Chronic diarrhoea in children >12years without any respiratory issues

see attached

• Association of Paediatric Palliative Medicine Fomulary

See attached

• Paediatric Acute Sickle Cell Pain Pathway-Approved 2018.pdf

See attached

• Paediatric Pain Guidelines February 2018 Trust template.doc

• NEONATAL FORMULARY VERSION 9 2016 BARTS HEALTH_Dec 2016.pdf

For chronic diarrhoea, irritable bowel where diarrhoea is predominant, and Short Bowel Syndrome

see attached

• Association of Paediatric Palliative Medicine Formulary

• Orlistat Use in Childhood Obesity June 2015.doc

4th line treatment for paediatric ulcerative colitis (see attached algorithm below)

IV infusion loading dose 6mg/kg (max dose 300mg) at week 0, 2 and 6 then maintenance every 8 weeks.

Blueteq form required for post-pubescent patients - check paediatric gastroenterology pharmacist is aware of all new patients starting treatment.

• PAEDIATRIC ULCERATIVE COLITIS ALGORITHM FOR VEDOLIZUMAB.doc

Post-pubescent patients only - Blueteq form required. Dosing as for ulcerative colitis.

Acute Crohn's disease in combination with Methotrexate or Azathioprine
 

https://pathways.nice.org.uk/pathways/crohns-disease

see attached

• Azathioprine 50mg in 5ml Liquid_BartsHealth.doc

CYTOTOXIC- tablets should not be broken, crushed or dissolved

Unresponsive or chronically active Crohn's disease

Severe Ulcerative Colitis/ Crohn's disease incombination with steroids

Alternative to aminosalicylates-for resistant or frequently relapsing cases of Ulcerative Colitis/Crohn's disease

Alternative to metronidazole/Ciprofloxacin for fistulating Crohn's disease
 

https://pathways.nice.org.uk/pathways/crohns-disease

https://pathways.nice.org.uk/pathways/ulcerative-colitis

http://publications.nice.org.uk/ulcerative-colitis-cg166

Use budesonide nebuliser solution according to guidelines attached.

• Budesonide Oral Viscous - For Eosinophilic Oesophagitis.doc

For Hospital Use Only

Ciclosporin - last line for Ulcerative Colitis not responsive to aminosalicylates & corticosteroids

Use Sandimmun brand for acute Ulcerative Colitis

Use Neoral brand for maintenance Ulcerative Colitis
 

https://pathways.nice.org.uk/pathways/ulcerative-colitis

Alternative to prednisolone for severe Inflammatory Bowel Disease OR disease not responding to oral corticosteroid

Acute treatment of Ulcerative Colitis and Crohn's disease and for maintenance in 'nil-by mouth' patients on prednisolone

https://pathways.nice.org.uk/pathways/ulcerative-colitis 

https://pathways.nice.org.uk/pathways/crohns-disease

see attached

• Guideline for the Prescribing and Administration of Infliximab in Paediatric IBD Patients.pdf

see attached

• Guideline for the Prescribing and Administration of Infliximab in Paediatric IBD Patients.pdf

Severe active Ulcerative Colitis/Crohn's disease

Maintenance of Ulcerative Colitis/Crohn's disease in patients that respond to the initial induction course

Last line for fistulating Crohn's disease refractory to conventional treatment

http://publications.nice.org.uk/ulcerative-colitis-cg166
http://publications.nice.org.uk/crohns-disease-cg152

CYTOTOXIC- tablets should not be broken, crushed or dissolved

Unresponsive or chronically active Crohn's disease

Alternative to aminosalicylates-for resistant or frequently relapsing cases of Ulcerative Colitis/Crohn's disease

Second line if Azathioprine not tolerated

Alternative to metronidazole/Ciprofloxacin for fistulating Crohn's disease

• Drugs used in Paediatric IBD 2014.doc

*Specify preparation by brand name*
 Use most cost-effective brand for initiation of treatment (currently Salofalk)

used for chronic bowel disorders (Ulcerative Colitis/ Crohn's disease
 
https://pathways.nice.org.uk/pathways/ulcerative-colitis

https://pathways.nice.org.uk/pathways/crohns-disease

Hospital Use Only

see attached

• TDM Monitoring Values - Paed Rheumatology.doc

see attached

• Methotrexate Blood Monitoring schedule.doc

*ONCE WEEKLY dosing*

Unresponsive or chronically active Crohn's disease

Last line for Crohn's disease when azathioprine and mercaptopurine are ineffective
 

https://pathways.nice.org.uk/pathways/crohns-disease

see attached

• Microsoft Word - BLT Non-CF Bronchiectasis Prescribing Pathway June 2012 Version 1.1.pdf
• CF Prescribing Pathway Final Version 5 Dec 2015.doc

First line for Inflammatory Bowel Disease in conjunction with oral aminosalicylate for refractory or moderate disease

