meningitis and Meningococcal Septicaemia (June 2010). In hospital, consideration should be given to the addition of vancomycin to initial, empirical antibacterial therapy if the child has received prolonged or multiple use of other antibacterials in the last 3 months, or if the child has travelled, in the last 3 months, to areas outside the UK with highly penicillin- and cephalosporin-resistant pneumococci.
Guidance on the treatment of HIV infection has been updated in BNFC (section 5.3.1) to take into account recommendations from the Paediatric European Network for Treatment of AIDS (PENTA) and the Children’s HIV Association (CHIVA). Doses for various antiretrovirals have been introduced in BNFC.
Advice on the interactions of combined hormonal contraceptives and progestogen-only contraceptives has been updated in section 7.3.1 and section 7.3.2 to take into account the recommendations of the Faculty of Sexual and Reproductive Healthcare Clinical Guidance: Drug Interactions with Hormonal Contraception (January 2011):
Advice on the management of nocturnal enuresis has been updated in section 7.4.2 to take into account the recommendations of the NICE guideline: Nocturnal Enuresis, The Management of Bedwetting in Children and Young People (October 2010). Treatment of nocturnal enuresis may now be considered in children over the age of 5 years. If initial dietary and behavioural advice is not successful, an enuresis alarm should be first line treatment; if unsuccessful, drug therapy with desmopressin may be considered. If the child has not responded to other treatments, the tricyclic antidepressant imipramine may be considered.
A revised set of cautionary and advisory labels have been introduced into BNFC 2011–2012. All of the existing labels were user-tested, and revised wording was selected to reflect terminology that is better understood by patients; the revised labels were then published in BNF 61 (March 2011). In response to feedback from users on the labels published in BNF 61, labels 4 and 25 have been further revised, and the changes are reflected in BNFC 2011–2012. Pharmacists should consult Appendix 3 (BNFC) or Appendix 9 (BNF) for further information on the labelling of dispensed medicines. Pharmacy labelling systems should be updated. We would be grateful to receive any constructive comments on the labelling suggested for any preparation.
Manufacturers are now required to express the strength of all noradrenaline preparations as noradrenaline base. While this is being implemented, for a period of time preparations on the UK market may be described as either noradrenaline base or noradrenaline acid tartrate. Doses in BNFC continue to be expressed as noradrenaline base (section 2.7.2).
Table 1 (section 5.1), which provides a summary of antibacterial therapy for infections, has been reformatted in BNFC 2011–2012, making it easier to identify first-line antibacterial treatments, suggested durations of treatment, the alternatives to these treatments and, where appropriate, the circumstances under which the alternatives should be prescribed.
Teaching sessions on Getting the Best Out of Your BNFC have revealed that healthcare professionals (from the recently qualified to those who have been practising for many years) and students training to join these professions have much to learn about BNFC. The section on How to Use BNFC has been expanded in this edition; it is now linked to the main elements of rational prescribing, such as, using BNFC to select drugs that minimise harm in children with co-morbidities, and writing prescriptions in a way that helps to reduce medication errors. The generic structure of this section means that it can be adapted easily for teaching and learning in different clinical settings.
The BNF and BNFC free e-newsletter is issued several times a year. To register for regular updates, case studies, and tips on using these publications effectively, please sign up at http://www.pharmpress.com/bnfalerts.asp. To visit the e-newsletter archive, go to http://bnfc.org/ bnfc/bnfcextra/current/450066.htm.
The UK health departments distribute BNFCs to NHS hospitals, doctors, and community pharmacies.
In Scotland, contact by email: nss.psd-bnf@nhs.net
In Wales, contact the Business Services Centre. Tel: 01495 332 000
In Northern Ireland, contact by email: ni.bnf@hscni.net
The National Institute for Health and Clinical Excellence (NICE) distributes the BNFC to NHS organisations in England only. To ensure that all appropriate professionals in England receive a copy of BNFC, they are being addressed to individuals.
If you work for the NHS in England and think you are entitled to a copy of the BNFC but have not received one, or have a query regarding mailed BNFCs, contact the DH Publications Orderline. Tel: 0300 123 1002.
Numerous changes are made for each edition of the BNFC. The most significant changes that have been made for BNFC 2011―2012 can be reviewed by following the links below:
