Tailoring treatment: children

Last updated: Sunday, June 13, 2021

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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?

You know that flucloxacillin oral solution 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. 

After considering the benefits of the child being able to take the antibiotic versus the potential risks of trying to disguise the taste, you ring the mother back. You advise her that ideally flucloxacillin should not be mixed with food. However she could offer her child milk or fruit juice after taking the dose, or with the dose if that fails. 

If she does mix the antibiotic with juice or milk then she should add it to only a small rather than a large volume to try to ensure her child receives the whole dose (if the child refuses some of the drink then dose administered won’t be known). You also reassure the mother that flucloxacillin does have an unpleasant taste and that it is not unusual for children to refuse to take it; an alternative antibiotic may be required if these steps are unsuccessful.