Excessive dilution of oral antibiotic suspensions and oversized bottles: an exploratory survey based on pediatricians’ experiences in Kabul

Abstract

Abstract Medication errors in the reconstitution of oral suspensions, which include excessive dilution, may affect the treatment outcome despite the correct diagnosis and selection of appropriate treatment. Objective: To document the practice of parents/caregivers adding more than double the recommended volume of water to oversized bottles of oral Azithromycin or Cefixime suspensions. Method: An exploratory survey was conducted using self-administered anonymous questionnaires. It involved the participation of 32 pediatricians from different pediatrics departments at Maiwand Teaching Hospital, an inner-city hospital in Kabul. The survey aimed to gather pediatricians' experiences with parents/caregivers adding excessive water to Azithromycin or Cefixime oral suspensions, surpassing the recommended amount. Results: twenty-five participating pediatricians (78.1%) reported encountering at least one instance where more than double the recommended amount of water was added to Azithromycin or Cefixime suspensions. The majority of these cases (84%) were observed in the outpatient department. Eighteen participants (72%) thought the issue was rare or infrequent, while seven (28%) thought it was frequent. Conclusion: Bottles of oversized oral antibiotic suspensions had been filled up with water to nearly their full volumes, which reduced the concentration of active substances to half or less, and may threaten the treatment outcome. This problem is not confined to any particular country but can arise in any situation where non-healthcare professionals reconstitute pediatric oral suspensions using oversized bottles. Improved reconstitution education, separate diluent bottles for oral suspension, and the establishment of standards and ceilings relative to total dose volume for oral suspension bottles are recommended.