Clarification of the Doses at extremes of body-weight statement for vancomycin in BNF and BNF for Children

In July, BNF and BNF for Children digital products were updated in line with the SPC to recommend weight-based dosing of intravenous vancomycin. The ‘doses at extremes of body-weight’ section erroneously included a recommendation about dosing based on ideal body-weight. Note that the manufacturer recommends that intravenous weight-based doses for all patients should be based on total [actual] body-weight.

BNF and BNF for Children digital products will be updated to reflect this recommendation in both BNF and BNF for Children in the next scheduled update in mid-August.

Clarification of the parenteral dose of quinine for the treatment of malaria in BNF and BNF for Children

The maintenance dosing recommendations for parenteral quinine for the treatment of malaria have been updated in the BNF and BNF for Children digital publications. The requirement to reduce the maintenance dose to 5–7 mg/kg if parenteral treatment is needed for more than 48 hours has been added to all parenteral dose statements.

These updated recommendations will be present in the June monthly update for all digital products of BNF and BNF for Children; these changes will also be reflected in the print editions for BNF 76 and BNF for Children 2018-2019.

June 2018 eNewsletter

The June newsletter contains the latest guidance and content updates to the BNF and BNFC. This month features the new BNF case studies, the live MedicinesComplete site and new monographs.

Previous eNewsletters can be found below:

June 2018

May 2018

April 2018

March 2018

February 2018

January 2018

December 2017

November 2017

October 2017

September 2017

August 2017

July 2017

June 2017

May 2017

April 2017

March 2017

February 2017

January 2017

Sign up to receive the BNF monthly eNewsletter

Clarification of dose of tramadol with paracetamol in BNF and BNF for Children

In light of a range of strengths now being available for combination tramadol-paracetamol preparations, the dose in BNF and BNF for Children has been updated in digital products.

The previous dose, expressed as tablets was not appropriate for the highest strength preparation (tramadol 75mg and paracetamol 650mg). The dosing has therefore been updated to express the dose in milligrams.

The new dosing has now been published in the tramadol with paracetamol monograph in digital versions of the BNF Publications.

Palliative care: tell us what you think

BNF Publications are always looking for ways to improve. Currently, we are particularly keen to understand what users think about the palliative care content within our publications.

With that in mind, below is a link to a short survey (approximately 10 minutes) that aims to help us understand how BNF Publications can further support palliative care practice. We thank you in advance for your participation.

BNF Palliative Care Survey

Correction of dose of Ironorm® Drops in BNF for Children

The dose of Ironorm® Drops for the treatment of iron deficiency anaemia has been updated in the BNF for Children digital products.

The dose incorrectly stated a maximum volume per dose of 8mL, instead of a maximum volume per day of 8mL.

The correct dose is as follows:

Iron-deficiency anaemia (therapeutic)

By mouth

Child 1 month–5 years
0.12–0.24 mL/kilogram daily in 2–3 divided doses; maximum 8 mL per day.

Child 6–11 years
0.12–0.24 mL/kilogram daily in 2–3 divided doses; maximum 8 mL per day.

Child 12–17 years
4 mL 1–2 times a day.

This updated dose will be present in the October monthly update for all digital products of BNF for Children.

Appointments to the BNF for Children’s Paediatric Formulary Committee

BNF Publications are pleased to announce the appointments of a Chair and Deputy Chair of the BNF for Children’s Paediatric Formulary Committee (PFC).

Dr David Tuthill has been appointed as the Chair of the BNF for Children’s PFC. David is a consultant general paediatrician at the Children’s Hospital for Wales and Llandough Hospital. His main clinical focus is children with allergic and general paediatric problems. He has been involved in work around medication and patient safety and also has expertise in quality improvement. He has been a member of the PFC since 2011. David is also a member of the Medicines Committee at the Royal College of Paedatrics and Child Health (RCPCH). He has been actively involved in development of the Medicines for Children website, a joint initiative between RCPCH, the Neonatal and Paediatric Pharmacists Group (NPPG) and Wellchild.

