Guidelines endorsed by RCPCH - Pharmacology

The College reviews high quality guidelines and standards produced and published by other organisations against the RCPCH Standards for Endorsement. We believe the following publications will be of interest to paediatricians working in pharmacology.

The following have been endorsed and supported by the College.

Endorsed guidelines

Antibiotics for neonatal infection (NICE)

Neonatal infection is a significant cause of mortality and morbidity in newborn babies, and may be early-onset or late-onset. Neonatal infection can lead to life-threatening sepsis and accounts for 10% of all neonatal mortality. 
 
This quality standard covers the use of antibiotics to prevent and treat infection in newborn babies from birth to 28 days in both primary and secondary care. This standard includes antibiotics given to newborn babies, or mothers, during intrapartum care in order to prevent neonatal infection (antibiotic prophylaxis).
 
This quality standard is expected to contribute to improvements in the following outcomes:
  • infant mortality
  • admissions and readmissions to neonatal care units
  • maternity and neonatal length of hospital stay
  • neonatal neurological and auditory development
Date of Publication: December 2014
Endorsed on: May 2015
 
Full quality standard (PDF, 236KB, 43 Pages)
 

Antibiotics for Early Onset of Neonatal Infection (NICE NCC-WCH)

This clinical guideline offers evidence-based advice on the use of antibiotics to prevent and treat early-onset neonatal infection (infection with onset within 72 hours of birth). It includes a review of the risk factors for infection, clinical indicators of possible infections and investigation before starting antibiotics. The guideline covers recommendations about choice of antibiotics, duration of course and therapeutic monitoring.  
 
This guideline is particularly relevant to healthcare professionals who work within the acute and primary healthcare sectors who have direct contact with postnatal women and their babies, those responsible for commissioning and planning healthcare services, public health and trust managers and women who have recently given birth, their partners, families and other carers.
 
RCPCH Notes:
 
This national clinical guidance is very welcomed. The guideline presents recommendations for practice within the limit of current evidence. Much of the guideline is consistent with current practice and many elements of good practice are highlighted. However, There is a lack of evidence for some of the recommendations which have therefore been reached by consensus expert opinion.
 
Date of Publication: August 2012
Date of Endorsement: August 2012 (badged September 2014)
 
Full Guideline (PDF, 172KB, 39 Pages)
 

Antimicrobial stewardship (NICE)

This quality standard covers the effective use of antimicrobials (antibacterial, antiviral, antifungal and antiparasitic medicines) to reduce the emergence of antimicrobial resistance (loss of effectiveness of antimicrobials).

It covers all settings, all formulations of antimicrobials (oral, parenteral and topical agents) and is for health and social care practitioners, organisations that commission, provide or support the provision of care, as well as people using antimicrobials and their carers.

RCPCH notes:

The College endorses the quality standards and notes that the document would have benefitted from specifying the route of administration and by adding a reminder that sometimes more than one microbiological sample (or none) might be need to be collected. The option of offering back-up (delayed) prescribing in Primary care would have been preferred to be suggested as a last resort and only in situations where the doctor has a clear opinion as to a likely bacterial cause of an illness that may not be self-limiting.

Date of Publication: April 2016 
Endorsed on: August 2016

Full Quality Standard (PDF, 177KB, 39 Pages)
 

Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use (NICE)

Awareness of antimicrobial resistance is important in ensuring the antimicrobial medicines are used when needed but that use is reduced without an increase in harm when use is not indicated. Resistance to all antimicrobials is increasing and, combined with a lack of new medicines, there is an increasing risk in the future that infections may not be able to be treated.
 
There have been several initiatives and guidance published to attempt to tackle the growing concern of appropriate use of antimicrobials and antimicrobial resistance; however, prescribing is still variable. 
 
This medicines practice guideline is needed to consider the evidence for effective interventions, in particular for changing prescriber and patient behaviour when using antimicrobials and for minimising antimicrobial resistance. 
 
Date of Publication: August 2015
Endorsed on: September 2015

NICE guideline (PDF, 197KB, 50 Pages) 
 

Atopic eczema in children (NICE)

The guideline covers the assessment, diagnosis and management of atopic eczema in children from birth until 12 years and provides information and education for children, parents and their carers. It is particularly relevant to all healthcare professionals who are involved in the care of children who have atopic eczema, those responsible for commissioning and planning healthcare services, and children with atopic eczema and their families.

The guideline is accompanied by a quick reference guide, information for parents/carers, slides highlighting the key messages, costing tools and implementation advice. It includes audit criteria and key priorities for implementation.

Date of Publication: December 2007
Date of Endorsement: April 2008

Full guideline (PDF, 2.37MB, 220 Pages)
NICE guideline (PDF, 190KB, 39 Pages)
 

Autism spectrum disorders in children and young people: recognition, referral and diagnosis (NICE)

This guideline covers the recognition, referral and diagnosis of autism in children and young people from birth up to 19 years. It emphasises the need for coordination between health agencies and other key services.

RCPCH comment:

We note that some of the service descriptions may have implications for trainees. NICE states that "the GDG acknowledge that it is important to consider the different ways in which these services operate, and how trainees are supported and supervised. The descriptions are not meant as specific blue prints for how services should operate."

