GMC issues updated prescribing guidance
March 22, 2013 by admin
The General Medical Council has updated its prescribing guidance for doctors, in Good practice in prescribing and managing medicines and devices (2013).
Some of the information is relevant for non-medical prescribers:
- The guidance sets out the information sources that doctors should use to improve prescribing safety: the Medicines and Healthcare products Regulatory Agency’s (MHRA) Drug Safety Update; the the National Prescribing Centre, now part of NICE Medicines and Prescribing Centre and the electronic Medicines Compendium (eMC). It also sets out the sources of clinical guidelines that doctors should take account of. See here and here for ways in which medicines information is changing (Bill please add links to articles 3 and 4 for “here” and “here”)
- It includes the updated GMC stance on remote prescribing of Botox and other injectable cosmetic products. The Nursing and Midwifery Council (NMC) advice is here.
- A section on raising concerns, very interesting in the light of recent news saying, “You must protect patients from risks of harm posed by colleagues’ prescribing, administration and other medicines-related errors. You should question any decision or action that you consider might be unsafe. You should also respond constructively to concerns raised by colleagues, patients and carers about your own practice.”
- The section on unlicensed medicines says that some medicines are routinely used outside their licenses, and that in some situations, “it may not be practical or necessary to draw attention to the licence” - for example in emergencies or if realistically there is no alternative and the information is likely to be distressing. The NMC circular on nurse and midwife prescribing of unlicensed medicines from 2010 says that one of the conditions for prescribing is that, “The patient or client agrees to the prescription in the knowledge that the medicine is unlicensed and understands the implications of this.” The GMC points out two useful sources, if explaining about unlicensed medicines: the Medicines for Children leaflets including one on unlicensed medicines; and a British Pain Society leaflet on using medicines beyond their license.
- A section on sports medicine that deals with performance enhancement.
The NMC standards of proficiency for nurse and midwife prescribers were issued in 2006, with several circulars addressing prescribing issues and changes issued since.
Oral penicillin: children’s dosage recommendations
January 26, 2012 by admin
How many of the 5 million children in England who receive oral penicillins each year really need them, and what are the effective doses? It is time to replace the rule of thumb used for dosing with up-to-date evidence, according to a paper published on behalf of the improving Children’s Antibiotic Prescribing UK Research Network (iCAP).
The authors used a literature and formulary search to find out where the current, sometimes confusing, recommendations come from. It appears that, ‘a general recommendation to use age banding for all antibiotics in children, irrespective of the type of penicillin or disease indication, was published in the BMJ in 1963…Critically, these recommendations have remained unchallenged and unchanged to this day’.
Does a big child = half an adult? The BNF recommendations to halve doses between successive age bands for children have remained unchanged, for penicillin V, flucloxacillin and amoxicillin since they first appeared in it in the 1960s and 1970s. Adult penicillin doses have increased substantially but those for children have not. The mg/kg doses may also now be even lower than they were, because of an increase in average children’s weights. When the authors analysed the actual doses that would be received today, they found that at the older age/weight ranges, the doses are ’strikingly low’. Many of the older children’s medicines do have a limited evidence base, but these authors were surprised at how little recent evidence supports the current recommendations.
They warn of the risks of low dosing - for antimicrobial resistance, severe complications and need for retreatment, and conclude that work is needed to determine the effective doses for children of all weights and ages, and also to, ‘establish more clearly which children really need antibiotics in the era of pneumococcal conjugate (PCV 13), Haemophilus influenzae B, and meningitis C vaccines’.
Ahmed U et al. Dosing of oral penicillins in children: is big child=half an adult, small child=half a big child, baby=half a small child still the best we can do? BMJ 2011;343:d7803
http://dx.doi.org/10.1136/bmj.d7803
More specific dosages introduced for children’s paracetamol
June 29, 2011 by admin
The Medicines and Healthcare products Regulatory Agency (MHRA) has announced new dosing advice for children’s medicines containing paracetamol that:
- replaces the current three age bands with seven: 3-6 months, 6-24 months, 2-4 years, 4-6 years, 6-8 years, 8-10 years and 10-12 years.
- defines a single dose for each age band.
Products should carry these instructions by the end of the year. See here for details.
Paracetamol prescribing in children
June 8, 2011 by admin
There are ‘relatively high levels of potential overdosing in the youngest children and potential underdosing in the oldest children’ in paracetamol prescribing in primary care, according to the conclusions of this study. It analysed a year’s data about paracetamol prescriptions in children aged 0-12 in general practices in Scotland.
About one-fifth of the paracetamol prescriptions were defined as off-label - being outside the BNF for Children age and dose recommendations - with incorrect doses being the most common reason. In addition, another 15% of prescriptions did not have dosage instructions.
The risk of over-dosing in young children carries a risk of toxicity, particularly as parents and carers often use paracetamol for children before they seek professional advice. For older children receiving doses that are too low, there is a risk of treatment failure and prescribing not being cost-effective.
Kazouini A et al. Paracetamol prescribing in primary care: too little and too much? Br J Clin Phamacol 2011; in press.
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