to want to change perscriptions...pharmaceutical advice

[4anddone]

I have 2 children with tonsillitis. Both prescribed phenoxymethyl-penicillin. The elder after taking it on the 1st day (3 doses) came out in an itchy rash. On speaking to the pharmacist this morn I went back to gp and they have now prescribed klaricid paediatric suspension - clarithromycin. MY QUESTION - the 1st is a nightmare to administer they both hated it and the youngest especially will violently fight against it. the 2nd is only twice a day instead of 4 and seems to taste a lot better got youngest to try a drop. bearing in mind I've got 8 more days to go should I go back and try and get the new option for the younger one. why is the vile one the 1st option cost? effectiveness? habit? Day 2 and I am not sure I can complete a 10 day course with the youngest running out of bribes and the better he feels the harder it will be! WWYD

I'm sorry but Klaricid is extremely expensive and should be used as a second line option, for example when the patient has an allergy or reaction to penicillin, not because another drug doesn't taste nice.

That's a sensible point from a health professional point of view, but not so much for a mother who is struggling to persuade an ill child to take medicine that he needs but detests.

4anddone, you can always ask - but it may not be appropriate for your youngest. Your eldest has had a possible allergic response to the original drug, your youngest doesn't like it. Not the same thing. But worth asking, if it really is extraordinarily difficult to get your youngest to take his medicine.

Penicillin is given as first line drug. If they have to change it eg for allergy the have to go to second line drig. The reason they prescribe first line drugs first is because of antibiotic resistance. If they prescribe second line drugs hand over fist just because it's easier to take its increasing chance if antibiotic resistance. There are only limited number of antibiotics in the world and soon we'll run out if people have stupid attitudes to taking them. Also by starting a course and not finishing/switching without a valid reason (like allergy) is also going to push up rates of antibiotic resistance.

Antibiotics are split into classes now according to how valuable they are to the general population in fighting the nastiest bugs out there.
First line drugs such as penicillins virtually useless against the really bad boys excellent of mild infections - tonsillitis would fall into this category.
Second line drugs still have some effectiveness against the bad boys and should only be used where first line are not suitable. Clarithromycin is in this group.
Third line drugs very useful against bad boys, should only be used where culture and sensitivity has shown these are approximate.
Fourth line there are very few of these and they should only be used for the bad boys.
The human market has had no new antibiotics for some considerable time so we have to protect very closely what we have got and these stringent prescribing guidelines are part of this.
The veterinary market has had a couple of new antibiotics which whilst amazing for cows and sheep are totally unsuitable for humans.

Drugs that are used second line may be only used that way because there is a higher risk of resistance developing among other things so they are only used if normal meds are not possible, such as an allergy as your first child has.

Agree with stayaway The NHS, and therefore all of us, should not be funding more expensive medicines because they taste nicer

I am an HCP Edam, with a child who hates penicillin - but if he has to take it - Tough that is what he needs.

Resistance is a huge issue and the NHS is on its knees - low cost, effective, safe prescribing is paramount - not patient choice.

I am glad medication tastes vile, it's hard to get the DC to take it and I know the DC will not be tempted to go into the medication cupboard if I forget to lock it.

Good points re. resistance, I stand corrected.

Generic clarithromycin is not that expensive, is it? Won't be as cheap as chips as PenV is, but cost is not the main issue IMO.

It is a second line antibiotic, useful for atypical bacterial infections as well was garden-variety ones and should therefore only be used if first-line treatment is not appropriate ie allergy.

FWIW, my DS2(9) spat generic Flucloxacillin across my kitchen which made me very cross, right up until I tried it - it's vile, proper gag-inducing horrible.

Most sore throats including tonsillitis don't necessarily need antibiotics btw. as they are self-limiting after 5-7 days. Which is how long it takes for antibiotics to take effect.

So, yes, either give it (bribe, cajole, beg - whatever works) or don't. Clarithromyin is not appropriate, but I know I have compromised my principles when asked, so asking your dr won't hurt...

Just checked the Drug Tariff and the price of Pen V has rocketed and is now more expensive than clarithromycin. Still unreasonable, as the real concern is with resistance.

I do agree that fluclox is vile, unfortunately if you are treating a skin infection it is far better than anything else.

Urm... Pen V is stupidly expensive, and klaricid is cheaper. I would discuss with the GP.

Thank you for all your (very quick) responses - I shall persevere, thank god it is advent calendar time of year!

It is not about the cost.

And is phenoxymethylpenicillin (generic PenV) also more expensive?
Do I really have to look up the online BNF at this time of night?
CBA.

It's not about the cost - it's about antibiotic overuse, resistances, appropriate prescribing.
Advice on management of upper respiratoy infections which includes tonsillitis.

That is what I said nocheese - but cost aside, what reason is there to prescribe clarithromycin? it is not a first line for tonsillitis. Why should patients be allowed to pick and choose what they want?

DT clarithromycin 125mg/5ml 4.56/70mls
DT Pen V 125mg/5ml 14.72/100mls

Can the pharmacist add flavoring to it? They do that here. It costs a couple of dollars I think.

No they can't Steff.

Yep, I get the same prices as StayAway, also for generic penicillin (you did make me remember my password for the BNF, tsp).

Not cost. Appropriateness.

And no, flavour cannot be added here.
I am not sure it would cover that antibiotic taste anyway - nothing does tbh.

I think that phenoxymethylpenicillin is more likely to be effective for tonsillitis than clarithromycin.

They might swap it for amoxicillin instead. PenV and Fluclox are vile. Most pharmacists I know would recommend asking the GP to change the prescription to Amoxicillin. It's probably the better option if it's that or nothing.

There's a host of various reasons but more practical advice that might help is to mix it with a bit of ribena as its so strongly flavoured.

Alternatively a spoon of med and then a spoon of thick creamy flavoured yoghurt or ice creamy, the posh ones are good at removing taste. Or a wine gum. Better than other foods.

Thank you for your knowledge. We will persevere, I used a larger spoon today and added come concentrate squash on to it, still vile I think but hopefully less bitter. I appreciate your time in replying.

GP's have to follow their NICE guidelines and they guidelines tell them what to prescribe in certain circumstances. These guidelines are based on cost and effectiveness of the drug.
They guide lines will say what to prescribe incase of allergy etc. They just follow the guidelines like little robots

Little robots?

I feel for you, we are on our third bout of tonsilitis in three months and ds (2.5) hates phenoxymethylpenicillin. He has preferred the pink strawberry version to the orange one though, maybe you could look into getting that. alos syyringe rather than spoon. I find the hardest the 3 hour without food (1 before 2 after) the hardest as he is so wants food!