Date of publication: September 2011
Date of endorsement: September 2011

NICE guideline (PDF, 262KB, 57 Pages) 
 

Borderline personality disorder (NICE)

This guideline covers the treatment and management of borderline personality disorder in adults and young people (less than 18 years) who meet the criteria for the diagnosis. It includes some specific recommendations for Child and Adolescent Mental Health (CAMH) professionals.

The guideline includes a quick reference guide, costing report, audit criteria, slide set and a service user/carer information leaflet.

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • The guideline development group did not include a paediatrician; however, children were not recognised to be a significant proportion of the target population.

Date of Publication: January 2009
Date of Endorsement: April 2009

Full guideline (PDF, 2.93MB, 495 Pages)
NICE guideline (PDF, 270KB, 41 Pages)
 

Diabetes in children and young people (NICE)

Diabetes is a long-term condition that can have a major impact on the life of a child or young person, as well as their family or carers. In addition to insulin therapy, diabetes management should include education, support and access to psychological services. Preparations should also be made for the transition from paediatric to adult services, which have a different model of care and evidence base.

This quality standard covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18. It is expected to contribute to improvements in the following outcomes:

  • prompt diagnosis of type 1 diabetes
  • glycaemic control: blood glucose and HbA1c levels
  • diabetes complications
  • quality of life
  • patient, parent and carer satisfaction
  • life expectancy

RCPCH notes: 

The RCPCH asks its members to note that the quality standards does not provide information on children and carers with marked anxiety about nocturnal hypoglycaemia, or young children who are unable to communicate their symptoms of hypoglycaemia, and screening for emotional health and wellbeing.

Date of Publication: July 2016
Endorsed on: August 2016

Full Quality Standard (PDF, 194KB, 40 Pages) 
 

Drug allergy - diagnosis and management (NICE)

This quality standard covers the diagnosis and management of drug allergy in adults, young people and children.
 
Diagnosing drug allergy can be challenging and there is considerable variation in management and in access to specialist drug allergy services. This can lead to under diagnosis, misdiagnosis and self-diagnosis. This variation may be caused by a lack of local drug allergy centres or awareness of available services. Some people are never offered a referral to specialist services and stay in primary care. Others have their drug allergy managed in other disciplines. Only a small proportion of people are treated in specialist allergy centres.
 
The quality standard is expected to contribute to improvements in the following outcomes:
  • patient experience of care
  • patient safety incidents reported
  • mortality from causes considered preventable
  • patient exposure to unnecessary broad-spectrum antibiotics
  • antibiotic prescribing and antimicrobial resistance rates.
Date of Publication: July 2015
Endorsed on: September 2015
 
Full Quality Standard (PDF, 206KB, 40 Pages)
 

Drug misuse - opioid detoxification (NICE)

The aim of this guideline is to evaluate the role of opioid detoxification in adults and young people who misuse drugs and to integrate these findings to provide advice regarding care of these individuals and implementation of these recommendations. It is intended to be used by all health professionals who have contact with and make decisions regarding the treatment and care of adults and young people who misuse drugs.

The guideline is accompanied by costing tools, a quick reference guide and presenter slides on implementation and includes audit standards.

Date of Publication: July 2007
Date of Endorsement: February 2008

Full guideline (PDF, 846KB, 185 Pages)
NICE guideline (PDF, 244KB, 36 Pages)
 

Familial hypercholesterolemia (NICE)

This guideline covers the diagnosis, identification strategies, drug, specific and general treatments and assessment and monitoring of familial hypercholesterolemia (FH) in individuals with possible or definite FH. It is particularly relevant to those who work in the primary, secondary and tertiary care dealing with case identification, diagnostic testing and the management of heterozygous FH in adults and children and homozygous FH in all age groups.

The guideline is accompanied by a quick reference guide, costing tools, and slides highlighting the key messages and includes key priorities for implementation and audit criteria.

Date of Publication: August 2008
Date of Endorsement: February 2009

Full guideline (PDF, 1.24MB, 244 Pages)
NICE guideline (PDF, 746KB, 48 Pages)
 

Medicines adherence (NICE)

This guideline covers the process of involving patients in decisions about medicines and on supporting patients in their adherence to medicine. It is focused on adults over 16 years of age but the recommendations may be considered for a child or young person who is deemed able to make a decision regarding their prescription.

The guideline is accompanied by a quick reference guide, information for patients, a costing statement and a slide set.

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • This guideline should be considered in the context of other work addressing medicines adherence in children.

Date of Publication: January 2009
Date of Endorsement: April 2009

Full guideline (PDF, 1.26MB, 364 Pages)
NICE guideline (PDF, 204KB, 30 Pages)
 

Post-traumatic stress disorder (NICE)

The guideline covers adult and children aged 2 to 18 years who meet, or are at risk of meeting, criteria for post-traumatic stress disorder (PTSD) and covers care provided by primary, secondary, and other healthcare professionals who have contact with PTSD sufferers. Recommendations are made on psychological and pharmacological interventions, the role of early interventions, and issues with diagnosis and screening.

