Need pharmacy advice please-left anti-biotic out of the fridge for 11 hours-will it be ok?

[Notimeforahaircut]

I accidentally left my little boys liquid flucoxicillin out of the fridge overnight (11 hours). Will it be safe to use? It hasn’t changed colour and I can’t see any splitting. Feeling so annoyed with myself! Thank you x

I would have advised you to taste it and see if it's tasting rancid if it was for yourself (I have tasted out of date liquid antibiotics and it was so awful it made me throw up) but as it's a child I would be safer and hold off till Monday if possible to get a new script.

The worst that can probably have happened is the fungus of the antibiotic has multiplied and is stronger. Worst case, it has evolved, into God knows what. I know this isn't very helpful. What do you think ? Follow your mother's intuition. Can the course be held off till Monday without your child becoming seriously unwell ? If you think so, I would take that option.

I'm sorry. Please ignore my previous comment. Don't give your DC that antibiotic. I would use it but don't chance it with a child. Call 111 in the morning and I'm sure you'll sort out another bottle

Flucloxacillin needs to be refrigerated because it degrades chemically, and the fridge slows it down. So that means that storage at room temperature causes faster degradation.

It won’t become harmful but it will have a bit less flucloxacillin in it than it should do.

You can continue to use it as normal - and keep it in the fridge - until you can get to speak to your pharmacist and see whether they think you should have a new bottle.

NB. There is no fungus in flucloxacillin, or in any other antibiotic.

I don’t think ThatFairy is qualified to give the advice that she has given.

What is antibiotic then ? I thought it was mould ?

I'm sorry OP. I was just trying to be helpful on what I would do personally but I am not qualified to give medical advice. @EyeLevelStick seems to be confident in what she has said

No. Penicillin was originally derived from a mould (not a fungus) but it’s a chemical (as are all antibiotics), not a micro-organism.

I am, drug stability is part of my job.

You really shouldn’t comment on posts if you know nothing about it.

It just made sense to me what I said I wasn't assuming she thought I was a doctor

I’m sure it made sense to Trump when he said we should drink bleach to cure Covid.

Fine. I might not have said what I said or gave health advice if I wasn't up all night going delirious with insomnia. I'm aware there are actual experts on this site.

Pharmacist here - Flucloxacillin once it's in liquid form slowly starts to breakdown. Keeping it cool slows that process down enough so that at the end of the 7 day shelf life there is still sufficient active drug left to be effective.

it will have degraded a little bit faster during those 11 hours but it won't gone 'off' or turned into anything bad so not unsafe.

There's a decent margin of error built into the dose and the storage info. Return to fridge and continue using would be my advice (certanly don't skip doses or not give it). If you are worried about the reduction in active ingredient (severely unwell, not improving or high risk illness/ child) then ask the GP to reissue another prescription for your peace of mind.

Thanks so much all. @AltitudeCheckwe actually only got given 100ml (will need a total of 140 to cover 7 days) as they didn’t have enough in stock, so we’re due to pick up a fresh bottle tomorrow. We’re only on the third full day so essentially he will have just had 1-2 days of weaker potency. If we get the fresh bottle which will cover the last couple of days do you think that across the course of 7 days he will have had ‘enough’ of the active ingredient? Thanks so much x

@Notimeforahaircut yes.

Even better margin of error in this situation as the medicine in the first bottle is only in use for max 5 days instead of a full 7 days.

@AltitudeCheckthank you. Interestingly I just spoke to 111 and they’ve referred us to out of ours GP to have a new prescription issued as they said it won’t be effective!!! They’re obviously just being cautious x they did ask if his condition is worsening in which case maybe they would have said to give him what we have but it’s not luckily x

It happened to me, they exchanged it for a new one. They told me not to use it if it was out of the fridge for more than 2 hours because it wouldn’t be effective anymore. Go back to the pharmacy or ring 111

They are being very cautious but that's fine :)

This paper that looks at how it can be used in Africa when access to a fridge may not be practical. It shows the degradation stored at 30°c compared to a fridge (table 2). You can see there is a big difference at the end of 8 days but that effect accumulates over time, after couple of days at 30°c, it hadn't degraded more than it would have in a fridge for a week, so 11 hours at UK room temp (much less than 30°c) would have a very small effect on the amount of active drug. The first couple of graphs show how rate of decay is initially very similar between fridge and room temp, it's only as time increases that the difference gets increasingly significant. Sorry for being a numbers geek! :)

www.researchgate.net/publication/327500790_STABILITY_STUDIES_ON_FLUCLOXACILLIN_SODIUM_IN_RECONSTITUTED_ORAL_SUSPENSIONS

@AltitudeCheck thanks so much-I LOVE geeky numbers! It’s really helpful to be aware of. It’s so easy to leave out especially for a couple of hours at a time! X

Ha ha - me too. The existence of a pharmacist who out-geeks me on this fair warms the cockles of my heart.

Hope your son is feeling better.