Using solid oral dosage form antibiotics in children (1)
Whole doses of solid oral dosage forms can be used 'off-label' in place of oral suspensions. This includes use for Group A streptococcal infections
Swallowing whole solid dose forms is preferred
Children should be encouraged to swallow oral solid dose forms (tablets and capsules), where possible:
- Medicines for Children has useful guides on how to give medicines, including giving tablets and capsules.
- KidzMed is an e-Learning resource from Health Education England for healthcare professionals teaching children to swallow pills
If a child is unable to swallow oral solid dose forms, the NHS Specialist Pharmacy Service have provided advice on how to give doses by dispersing or crushing tablets, or opening capsules below (1):
- use in this way is outside the product license ('off-label')
Phenoxymethylpenicillin (Penicillin V) tablets
Phenoxymethylpenicillin tablets are available in a 250mg strength.
| | |
- are film-coated but can be dispersed in water, or crushed and mixed with liquid or soft food
- crushing tablets should not be undertaken by anyone with a penicillin allergy
| - to disperse the tablet:
- place the tablet in the barrel of a 10mL oral syringe
- replace the plunger
- draw up approximately 5mL of water and 2mL of air
- shake well and allow to disperse (this may take up to 10 minutes)
- ensure all contents of the syringe are given
- alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well
| the dispersed or crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes: - use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the crushed tablet with food or drink, give it straight away
|
Phenoxymethylpenicillin would normally be given half an hour before food as food slightly decreases the peak plasma concentration of the drug; however, the manufacturer acknowledges food does not appear to affect the extent of absorption (1)
Clarithromycin tablets
Clarithromycin immediate-release tablets are available as 250mg and 500mg strengths
| | |
- the tablets are film-coated but can be crushed and mixed with liquid or soft food
- crushing tablets should not be undertaken by anyone with a macrolide allergy
- modified-release tablets must not be crushed
| - to disperse the tablet:
- place the tablet in the barrel of a 10mL oral syringe
- replace the plunger
- draw up approximately 5mL of water and 2mL of air
- shake well and allow to disperse (this may take up to 10 minutes)
- ensure all contents of the syringe are given
- alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well
| the crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes: - use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the crushed tablet with food or drink, give it straight away
|
Erythromycin tablets
Erythromycin tablets are available as 250mg and 500mg strengths. Some are film coated and some are enteric coated.
| | |
- film-coated tablets can be crushed and mixed with liquid or soft food
- crushing tablets should not be undertaken by anyone with a macrolide allergy
- enteric coated tablets should not be crushed
| to disperse the tablet: - place the tablet in the barrel of a 10mL oral syringe
- replace the plunger
- draw up approximately 5mL of water and 2mL of air
- shake well and allow to disperse (this may take up to 10 minutes)
- ensure all contents of the syringe are given
| crushed tablet will taste bitter - can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:
- use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the crushed tablet with food or drink, give it straight away
|
Note that some generic products advise to give one hour before food, however this may not be necessary and is not practical in this situation.
Amoxicillin capsules
Amoxicillin capsules are available in 250mg and 500mg strengths.
| |
capsules can be opened and the contents tipped out and mixed with liquid or soft food - however, this should not be undertaken by anyone with a penicillin allergy
| the capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes: - use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the powder with food or drink, give it straight away
|
Azithromycin capsules
Azithromycin capsules are available in a 250mg strength
| |
capsules can be opened and the contents tipped out and mixed with liquid or soft food - however, this should not be performed by anyone with a macrolide allergy
| capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes: - use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the powder with food or drink, give it straight away
|
Absorption of azithromycin capsules (but not tablets or oral suspension) can be decreased by food; however, it is not clear whether absorption of opened capsules is affected.
Azithromycin tablets
Azithromycin tablets are available as 250mg and 500mg strengths.
| | |
- azithromycin tablets are film-coated but can be crushed and mixed with liquid or soft food
- crushing tablets should not be undertaken by anyone with a macrolide allergy
| - to disperse the tablet:
- place the tablet in the barrel of a 10mL oral syringe
- replace the plunger
- draw up approximately 5mL of water and 2mL of air
- shake well and allow to disperse (this may take up to 10 minutes)
- ensure all contents of the syringe are given
- alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well
| the crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes: - use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the crushed tablet with food or drink, give it straight away
|
Cefalexin capsules
Cefalexin capsules are available as 250mg and 500mg strengths.
| |
cefalexin capsules can be opened and the contents tipped out and mixed with liquid or soft food - however, this should not be performed by anyone with penicillin or cephalosporin allergy
| capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes: - use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the powder with food or drink, give it straight away
|
Cefalexin tablets
Cefalexin tablets are available as 250mg and 500mg strengths.
| | |
- cefalexin tablets are film-coated but can be crushed and mixed with liquid or soft food
- crushing tablets should not be undertaken by anyone with a penicillin or cephalosporin allergy
| - to disperse the tablet:
- place the tablet in the barrel of a 10mL oral syringe
- replace the plunger
- draw up approximately 5mL of water and 2mL of air
- shake well and allow to disperse (this may take up to 10 minutes)
- ensure all contents of the syringe are given
- alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well
| the crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes: - use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
- it might be helpful to use an oral syringe for liquids
- after mixing the crushed tablet with food or drink, give it straight away
|
For further information then see Using solid oral dosage form antibiotics in children
Reference:
- NHS Specialist Pharmacy Service (December 2022). Using solid oral dosage form antibiotics in children