NOT for use as maintenance therapy unless weaning off or waiting for azathioprine to work, or for auto-immune hepatitis

Chronic bowel disorders (Ulcerative Colitis/ Crohn's disease)
 

https://pathways.nice.org.uk/pathways/ulcerative-colitis

https://pathways.nice.org.uk/pathways/crohns-disease

Non-formulary (except long term patients with compliance issues)

Chronic bowel disorders (Ulcerative Colitis/ Crohn's disease)

 https://pathways.nice.org.uk/pathways/ulcerative-colitis

https://pathways.nice.org.uk/pathways/crohns-disease

4^th line treatment (see attached algorithm below)

IV infusion loading dose 6mg/kg at week 0, followed by 8 weekly subcutaneous injection 45 mg (≤ 45kg) or 90 mg (>45kg) – weight dependent

DTC DEC 2021

Approval recevied to increase dosing frequency-  schedule to 6 weekly for 1 patient/year and 4 weekly for 1 patient every 2 years

• PAEDIATRIC CROHNS DISEASE ALGORITHM FOR USTEKINUMAB.doc

The licence has been extened for ustekinumab in children aged 6 years and over for paediatric plaque psoriasis, application of the Commissioning Medicines for Children policy also enables access to children aged 6 years and over with Crohn’s disease.

• Clinical commissioning policy

• SSC2668 NHS England Clinical Commissioning Policy Ustekinumab for refractory Crohns disease in pre-pubescent children .pdf

• Constipation guidelines.doc

• Bisacodyl rectal 2.74mg per ml_BartsHealth.doc

see attached

• Association of Paediatric Palliative Medicine Formulary

https://www.nice.org.uk/guidance/cg99

• Paed Onc Local Guidelines July 14.pdf

• Constipation guidelines.doc

see attached

• Association of Paediatric Palliative Medicine Formulary

https://www.nice.org.uk/guidance/cg99

BH Bowel Cleansing guidelines

• Guideline for the use of Klean-Prep.doc
• Guidelines for the use of ACE Stomas Enema Solutions in Paediatrics.doc

Bowel Cleansing

see attached

• Association of Paediatric Palliative Medicine Formulary

• Constipation guidelines.doc

• Bisacodyl rectal 2.74mg per ml_BartsHealth.doc

see attached

• Association of Paediatric Palliative Medicine Formulary

https://www.nice.org.uk/guidance/cg99

• Paed Onc Local Guidelines July 14.pdf

• Constipation guidelines.doc

see attached

• Association of Paediatric Palliative Medicine Formulary

https://www.nice.org.uk/guidance/cg99

see attached

• Association of Paediatric Palliative Medicine Formulary

https://www.nice.org.uk/guidance/cg99

Irritable Bowel Syndrome if increased dietary fibre is required

• Paed Onc Local Guidelines July 14.pdf

• Constipation guidelines.doc

• Microsoft Word - BLT Non-CF Bronchiectasis Prescribing Pathway June 2012 Version 1.1.pdf
• CF Prescribing Pathway Final Version 5 Dec 2015.doc

see attached

• Association of Paediatric Palliative Medicine Formulary

https://www.nice.org.uk/guidance/cg99
 
Avoid in Irritable Bowel Syndrome due to bloating

• Paed Onc Local Guidelines July 14.pdf

• Constipation guidelines.doc

see link

• Association of Paediatric Palliative Medicine Formulary

https://www.nice.org.uk/guidance/cg99

• Paed Onc Local Guidelines July 14.pdf

• Constipation guidelines.doc

see attached

• Paed Onc Local Guidelines July 14.pdf

see attached

• Association of Paediatric Palliative Medicine Fomulary

https://www.nice.org.uk/guidance/cg99

Hyoscine butylbromide oral doses commonly used at Barts Health:
5-10years - 5mg 3-4 times a day
>10years - 10mg 3-4 times a day

see attached

• Association of Paediatric Palliative Medicine Formulary

Diarrhoea resulting from the loss of bile-salt absorption

• NEONATAL FORMULARY VERSION 9 2016 BARTS HEALTH_Dec 2016.pdf

• CF Prescribing Pathway Final Version 5 Dec 2015.doc

Short Bowel Syndrome

Intestinal failure liver disease

• Paed Onc Local Guidelines July 14.pdf

• Constipation guidelines.doc

• Microsoft Word - BLT Non-CF Bronchiectasis Prescribing Pathway June 2012 Version 1.1.pdf
• CF Prescribing Pathway Final Version 5 Dec 2015.doc

see attached

• Association of Paediatric Palliative Medicine Formulary

https://www.nice.org.uk/guidance/cg99
 
Avoid in Irritable Bowel Syndrome due to bloating

On formulary:
- Glypressin injection 1mg

Injection Formulation is Hospital Use Only

For primary care only

• CF Prescribing Pathway Final Version 5 Dec 2015.doc

• Microsoft Word - BLT Non-CF Bronchiectasis Prescribing Pathway June 2012 Version 1.1.pdf
• CF Prescribing Pathway Final Version 5 Dec 2015.doc

• Oral Proton Pump Inhibitors - Guidelines for Paediatrics May2016.pdf
• Difficult to obtain letter_Omeprazole 20mg in 5mL Oral Solution May 2016.doc

https://pathways.nice.org.uk/pathways/acute-upper-gastrointestinal-bleeding

see attached

• Association of Paediatric Palliative Medicine Formulary

Seek advice from tertiary Paediatric Gastro team before initiating H pylori eradication treatment.

