BNF for Children 2011-2012

BNFC 2011–2012A brief description of the clinical uses of a drug canusually be found in the Indication and Dose section of itsmonograph (e.g. ibuprofen, p. 503); a cross-reference isprovided to any indications for that drug that are coveredin other sections of BNFC.The symbol U is used to denote preparations that areconsidered by the Joint Formulary Committee to be lesssuitable for prescribing. Although such preparationsmay not be considered as drugs of first choice, theiruse may be justifiable in certain circumstances.Drug management of medicalemergenciesGuidance on the drug management of medical emergenciescan be found in the relevant BNFC chapters (e.g.treatment of anaphylaxis is included in section 3.4.3). Asummary of drug doses used for Medical Emergenciesin the Community can be found in the glossy pages atthe back of BNFC. Algorithms for Newborn, PaediatricBasic, and Paediatric Advanced Life Support can also befound within these pages.Minimising harm in children with comorbiditiesThe drug chosen to treat a particular condition shouldhave minimal detrimental effects on the child’s otherdiseases and minimise the child’s susceptibility toadverse effects. To achieve this, the Cautions, Contraindications,and Side-effects of the relevant drug shouldbe reviewed, and can usually be found in the drugmonograph. However, if a class of drugs (e.g. tetracyclines,p. 274) share the same cautions, contra-indications,and side-effects, these are amalgamated in theprescribing notes while those unique to a particular drugin that class are included in its individual drug monograph.Occasionally, the cautions, contra-indications,and side-effects may be included within a preparationrecord if they are specific to that preparation or if thepreparation is not accompanied by a monograph.The information under Cautions can be used to assessthe risks of using a drug in a child who has co-morbiditiesthat are also included in the Cautions for thatdrug—if a safer alternative cannot be found, the drugmay be prescribed while monitoring the child foradverse-effects or deterioration in the co-morbidity.Contra-indications are far more restrictive than Cautionsand mean that the drug should be avoided in achild with a condition that is contra-indicated.The impact that potential side-effects may have on achild’s quality of life should also be assessed. Forinstance, in a child who has constipation, it may bepreferable to avoid a drug that frequently causes constipation.The prescribing notes in BNFC may highlightimportant safety concerns and differences betweendrugs in their ability to cause certain side-effects.xiiiPrescribing for children with hepatic orrenal impairmentDrug selection should aim to minimise the potential fordrug accumulation, adverse drug reactions, and exacerbationof pre-existing hepatic or renal disease. If it isnecessary to prescribe drugs whose effect is altered byhepatic or renal disease, appropriate drug dose adjustmentsshould be made, and the child should be monitoredadequately. The general principles for prescribingare outlined under Prescribing in Hepatic Impairment(p. 14) and Prescribing in Renal Impairment (p. 14).Information about drugs that should be avoided orused with caution in hepatic disease or renal impairmentcan be found in drug monographs under HepaticImpairment and Renal Impairment (e.g. fluconazole,p. 301). However, if a class of drugs (e.g. tetracyclines,p. 274) share the same recommendations for use inhepatic disease or renal impairment, this advice ispresented in the prescribing notes under HepaticImpairment and Renal Impairment and any advicethat is unique to a particular drug in that class isincluded in its individual drug monograph.Prescribing for patients who arepregnant or breast-feedingDrug selection should aim to minimise harm to thefetus, nursing infant, and mother. The infant should bemonitored for potential side-effects of drugs used by themother during pregnancy or breast-feeding. The generalprinciples for prescribing are outlined under Prescribingin Pregnancy (p. 16) and Prescribing in Breast-feeding(p. 16). The prescribing notes in BNFC chapters provideguidance on the drug treatment of common conditionsthat can occur during pregnancy and breast-feeding (e.g.asthma, p. 133). Information about the use of specificdrugs during pregnancy and breast-feeding can befound in their drug monographs under Pregnancy andBreast-feeding (e.g. fluconazole, p. 301). However, if aclass of drugs (e.g. tetracyclines, p. 274) share the samerecommendations for use during pregnancy or breastfeeding,this advice is amalgamated in the prescribingnotes under Pregnancy and Breast-feeding while anyadvice that is unique to a particular drug in that class isincluded in its individual drug monograph.Minimising drug interactionsDrug selection should aim to minimise drug interactions.If it is necessary to prescribe a potentially seriouscombination of drugs, children should be monitoredappropriately. The mechanisms underlying drug interactionsare explained in Appendix 1 (p. 655).Details of drug interactions can be found in Appendix 1of BNFC (p. 656). Drugs and their interactions are listedin alphabetical order of the non-proprietary drug name,and cross-references to drug classes are provided whereappropriate. Each drug or drug class is listed twice: inthe alphabetical list and also against the drug or classwith which it interacts. The symbol . is placed againstinteractions that are potentially serious and where combinedadministration of drugs should be avoided (oronly undertaken with caution and appropriate monitoring).Interactions that have no symbol do not usuallyhave serious consequences.If a drug or drug class has interactions, a cross referenceto where these can be found in Appendix 1 is providedunder the Cautions of the drug monograph or prescribingnotes.