The guideline is accompanied by a costing report and template, a slide set, and a commissioning guide. It includes key recommendations for implementation.

Date of Publication: March 2005
Date of Endorsement: October 2005

Full guideline (PDF 248KB, 176 Pages)
NICE guideline (PDF, 147KB, 41 Pages)
 

Prophylaxis against infective endocarditis (NICE)

This guideline covers the use of antimicrobial prophylaxis against infective endocarditis before an interventional procedure for adults and children. It is particularly relevant for healthcare professionals who have direct contact with patients within primary health and dental care, secondary care and community settings. The target population is adults and children with known underlying structural cardiac defects, including those who have previously had infective endocarditis.

The guideline is accompanied by a quick reference guide, information for patients/parents/carers, slides highlighting the key messages, costing tools and an online educational tool. It includes audit criteria and key priorities for implementation.

Date of Publication: March 2008
Date of Endorsement: May 2008

Full guideline (PDF, 561KB, 107 Pages)
Quick reference guide (PDF, 52KB, 2 Pages)
College response to guideline (PDF, 44KB, 1 Page)
 

Psychosis with coexisting substance misuse: assessment and management in adults and young people (NICE)

This guidance offers best practice advice on the assessment and management of adults and young people (aged 14 years and older) with psychosis and coexisting substance misuse.  Recommendations include: recognition of psychosis with coexisting substance misuse in adults and young people as well as specific issues for young people.  

RCPCH notes: The complex yet important issue of transition has not been covered in as much depth as warranted as it is unfortunately outside of the scope proposed by NICE. NICE state that transition should be planned and managed according to the best practice guidance described in ‘Transition: getting it right for young people’ (available from http://www.dh.gov.uk/).

Date of Publication: March 2011
Date of Endorsement: November 2011

NICE guideline (PDF, 1.5MB, 43 Pages)
 

Sedation in children and young people (NICE)

This guideline covers the sedation of infants, children and young people up to the age of 19 years for diagnostic and therapeutic procedures.

The guideline is accompanied by a quick reference guide, audit support, a costing report, a baseline assessment tool and a slide set.

The RCPCH welcomes the publication of this guideline but asks Members to note the following:

  • The guideline recommends that referral to a mental health specialist should be considered for all children who are severely anxious or who have a learning disability undergoing an elective procedure. The College notes that this may significantly increase the waiting times for procedures, given the existing pressures upon mental health services.

Date of Publication: November 2010
Date of Endorsement: January 2011

Full guideline (PDF, 3.67MB, 385 Pages)
NICE guideline (PDF, 2.4MB, 30 Pages)
Quick Reference Guide (PDF, 1.7MB, 16 Pages)
 

Tuberculosis: Pevention, diagnosis, management and service organisation (NICE) 

TB is a curable disease caused by a bacterium called Mycobacterium tuberculosis (‘M. tuberculosis’ or ‘M.Tb’), or other bacterium in the M. tuberculosis complex (that is, M. bovis or M. africanum). It is spread by one person inhaling the bacterium in droplets coughed out by someone with infectious tuberculosis. Not all forms of tuberculosis are infectious. 
 
Those with TB in organs other than the lungs are not infectious to others, nor are people with just latent tuberculosis. Some people with pulmonary tuberculosis are infectious, particularly those with bacteria which can be seen on simple microscope examination of the sputum, who are termed ‘smear positive’. The risk is greatest in those with prolonged, close household exposure to a person with infectious TB.
 
This guideline makes recommendations on the prevention, diagnosis and management of latent and active tuberculosis (TB), including both drug susceptible and drug resistant forms of the disease. It covers the organisation of relevant TB services. It relates to activities undertaken in any setting in which NHS or public health services for TB are received, provided or commissioned in the public, private and voluntary sectors.
 
Date of Publication: January 2016
Endorsed on: March 2016
 
Full Clinical Guideline (PDF, 4,849KB, 551 Pages) 
NICE Clinical Guideline (PDF, 575, 177 Pages)
 

Supported guidelines

Guidelines for the management of children referred for dental extractions under general anaeshesia (APABGI)

The guidelines are designed to provide evidence-based information on the management of children and young people who are referred for dental extractions under general anaesthesia.

Date of Publication: September 2011
Date of College Support: September 2011

Full guideline (PDF, 570KB, 52 pages)
Executive summary (PDF, 282KB, 12 pages)
 

Good practice in postoperative and procedural pain management (APA)

It is intended that this guideline will be used by practitioners involved in the acute care of children undergoing pain management after surgery or for painful medical procedures. The guideline is designed to provide evidence-based information on the efficacy of analgesic strategies such that an informed choice of analgesics that are appropriate for the patient and clinical setting can be made.

The document includes advice on the assessment of pain and a summary of current evidence for the efficacy of analgesic strategies, including evidence-based recommendations which have been graded using the SIGN criteria and grouped according to named procedures. It is an update of the guideline published in 2008.

Date of Publication: July 2012
Date of College Support: July 2012

Full guideline (PDF, 732KB, 79 Pages)