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Antibiotics in children - using solid oral dosage form in place of oral suspensions

Last edited Dec 8, 2022. Last reviewed Feb 7, 2023

Using solid oral dosage form antibiotics in children (1)

Whole doses of solid oral dosage forms can be used 'off-label' in place of oral suspensions. This includes use for Group A streptococcal infections

Swallowing whole solid dose forms is preferred

Children should be encouraged to swallow oral solid dose forms (tablets and capsules), where possible:

Medicines for Children has useful guides on how to give medicines, including giving tablets and capsules.
KidzMed is an e-Learning resource from Health Education England for healthcare professionals teaching children to swallow pills

If a child is unable to swallow oral solid dose forms, the NHS Specialist Pharmacy Service have provided advice on how to give doses by dispersing or crushing tablets, or opening capsules below (1):

use in this way is outside the product license ('off-label')

Phenoxymethylpenicillin (Penicillin V) tablets

Phenoxymethylpenicillin tablets are available in a 250mg strength.

dispersing or crushing	dispersing tablets	masking the taste
are film-coated but can be dispersed in water, or crushed and mixed with liquid or soft food crushing tablets should not be undertaken by anyone with a penicillin allergy	to disperse the tablet: place the tablet in the barrel of a 10mL oral syringe replace the plunger draw up approximately 5mL of water and 2mL of air shake well and allow to disperse (this may take up to 10 minutes) ensure all contents of the syringe are given alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well	the dispersed or crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes: use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose it might be helpful to use an oral syringe for liquids after mixing the crushed tablet with food or drink, give it straight away

Phenoxymethylpenicillin would normally be given half an hour before food as food slightly decreases the peak plasma concentration of the drug; however, the manufacturer acknowledges food does not appear to affect the extent of absorption (1)

Clarithromycin tablets

Clarithromycin immediate-release tablets are available as 250mg and 500mg strengths

dispersing or crushing	dispersing tablets	masking the taste
the tablets are film-coated but can be crushed and mixed with liquid or soft food crushing tablets should not be undertaken by anyone with a macrolide allergy modified-release tablets must not be crushed	to disperse the tablet: place the tablet in the barrel of a 10mL oral syringe replace the plunger draw up approximately 5mL of water and 2mL of air shake well and allow to disperse (this may take up to 10 minutes) ensure all contents of the syringe are given alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well	the crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes: use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose it might be helpful to use an oral syringe for liquids after mixing the crushed tablet with food or drink, give it straight away

Erythromycin tablets

Erythromycin tablets are available as 250mg and 500mg strengths. Some are film coated and some are enteric coated.

dispersing or crushing	dispersing tablets	masking the taste
film-coated tablets can be crushed and mixed with liquid or soft food crushing tablets should not be undertaken by anyone with a macrolide allergy enteric coated tablets should not be crushed	to disperse the tablet: place the tablet in the barrel of a 10mL oral syringe replace the plunger draw up approximately 5mL of water and 2mL of air shake well and allow to disperse (this may take up to 10 minutes) ensure all contents of the syringe are given	crushed tablet will taste bitter can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes: use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose it might be helpful to use an oral syringe for liquids after mixing the crushed tablet with food or drink, give it straight away

Note that some generic products advise to give one hour before food, however this may not be necessary and is not practical in this situation.

Amoxicillin capsules

Amoxicillin capsules are available in 250mg and 500mg strengths.

opening and dispersing

masking the taste

capsules can be opened and the contents tipped out and mixed with liquid or soft food

however, this should not be undertaken by anyone with a penicillin allergy

the capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:

use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
it might be helpful to use an oral syringe for liquids
after mixing the powder with food or drink, give it straight away

Azithromycin capsules

Azithromycin capsules are available in a 250mg strength

opening and dispersing

masking the taste

capsules can be opened and the contents tipped out and mixed with liquid or soft food

however, this should not be performed by anyone with a macrolide allergy

capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:

use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
it might be helpful to use an oral syringe for liquids
after mixing the powder with food or drink, give it straight away

Absorption of azithromycin capsules (but not tablets or oral suspension) can be decreased by food; however, it is not clear whether absorption of opened capsules is affected.

Azithromycin tablets

Azithromycin tablets are available as 250mg and 500mg strengths.

dispersing or crushing	dispersing tablets	masking the taste
azithromycin tablets are film-coated but can be crushed and mixed with liquid or soft food crushing tablets should not be undertaken by anyone with a macrolide allergy	to disperse the tablet: place the tablet in the barrel of a 10mL oral syringe replace the plunger draw up approximately 5mL of water and 2mL of air shake well and allow to disperse (this may take up to 10 minutes) ensure all contents of the syringe are given alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well	the crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes: use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose it might be helpful to use an oral syringe for liquids after mixing the crushed tablet with food or drink, give it straight away

Cefalexin capsules

Cefalexin capsules are available as 250mg and 500mg strengths.

opening and dispersing

masking the taste

cefalexin capsules can be opened and the contents tipped out and mixed with liquid or soft food

however, this should not be performed by anyone with penicillin or cephalosporin allergy

capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:

use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
it might be helpful to use an oral syringe for liquids
after mixing the powder with food or drink, give it straight away

Cefalexin tablets

Cefalexin tablets are available as 250mg and 500mg strengths.

dispersing or crushing	dispersing tablets	masking the taste
cefalexin tablets are film-coated but can be crushed and mixed with liquid or soft food crushing tablets should not be undertaken by anyone with a penicillin or cephalosporin allergy	to disperse the tablet: place the tablet in the barrel of a 10mL oral syringe replace the plunger draw up approximately 5mL of water and 2mL of air shake well and allow to disperse (this may take up to 10 minutes) ensure all contents of the syringe are given alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well	the crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes: use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose it might be helpful to use an oral syringe for liquids after mixing the crushed tablet with food or drink, give it straight away

For further information then see Using solid oral dosage form antibiotics in children

Reference:

NHS Specialist Pharmacy Service (December 2022). Using solid oral dosage form antibiotics in children

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Antibiotics in children - using solid oral dosage form in place of oral suspensions

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