BNF for Children September 2022- 2023

Published jointly by the British Medical Association, Royal Pharmaceutical Society, the Royal College of Paediatrics and Child Health, and the Neonatal and Paediatric Pharmacists Group

The BNF for Children is the first choice for concise medicines information for children. Trusted by healthcare professionals across the world to support confident decision-making at the point of care.

The new edition provides up-to-date guidance on prescribing, dispensing, and administering medicines to children, plus legal and professional guidelines.

Recommendations in the BNF for Children have been constructed on the basis of authoritative sources, emerging evidence, best practice guidelines and advice from a network of paediatric experts. The process is overseen by a paediatric formulary committee.

Extensive content updates in the BNF for Children 2022-2023 edition include:

New monographs for:

• Acarizax® [house dust mite extract] for house dust mite allergic rhinitis
• Adakveo® [crizanlizumab] for vaso-occlusive crises in sickle-cell disease
• Cibinqo® [abrocitinib] for atopic eczema
• Dificlir® [fidaxomicin] for Clostridioides difficile infection
• Evrysdi® [risdiplam] for 5q spinal muscular atrophy
• Fintepla® [fenfluramine] for adjunctive therapy of seizures associated with Dravet syndrome
• Givlaari® [givosiran] for acute hepatic porphyria
• Keytruda® [pembrolizumab] for classical Hodgkin lymphoma
• Koselugo® [selumetinib] for inoperable plexiform neurofibromas in patients with neurofibromatosis type 1
• Liraglutide for weight management or type 2 diabetes mellitus
• Orladeyo® [berotralstat] for hereditary angioedema
• Pradaxa® [dabigatran etexilate] for prophylaxis or treatment of venous thromboembolism
• Rinvoq® [upadacitinib] for atopic eczema
• Ruconest® [conestat alfa] for hereditary angioedema in patients with C1-esterase inhibitor deficiency
• Ryaltris® [mometasone furoate with olopatadine] for allergic rhinitis
• Taltz® [ixekizumab] for plaque psoriasis
• Ultomiris® [ravulizumab] for atypical haemolytic uraemic syndrome or paroxysmal nocturnal haemoglobinuria
• Xarelto® [rivaroxaban] for prophylaxis or treatment of venous thromboembolism
• Xeljanz® [tofacitinib] for polyarticular juvenile idiopathic arthritis or juvenile psoriatic arthritis
• Xevudy® [sotrovimab] for COVID-19
• Xofluza® [baloxavir marboxil] for post-exposure prophylaxis or treatment of influenza

MHRA advice on:

• Adrenaline/epinephrine auto-injectors: reminder for prescribers to support safe and effective use
• Amiodarone hydrochloride (Cordarone X®): reminder of risks of treatment and need for patient monitoring and supervision
• Atezolizumab (Tecentriq®) and other immune-stimulatory anti-cancer drugs: risk of severe cutaneous adverse reactions (SCARs)
• Chloral hydrate, cloral betaine (Welldorm®): restriction of paediatric indication
• Chloramphenicol eye drops containing borax or boric acid buffers: use in children younger than 2 years
• Chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions
• Hydroxychloroquine sulfate: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions
• Ivacaftor, tezacaftor, elexacaftor (Kaftrio®▼) in combination with ivacaftor (Kalydeco®): risk of serious liver injury; updated advice on liver function testing
• Levothyroxine sodium: new prescribing advice for patients who experience symptoms on switching between different levothyroxine products
• Metformin hydrochloride: study shows no safety concerns in pregnancy
• Oral retinoid medicines: temporary monitoring advice during COVID-19 pandemic
• Remdesivir: reporting to the UK COVID-19 Antivirals Pregnancy Registry
• Tofacitinib (Xeljanz®): new measures to minimise risk of major adverse cardiovascular events and malignancies
• Topical corticosteroids: information on the risk of topical steroid withdrawal reactions
• Yellow fever vaccine, live (Stamaril®): new pre-vaccination checklist

Other significant changes include updated guidance on:

• Aciclovir: important safety information added to highlight different approaches to calculating doses depending on the age of the child
• Management of acne
• Management of anaphylaxis
• Contraceptives, interactions
• COVID-19 updated guidance in-line with Public Health England/UK Health Security Agency recommendations, including reports of myocarditis and pericarditis with the Pfizer/BioNTech and Moderna vaccines and update to age range of Pfizer/BioNTech vaccine
• Diabetic hyperglycaemic emergencies
• Management of acute otitis media
• Emergency contraception
• Management of Clostridioides difficile infection
• Immunisation schedule updated guidance in-line with Public Health England/UK Health Security Agency recommendations, including Bacillus Calmette-Guérin, human papillomavirus, and influenza vaccines and immunisation of neonates
• Levetiracetam dosing added for convulsive status epilepticus in children
• Malaria prophylaxis in-line with Public Health England recommendations
• Miconazole oral gel no longer licensed for treatment of intestinal candidiasis
• Preventative migraine treatment
• Management of nausea and vomiting during pregnancy
• New guidance on management of neonatal bacterial infection
• Oral anticoagulants
• Paediatric Steroid Treatment Card to support early recognition and treatment of adrenal crisis in children with adrenal insufficiency [British Society for Paediatric Endocrinology and Diabetes]
• Chronic pain
• Phenobarbital oral solutions and advice from the RCPCH/NPPG
• Phosphate imbalance
• Potassium permanganate: inadvertent oral administration of potassium permanganate [National Patient Safety Alert advice]
• Prescribing in renal impairment
• Rabies vaccine and post-exposure management
• Remdesivir treatment duration
• Management of secondary bacterial infection of common skin conditions, including eczema
• Smoking cessation
• Tetanus vaccine and the use of immunoglobulin for tetanus infection and prophylaxis in-line with Public Health England recommendations
• Trientine dihydrochloride: name change to Trientine, and update to dosing for Wilson’s disease
• Recommended insulin regimens in type 1 diabetes
• Vitamin D

BNF for Children 2022-2023 is an essential publication, it provides you with:

• Up-to-date information on prescribing, dispensing, and administering medicines
• Authoritative, independent guidance on best practice enabling you to select safe and effective medicines
• Information you know you can trust for quality, reliability, and independence
• Everything you need at your fingertips, all in one book