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Tuesday, April 15, 2014

Shorted at the pharmacy

Has this ever happened to you? Your baby has an ear infection, so you pick up the antibiotic and diligently give it as directed on the bottle. Every day you remember it because you want the infection to go away. But as the days pass, you notice there isn't enough in the bottle to give the full 10 days of medicine.

We get frequent calls from worried parents that they run out of medicine before the full course is completed.

Since pharmacists give exactly the amount calculated for the dose to be dispensed, it is understandable that it doesn't quite last that long.

Why?

A little medicine will stick to the insides of the bottle. A few drops can be lost on a syringe. If you're using a dosing cup, it can be over or under filled by a few milliliters (or more if you look at an angle) each time you use it. Add a few milliliters with each dose, often twice a day for 10 days, it is easy to see how you can be off by a couple teaspoons by the end of the 10 day course.

photo source: Shutterstock


When I was in training, I was taught to increase the dispense volume by 10- 20%. This means if a child would take 5ml twice a day for 10 days I would give 110 - 120 mls.

5ml x 2 x 10 days = 100 ml
10% x 100 ml = 10 ml "extra" or 20% x 100 ml = 20ml "extra" 
100ml + 10ml = 110 ml or  100ml + 20ml = 120 ml

Pharmacists no longer will give extra volume. If the dose is 5 ml twice a day for 10 days, they will only give 100ml. That means there is no wiggle room. Small drops of "waste" all add up by the end of the bottle and you will come up short.


What you can do to help:



Can you tell from the poor photo quality that this was taken by me with old dosing devices I found at home?
  • Only use a medicine dispensing container, such as a syringe, dosing spoon, or dosing cup. A cereal spoon varies in size and is not reliable.
  • Shake the bottle before dispensing liquid medicines.
  • Tighten the lid after use to decrease the risk of spills.
  • Store the medicine away from kids. 
  • Refrigerate medicines if needed - the label should state this.
  • Measure carefully. 
    • If the dosing device is labeled with a different measurement type (such as tsp vs ml) be sure you know the conversion-- if not, ask the pharmacist before you make the purchase.
    • Syringe: Use the smallest syringe that will fit the entire dose. For instance, if your child needs 0.6 ml, but you use a 10ml syringe, it will not be accurate. Be sure to hold the syringe straight up and down, not at an angle, or one part of the liquid will be higher than the other. Also be sure the syringe is marked for the dose you need to give-- don't guess where 3.75 is between 3 and 4. 
    • Medicine cup: I find it helps to put the medicine cup on the counter to level it out, then I get my eyes at the level of the cup to measure. Again, be sure it is marked for the volume you need.
    • Medicine spoon: Hold it at eye level straight up and down to align the medicine with the appropriate line.
  • If you use a syringe, see if the pharmacist has a syringe adapter for the bottle (as pictured above) to be able to hold the bottle upside down to avoid sticking the syringe into the bottle and losing medicine on the outside of the syringe.
  • Don't share medications. 
  • Don't save "leftover" medicines for another time. Liquid medicines tend to expire pretty quickly and no prescription medicine should be used without a professional evaluating the need for it.
Despite your best efforts, it is possible that you will run out of medicine before the full number of doses you were supposed to give. 
  • If it is an antibiotic: There is research supporting shorter courses of antibiotic work as well as the traditional 7-10 days for some infections, so you might just need to have your doctor check to be sure the infection cleared before filling another prescription. 
  • If it is a long term medicine that needs to be taken daily: Talk to your doctor to see if they can help get a little more medicine per bottle if you routinely are short at the end of the month.