Neil Caldwell has been appointed as the Deputy Chair of the BNF for Children’s PFC. Neil is a consultant pharmacist for children’s services at Wirral University Teaching Hospital and honorary lecturer at Liverpool John Moores University and has been a member of the PFC since 2011. Neil is a lead reviewer of Medicines for Children leaflets and, since 2009, he has been member of the NPPG committee; he was also part of the NICE Guideline Development Group for Antibiotics for Early Onset Neonatal Infection from 2010­–2012. Neil was awarded a Faculty Fellow of Royal Pharmaceutical Society in 2014.

New BNF & BNFC App launches for UK NHS Professionals

A new BNF & BNFC App is available to download from App Store and Google Play.  Containing the latest content from both the BNF and BNF for Children (BNFC), the app provides access to practical, evidence-based medicines information whenever – and wherever – it is needed.

The App is aimed at prescribers, pharmacists, and other health and social care professionals working within the NHS in the UK who need accurate, up-to-date information about the use of medicines. It features the same content structure as the BNF print and web editions and has been purpose-built for iOS and Android platforms.

The App’s predictive searching is fast and intuitive, the BNF drug monographs make dosage and prescribing information immediately accessible, and the arrangement of information into sections on Drugs, Treatment summaries, Interactions, Medical devices, Borderline substances and Wound care makes it easy to navigate. The App includes a robust interactions checker that makes identifying potentially serious issues between combinations of drugs quick and simple.

The App lets users search and retrieve BNF content without a connection to the internet. Its clinical content is updated every month, so users can be sure they are basing their decisions on the latest information available.

BNF Director, Karen Baxter comments:

“The new BNF & BNFC App has been designed to be responsive, interactive and very easy to access, saving clinicians valuable time. We have had great initial feedback from our test group on its intuitive design and ease of use.  This new digital format adds to the range of ways health professionals can access BNF content and we are delighted to be able to share it with you.”

Commercial users of the BNF who wish to use the App should contact opsteam@rpharms.com to discuss licencing arrangements.

Prices in the BNF

Since launching the new BNF structure, we have had a number of queries about how the prices in current BNF Publications align with the prices in BNF legacy products.

Print

For branded preparations, prices are derived from the NHS Dictionary of Medicines and Devices (DM+D). This policy has not changed in the move to the new BNF structure.

Due to space constraints in print publications, we are not able to list all available generic preparations cited in the NHS Dictionary of Medicines and Devices (DM+D). Instead, we have editorial processes that allow us to create a preparation entry that is representative of all generic preparations, including a representative price. This price is based on the NHS indicative price for all related generics in DM+D. This policy has not changed in the move from the legacy BNF structure.

Digital

For branded preparations, the situation is the same described under Print, above.

In digital versions of the new BNF Publications there are no space constraints and so for generic preparations, prices for all available preparations are included. This has changed in the move to the new BNF structure – in the past, only a representative generic preparation was listed, as described under Print, above.

Drug tariff

BNF Publications based on the new structure also list the Drug Tariff price, where available.  This is an enhancement added to the new structure based on user feedback and is not included in BNF legacy products.

Updating

The new BNF Publications have been built to allow a more seamless updating of the price information and the price can more rapidly be updated than was possible with the legacy system, which required a laborious manual process.

Legacy versions are due for retirement and therefore there is minimal support for non-clinical content i.e. product information such as prices. We advise that the new BNF Publications should be used in preference to the legacy BNF Publications, but this is particularly true when considering price, where the content will be more up-to-date.

Update to nystatin dose in BNF and BNF for Children

The nystatin dose for oral candidiasis in the BNF has historically reflected the posology recommendations in the Nystan® Summary of Product Characteristics (SPC). Following discussions with the MHRA the dose has been updated (live in digital versions of the BNF from March 2017) and now reflects current posology recommendations for generic nystatin products.