RxPG - What is New in BNF 50 (September 2005)?

The BNF is a joint publication of the British Medical Association and the Royal Pharmaceutical Society of Great Britain. It is published biannually under the authority of a Joint Formulary Committee which comprises representatives of the two professional bodies and of the UK Health Departments. The current edition must always be used for making clinical decisions. The more important changes for this edition are listed under Significant changes. For doctors wishing to practise in UK (PLAB Exam Takers) or already working in UK, the knowledge of the updates of BNF is absolutely essential.

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Malaria prophylaxis for southern Africa
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In line with the Health Protection Agency's advice, the BNF no longer recommends prophylaxis with chloroquine plus proguanil for parts of Botswana, Namibia and Zimbabwe (BNF section 5.4.1). Travellers are now advised to use the same regimen as that for the rest of sub-Saharan Africa where the risk of malaria transmission is intense and high-level chloroquine resistance very prevalent. Appropriate prophylactic antimalarials for these areas are mefloquine, or doxycycline, or the combination of atovaquone with proguanil. The BNF works closely with the Health Protection Agency's Advisory Committee on Malaria Prevention to provide up-to-date advice. Expert members of the Committee also advise the BNF on the treatment of malaria in returning travellers.

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Tricyclic antidepressants
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Following reports of fatalities from overdose of certain tricyclic antidepressants, the BNF has further emphasised the dangers of using particular antidepressants for the management of depression (BNF section 4.3.1). Readers are advised that limited quantities of tricyclic antidepressants should be prescribed at any one time because their cardiovascular effects are dangerous in overdosage. An overview of the management of antidepressant poisoning is presented in the BNF section on emergency treatment of poisoning.

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Advice on vaccination
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Changes to the BCG vaccination programme announced by the Chief Medical Officer (PL/CMO/2005/3) are reflected in BNF 50. The new programme is better targeted and no longer requires routine vaccination of all children; vaccination is required only for individuals at highest risk (because of local prevalence or prevalence in the region of their origin). The Heaf test for determining tuberculin reactivity is being phased out and is being replaced by the Mantoux test. The advice on rabies vaccination has been completely revised. More detail is now provided on post-exposure prophylaxis of rabies.
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The BNF aims to provide prescribers, pharmacists and other healthcare professionals with sound up-to-date information about the use of medicines.

The BNF provides ready access to key information on the selection, prescribing, dispensing and administration of medicines. Medicines that are generally prescribed in the UK are covered and those considered less suitable for prescribing are clearly identified. Little or no information is included on medicines promoted for purchase by the public.

Information about drugs is drawn from the manufacturers' product literature, medical and pharmaceutical literature, regulatory and professional authorities, and data used for pricing prescriptions. Advice is constructed from clinical literature and reflects, as far as possible, an evaluation of the evidence from diverse sources. The advice also takes account of authoritative national guidelines and emerging safety concerns. In addition, the Joint Formulary Committee receives expert clinical advice on all therapeutic areas in tune with current best evidence; this ensures that the BNF's recommendations are relevant to practice. Many individuals and organisations contribute towards the preparation of each edition of the BNF.

The BNF is designed as a digest for rapid reference and it may not always include all the information necessary for prescribing and dispensing. Also, less detail is given on areas such as obstetrics, malignant disease, and anaesthesia since it is expected that those undertaking treatment will have specialist knowledge and access to specialist literature. The BNF should be interpreted in light of professional knowledge and supplemented as necessary by specialised publications and by reference to the product literature. Information is also available from medicines information services.