Pediatric Press Newsletter

Publication date: 2003-05-15

Palatable Solutions to Clinical Issues

This report was reviewed for medical and scientific accuracy by Amisha Malhotra, MD, Assistant Professor of Pediatrics, University of Medicine & Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey

Perspective

Selection of antibiotic therapy for a child necessitates the consideration of several factors. First and foremost is the efficacy of the antibiotic in eliminating the offending pathogen. The propensity of an antibiotic to produce adverse or toxic effects is also crucial. After the antibiotic's efficacy and adverse event profile, clinicians must consider the likelihood of compliance. It is frustrating for physicians to learn that poor compliance has undermined the potential therapeutic benefit of a medication, thus it is an important factor in determining therapeutic choices.

Because children frequently experience difficulty swallowing tablets or capsules, bacterial infections are often treated with suspensions. From the child's perspective, compliance with a medication is largely determined by its palatability, and perhaps also by its smell or appearance. Medication palatability and patient acceptance are essential for compliance.^1-3 Parents are all too familiar with the challenge of cajoling a child into swallowing a bad-tasting medication. This influences physicians' and parents' preferences for therapy.^4,5 Several other factors can influence compliance in children. The nature of the illness, quality of rapport between physician and parent, and various social and cultural factors may positively or negatively affect compliance.

While the efficacy and safety of antibiotics are thoroughly tested before they are approved by the Food and Drug Administration, the palatability of these medications is less well studied. This Pediatric Press Newsletter reviews data relevant to the assessment of palatability and patient acceptance to a variety of antibiotic suspensions available to the physician.

Factors Associated with Poor Compliance in Children Prescribed Antibiotics

The identification of factors leading to poor compliance in taking medications by children is an important first step to improving clinical outcomes. Mattar and colleagues evaluated the compliance of 100 children who were prescribed antibiotic therapy for acute otitis media.⁶ The subjects were children aged 1 to 12 years, each prescribed a 10-day course of oral antibiotics and/or an oral decongestant. Parents of the children were asked to bring all bottles of medication to the follow-up visit, at which time the parents were interviewed with a standard questionnaire and the bottles of medication examined. Compliance was measured as the number of full days' worth of medication taken during the 10-day period.

The overall compliance rate was poor, with only 5 (5%) children completing the full course of medication in 10 days. Fifty-nine (59%) patients took less than half of the medication.

Several factors were identified as contributing to poor compliance. Most parents had incomplete knowledge of the medication, with only 4 of the 100 families able to correctly identify the medications and state their purposes. Only 20 families used calibrated medicine vials to measure the correct dose of medication. Thirty-six families found it challenging to administer a medication 4 times a day for 10 days. It was reported that parents of 40 (40%) children had difficulty giving the medications with 19 (19%) children spitting the doses back; several having problems with taste. In addition to identifying palatability of the medication as a contributing factor to compliance, the importance of detailed therapy instructions to patients and their caretakers was recognized.

Recognizing the significance of poor compliance contributing to poor clinical outcomes, two well-respected studies looked at factors that affect compliance.

Selection of Therapy: Issues Related to Compliance

A great deal of