To question pharmacist RE: antibiotic

[WineDup]

My son (11m) was prescribed amoxicillin on the 16th. We struggled to get the exact prescription but a pharmacist agreed to prescribe double strength, and just give half a dose from 5ml to 2.5ml. Makes sense.

However, I think they have given him an abnormally long course, he’s still not finished! This is day 10. There isn’t much left and we may have missed a dose here and there but we have been pretty consistent.

His illness was a relatively minor upper respiratory issue, the only reason we were seen as he was hospitalised last year (only for one night) with croup and bronchiolitis and I was concerned it was the same thing again.

My suspicion is that he was supposed to get 100ml of the weaker antibiotic, but take 5ml 3x/day, and I feel like they have given 100ml of the stronger antibiotic to be taken at 2.5ml/day, thus doubling the amount of antibiotic. A 10+ day course of antibiotics just doesn’t make sense to me.

Am I correct to think that the pharmacist (and in turn myself) have made a mistake?

Your dose didn’t change though as you were given half the volume? So course length should stay the same

Does it not say on the bottle discard after 7 days?

Ours have been wrong before because the doctor didn't change the dose for increase in weight...babies grow fast! I'm very diligent and check the leaflet Vs what the prescription says and always get it changed if needed. It should say how many days on prescription as well. I always ask the doctor that as well. Questions and leaflets are handy....they do not always do it right!

3 x 5ml x 10 days = 150ml
3 x 2.5ml x 10 days = 75ml

i.e. 75% of a 100ml bottle should have been used on completion of the course .... assuming the 100ml bottle was full at the outset.

Strep A is usually a 10 day course.

I’m sure -I’ve just double checked and it said to finish the course.

It possibly is a 10 day course though - between childcare and working patterns we might have missed a few doses.

I don’t think we were given half the volume though, that’s what I’m checking.

I believe the antibiotic comes in 100ml bottles (since it comes in a powder and is made up with water by the pharmacist)

Initial instruction was 125/5, 5ml 3x/day, 100ml liquid, finish the course.

pharmacist gave 250/5, 2.5ml 3x/day, 100ml liquid - which is the same daily dose of abx, but will let double as long because the volume is the same.

Instead of changing the instruction to “for x days” (to give the same total quantity of antibiotic) the pharmacist retained the doctors instruction of “finish the course”

I may be being stupid.

There was no suggestion it was strep A - it was a mild cough he had. The concern was croup or bronchiolitis.

My dd had a 10 day course for a chest infection at Christmas.

It says discard after 14 days

I wasn’t given a course length - I was told to finish the bottle, which was 100ml. I believe both come in 100ml bottles. To finish the 100ml bottle at 2.5ml/dose would take double as long, hence my son got double the total amount of my antibiotic.

I am fully aware I might be wrong here though - I have dyscalculia.

Well that's odd then, because neither croup nor bronchiolitis (in absence of a secondary chest infection) are treated by antibiotics, as they're caused by viruses.

If he’s had 10 days stop now then, I wouldn’t worry overly about any missed doses but as long as he’s better and he’s had the meds stop. We often have the stronger version in hospital as it’s less volume for kids to take especially if they are not keen but was never dispensed due to possibility of error similar with the 6+ paracetamol we gave on ward but did not dispense home. If he has recurring symptoms go back to your gp

They should not have issued different to the prescription. If they didn't have what was prescribed a new prescription should have been requested from the prescribing doctor!

What exactly does it say on the label?

If it's in a sealed 100ml bottle you've got twice as much as you need

Jeezus why do people state things as fact that they nothing about.
Some pharmacists can indeed change the script if needed/lack of availability. Especially recently when there has been such shortage of antibiotics.

Finish the course and empty the bottle are completely different things. A 10 day course is normal.

I work in a GP surgery and whenever a script needs altering our local pharmacies or the patient always contact us to send a new electronic prescription to dispense what they do have and the correct dose!!! Can you imagine the backlash to a GP if something goes wrong because a pharmacist has issued different to what was originally prescribed!

Antibiotics for a chest infection is usually 5 days. I'd check with your GP how longs it's for. Above poster is right - croup and bronchiolitis are both viral

I'm an actual GP (of over 20 yrs) . I assure you that some pharmacists can do do change scripts. Jeez.

www.pulsetoday.co.uk/news/politics/pharmacists-to-be-given-power-to-swap-gp-prescriptions-during-shortages-from-february/

No need for the constant jeez! I would rather have an alternative medication re prescribed from a Dr! There is absolutely no way the Dr can cover their own arse if a patient is issued an alternative but hey ho your a GP so guess you must be happy with that!

Just hope they check for any medication allergies or sensitivities!

Pharmacists have been given permission to change antibiotic prescriptions without needed to have a new one issued by the NHS until the end of January.
No need to send patients back to the GP, they can even change the actual antibiotic issued under this agreement.
The guidance was issued in December.