• Barts Health Paediatric H pylori eradication Guideline.doc

• Oral Proton Pump Inhibitors - Guidelines for Paediatrics May2016.pdf
• Difficult to obtain letter_Omeprazole 20mg in 5mL Oral Solution May 2016.doc

• NEONATAL FORMULARY VERSION 9 2016 BARTS HEALTH_Dec 2016.pdf

• CF Prescribing Pathway Final Version 5 Dec 2015.doc

• Microsoft Word - BLT Non-CF Bronchiectasis Prescribing Pathway June 2012 Version 1.1.pdf
• CF Prescribing Pathway Final Version 5 Dec 2015.doc

see attached 

• The Association of Paediatric Palliative Medicine Formulary - 2017

For NICE guidance on management of upper GI bleeding in children over 16 years:

https://pathways.nice.org.uk/pathways/acute-upper-gastrointestinal-bleeding

• CF Prescribing Pathway Final Version 5 Dec 2015.doc

First line for gastro-oesophageal reflux disease

http://publications.nice.org.uk/acute-upper-gastrointestinal-bleeding-management-cg141

see attached

• NEONATAL FORMULARY VERSION 9 2016 BARTS HEALTH_Dec 2016.pdf

see attached

• Microsoft Word - BLT Non-CF Bronchiectasis Prescribing Pathway June 2012 Version 1.1.pdf
• CF Prescribing Pathway Final Version 5 Dec 2015.doc

First line for gastro-oesophageal reflux disease
 
https://pathways.nice.org.uk/pathways/acute-upper-gastrointestinal-bleeding

Please see memo for management during shortage at Barts Health

• Ranitidine Shortage Memo 28.11.19.docx

Last line for haematemesis despite optimal treatment with other drugs

see attached

• The Association of Paediatric Palliative Medicine Formulary - 2017

Only the injection formulation is on formulary, and is restricted for use in Paediatrics.

Injection Formulation is a Hospital Only drug

Following the discontinuation of omeprazole bolus injection, we have switched to esomeprazole injection as the IV Proton Pump Inhibitor (PPI) of choice in paediatrics.

Recommended dosing:
Under 1 year: 0.5 – 1mg/kg once daily

1 – 11 years:
Body-weight < 20kg: 10mg once daily
Body-weight ≥ 20kg: 10 – 20mg once daily

12 – 18 years: 20 – 40mg once daily

see attached

• Oral Proton Pump Inhibitors - Guidelines for Paediatrics May2016.pdf
• Difficult to obtain letter_Omeprazole 20mg in 5mL Oral Solution May 2016.doc

• CF Prescribing Pathway Final Version 5 Dec 2015.doc

• Microsoft Word - BLT Non-CF Bronchiectasis Prescribing Pathway June 2012 Version 1.1.pdf
• CF Prescribing Pathway Final Version 5 Dec 2015.doc

• Oral Proton Pump Inhibitors - Guidelines for Paediatrics May2016.pdf
• Difficult to obtain letter_Omeprazole 20mg in 5mL Oral Solution May 2016.doc

https://pathways.nice.org.uk/pathways/acute-upper-gastrointestinal-bleeding

see attached

• Association of Paediatric Palliative Medicine Formulary

Seek advice from tertiary Paediatric Gastro team before initiating H pylori eradication treatment.

• Barts Health Paediatric H pylori eradication Guideline.doc

• Oral Proton Pump Inhibitors - Guidelines for Paediatrics May2016.pdf
• Difficult to obtain letter_Omeprazole 20mg in 5mL Oral Solution May 2016.doc

• NEONATAL FORMULARY VERSION 9 2016 BARTS HEALTH_Dec 2016.pdf

• CF Prescribing Pathway Final Version 5 Dec 2015.doc

• Microsoft Word - BLT Non-CF Bronchiectasis Prescribing Pathway June 2012 Version 1.1.pdf
• CF Prescribing Pathway Final Version 5 Dec 2015.doc

see attached 

• The Association of Paediatric Palliative Medicine Formulary - 2017

For NICE guidance on management of upper GI bleeding in children over 16 years:

https://pathways.nice.org.uk/pathways/acute-upper-gastrointestinal-bleeding