Challenges Prescribing and Dispensing Oral Antibiotics with Poor Palatability for Paediatric Patients: A Qualitative Interview Study with GPs and Pharmacists

Overview

Journal Explor Res Clin Soc Pharm

Date 2024 Dec 18

PMID 39691775

Authors

Ayat Elgammal

Joseph Ryan

Colin Bradley

Abina Crean

Margaret Bermingham

Affiliations

Soon will be listed here.

Abstract

Background: Poor palatability of antibiotics is a key cause for non-adherence to antibiotic treatment among children. Failure to complete antibiotic treatment because of poor palatability can cause disease recurrence and may contribute to increasing rates of antimicrobial resistance. The aim of this study was to investigate the experience and challenges faced by general practitioners (GPs) and community pharmacists regarding prescribing and dispensing oral liquid antibiotics for children and the impact of poorly palatable antibiotic formulations on patients and the health-system.

Methods: One-to-one semi-structured interviews with GPs and pharmacists were conducted via an online video-conferencing platform. Data were analysed using thematic analysis.

Results: Twenty participants (7 GPs and 13 pharmacists) were interviewed. Three main themes and eight subthemes were identified. Theme 1: included four subthemes; (i) factors affecting prescribing and dispensing antibiotics, (ii) reasons to select poorly palatable antibiotics, (iii) palatability discussion with parents, and (iv) formulation factors affecting oral liquid antibiotic acceptability. Theme 2: encompassed two sub themes; (i) patient impact and (ii) health-system impact. Theme 3: involved two subthemes; (i) raising awareness of flavour and palatability issues among healthcare professionals and (ii) counselling parents while prescribing and before dispensing.

Conclusions: There is a need to increase palatability awareness among healthcare professionals and parents. The development of more palatable oral liquid formulations can play a role in improving prescribing and medicines taking practices.

References

van Dijk S, Gardarsdottir H, Wassenberg M, Oosterheert J, de Groot M, Rockmann H . The High Impact of Penicillin Allergy Registration in Hospitalized Patients. J Allergy Clin Immunol Pract. 2016; 4(5):926-31. DOI: 10.1016/j.jaip.2016.03.009. View

Hummers-Pradier E, Scheidt-Nave C, Martin H, Heinemann S, Kochen M, Himmel W . Simply no time? Barriers to GPs' participation in primary health care research. Fam Pract. 2008; 25(2):105-12. DOI: 10.1093/fampra/cmn015. View

Winnick S, Lucas D, Hartman A, Toll D . How do you improve compliance?. Pediatrics. 2005; 115(6):e718-24. DOI: 10.1542/peds.2004-1133. View

Barden L, Dowell S, Schwartz B, Lackey C . Current attitudes regarding use of antimicrobial agents: results from physician's and parents' focus group discussions. Clin Pediatr (Phila). 1998; 37(11):665-71. DOI: 10.1177/000992289803701104. View

Shallcross L, Davies S . The World Health Assembly resolution on antimicrobial resistance. J Antimicrob Chemother. 2014; 69(11):2883-5. DOI: 10.1093/jac/dku346. View

Biezen R, Grando D, Mazza D, Brijnath B . Dissonant views - GPs' and parents' perspectives on antibiotic prescribing for young children with respiratory tract infections. BMC Fam Pract. 2019; 20(1):46. PMC: 6437946. DOI: 10.1186/s12875-019-0936-5. View

Mitsui N, Hida N, Kamiya T, Yamazaki T, Miyazaki K, Saito K . Swallowability of Minitablets among Children Aged 6-23 Months: An Exploratory, Randomized Crossover Study. Pharmaceutics. 2022; 14(1). PMC: 8779905. DOI: 10.3390/pharmaceutics14010198. View

Ramgoolam A, Steele R . Formulations of antibiotics for children in primary care: effects on compliance and efficacy. Paediatr Drugs. 2002; 4(5):323-33. DOI: 10.2165/00128072-200204050-00005. View

Bielicki J, Lundin R, Patel S, Paulus S . Antimicrobial stewardship for neonates and children: a global approach. Pediatr Infect Dis J. 2015; 34(3):311-3. DOI: 10.1097/INF.0000000000000621. View

10.

Kardas P, Devine S, Golembesky A, Roberts C . A systematic review and meta-analysis of misuse of antibiotic therapies in the community. Int J Antimicrob Agents. 2005; 26(2):106-13. DOI: 10.1016/j.ijantimicag.2005.04.017. View

11.

Boland J, Banks S, Krabbe R, Lawrence S, Murray T, Henning T . A COVID-19-era rapid review: using Zoom and Skype for qualitative group research. Public Health Res Pract. 2022; 32(2). DOI: 10.17061/phrp31232112. View

12.

Batchelor H, Marriott J . Formulations for children: problems and solutions. Br J Clin Pharmacol. 2015; 79(3):405-18. PMC: 4345951. DOI: 10.1111/bcp.12268. View

13.

Steele R, Estrada B, Begue R, Mirza A, Travillion D, Thomas M . A double-blind taste comparison of pediatric antibiotic suspensions. Clin Pediatr (Phila). 1997; 36(4):193-9. DOI: 10.1177/000992289703600402. View

14.

Venables R, Batchelor H, Hodson J, Stirling H, Marriott J . Determination of formulation factors that affect oral medicines acceptability in a domiciliary paediatric population. Int J Pharm. 2015; 480(1-2):55-62. DOI: 10.1016/j.ijpharm.2015.01.023. View

15.

Bergene E, Holst L, Ro T, Steinsbekk A . Considering formulation characteristics when prescribing and dispensing medicinal products for children: a qualitative study among GPs and pharmacists. Fam Pract. 2018; 36(3):351-356. DOI: 10.1093/fampra/cmy086. View

16.

Alexander T, Yanke L, Topp E, Olson M, Read R, Morck D . Effect of subtherapeutic administration of antibiotics on the prevalence of antibiotic-resistant Escherichia coli bacteria in feedlot cattle. Appl Environ Microbiol. 2008; 74(14):4405-16. PMC: 2493153. DOI: 10.1128/AEM.00489-08. View

17.

Mendelson M, Matsoso M . The World Health Organization Global Action Plan for antimicrobial resistance. S Afr Med J. 2015; 105(5):325. DOI: 10.7196/samj.9644. View

18.

Hsieh H, Shannon S . Three approaches to qualitative content analysis. Qual Health Res. 2005; 15(9):1277-88. DOI: 10.1177/1049732305276687. View

19.

Segador J, Gil-Guillen V, Orozco D, Quirce F, Carratala M, Fernandez-Parker A . The effect of written information on adherence to antibiotic treatment in acute sore throat. Int J Antimicrob Agents. 2005; 26(1):56-61. DOI: 10.1016/j.ijantimicag.2005.03.009. View

20.

Pawar S, Kumar A . Issues in the formulation of drugs for oral use in children: role of excipients. Paediatr Drugs. 2002; 4(6):371-9. DOI: 10.2165/00128072-200204060-00004. View