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REMEDY : BNSSG referral pathways & Joint Formulary


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BNSSG Paediatric Joint Formulary

1.4 Disorders of gastric acid and ulceration

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1.4.1 Dyspepsia

First line drugs Second line drugs Specialist drugs Secondary care drugs

BNFc Dyspepsia

 

Alginates

Recommended:

Peptac® liquid (TLS Green)

  • Peptac® liquid is sugar-free but contains 3.1mmol sodium per 5mL

Gaviscon® infant (TLS Green)

  • For patients under 2

 

Antacids

BNFc Antacids

Simeticone (TLS Green)

Alternatives:

Co-magaldrox 195/220 suspension (Mucogel® - low in sodium) (TLS Blue)

Specific indication:

Sodium citrate (TLS Blue)

  • Prophylaxis of acid aspiration

 

1.4.2 Gastric and duodenal ulceration

Peptic Ulceration

 

Chelates and Complexes

BNFc Chelates

Sucralfate (oral) (TLS Red)

Sucralfate enema (unlicensed) (TLS Red)

 

H2-receptor Antagonists

BNFc H2 receptor antagonists

 

 

Proton Pump Inhibitors

BNFc Proton pump inhibitors

MHRA warning on increased risk of fractures

MHRA warning on increased risk of hypomagnesaemia

Omeprazole capsules/dispersible tablets (TLS Green)

Omeprazole 20mg/5ml (4mg/ml) oral suspension sugar free (TLS Blue) 

For Children aged under 1 year who are tube fed or children who require a dose of less than 10mg omeprazole only. Please refer to the BNSSG PPI prescribing pathway for children
Please note omeprazole 20mg/5ml (4mg/ml) oral suspension sugar free is non-formulary for all other cohorts.  Omeprazole 10mg/5ml (2mg/ml) oral suspension sugar free is non-formulary.

Esomeprazole (intravenous infusion) (TLS Red)

Omeprazole (intravenous infusion) (TLS Red)

Pantoprazole (intravenous infusion) (TLS Red)

Alternative:

Lansoprazole capsules (TLS Blue)

Specific indications:

Lansoprazole fastabs (TLS Blue)

Esomeprazole tablets (TLS Blue)

  • Endoscopically proven high grade oesophagitis
  • Laryngeal reflux
  • Patients with reflux associated cough who have not responded to omeprazole

Esomeprazole granules (TLS Blue)

  • For paediatric patients with NG tubes, or second line in children with swallowing difficulties

 

1.4.3 Gastro-oesphageal reflux disease

BRCH Gastro-Oesophageal Reflux Disease Management guideline (available via link)

Specific Indication:

Domperidone (TLS blue) - for resistant patients used as per MHRA alert

 

Eosinophilic Oesophagitis

Budesonide orodispersible tablets (Jorveza®) (TLS Amber 3 months) (SCP click here)

Budesonide nebules (TLS Amber 3 months) (SCP click here)

  • Mixed with water and Splenda® to form a slurry as detailed in SCP and leaflet

Patient leaflet- How to give budesonide nebules to your child for eosinophilic esophagitis

Fluticasone MDIs (TLS Red)

  • Dose to be swallowed