Correction of valganciclovir information in BNFfor Children

The valganciclovir drug monograph in BNF for Children has incorrectly included the following equivalence statement since the monograph was added for the July 2018 monthly digital update and the print edition BNF for Children 2018-2019.

Dose equivalence and conversion
Oral valganciclovir 900 mg twice daily is equivalent to intravenous ganciclovir 5 mg/kg twice daily.

This statement applies to dosing in adults only.

It will be removed from digital versions of BNF for Children for the August 2021 monthly update and the forthcoming print edition BNF for Children 2021-2022.

Interactions for combination drugs: check interactions for the individual component drugs

On MedicinesComplete, the interactions checker is currently not displaying interactions for co-drugs (e.g. co-codamol, co-trimoxazole) correctly. The results state that there are no interaction results for co-drugs, when this is not the case. Users are reminded to always check the interactions of all individual components of co-drugs to get the complete clinical information.

This issue applies to the interactions checkers for BNF and BNF for Children and the Stockley’s Interactions Checker on MedicinesComplete. In BNF and BNF for Children on MedicinesComplete, when using the navigation panel to filter search results of co-drugs by Interactions, the same issue also occurs.

The interactions are displaying correctly when the interactions information is accessed directly via links from the Interactions section of the co-drug monographs in BNF and BNF for Children.

This issue only affects interactions content on MedicinesComplete.

Please contact editor@bnf.org with any questions.

Note: This issue is now resolved.

BNF hosts antimicrobial summary guidance on behalf of NICE and PHE

BNF Publications will now host the Summary of antimicrobial prescribing guidance – managing common infections on behalf of the National Institute for Health and Care Excellence (NICE) and Public Health England (PHE). The hosting on BNF.org is an interim measure, whilst a long-term solution for the governance and hosting is established.

The Summary is a rapid reference containing recommendations around antimicrobial prescribing from NICE and PHE. The Summary will be updated at least quarterly and is available as a PDF and Word Document (updated August 2021).

BNF Interactions

In 2017 the BNF interactions were rewritten to be more consistently structured, allowing users to find interactions more easily, and giving more information about the severity and evidence of an interaction. All interactions are listed under individual drugs. When checking interactions for combination drugs or co-drugs, it is essential to refer to each drug in the combination. The interactions section of the drug monograph clearly states the drugs (or drug classes) that need to be referred to in the interactions (Appendix 1 in print).

Co-trimoxazole

Please note that co-trimoxazole currently has its own entry in print that does not include the interactions for trimethoprim. As stated above, it is essential to refer to both drugs (trimethoprim and sulfamethoxazole, under sulfonamides) to find all relevant interactions for this drug. This inconsistency will be corrected in the upcoming September editions, BNF 78 and BNF for Children 2019-2020. Digital products including MedicinesComplete and the BNF app have been corrected for the June monthly update.

For information on how to use the BNF, see How to use BNF publications. For more information on how to use the interactions content, see Appendix 1 Interactions.

Important notice to users of the iOS and Android BNF and BNFC Apps

Please ensure that you update your BNF app before you access the content. A fix has been made to correct a technical error that was resulting in some content not appearing. Online web versions of the BNF are unaffected.

The correct version to run for the December 2018 monthly update is 2.1.8 (iOS) and 2.1.11 (Android).

Please note that all digital platforms are updated every month. For the most up-to-date content and functionality, please ensure that you are using the latest version.

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.

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.

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.

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.