Tailoring treatment: children

Last updated: Tuesday, June 20, 2017

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Question
You take a call through your patient helpline from a mother whose child has been prescribed flucloxacillin by the paediatric assessment unit. The child is 2 years old and has been prescribed a 7 day course of the antibiotic for cellulitis. The mother has just tried to give the first 5ml dose but the child has spat the medicine out and is now refusing any further doses. Can the antibiotic be mixed with food and if not what should the mother do?

Outcome
You know that flucloxacillin is very bitter and that ideally it should be given on an empty stomach, but you can’t find any specific guidance to help the mother administer the antibiotic to her child. However your paediatric pharmacist directs you to some general advice about administering liquids to children. It suggests offering the child milk or fruit juice after giving the medicine. If this fails then it advises that some medicines may be mixed with milk or fruit juice if appropriate. Your paediatric pharmacist explains that the evidence to support this practice will be based on expert consensus rather than formal clinical studies. You need to weigh up the benefits of the child being able to take the antibiotic versus the potential risks of trying to disguise the taste.

 Applying this guidance to flucloxacillin, you rule out using milk. However the child could be offered fruit juice after taking the antibiotic. If this fails then mixing the flucloxacillin with juice prior to administration would also seem acceptable.

You ring the mother back and advise her that the flucloxacillin should not be mixed with food but that fruit juice may be used. If this doesn’t work and her child is not able to tolerate the medicine, then an alternative antibiotic may be required. You reassure her that flucloxacillin does have an unpleasant taste and that it is not unusual for children to refuse to take it.