Dispensing practices of amoxicillin suspension by community pharmacists.

Background: Amoxicillin suspension is frequently prescribed to children; we hypothesized that prescribing convention system constraints lead to unusual dosing regimens and unnecessary waste of the drug.

Objective: Identify antibiotic dispensing practices by community pharmacists and/or technicians to understand opportunities to decrease wasted amoxicillin liquid and optimize prescribing convention of liquid amoxicillin to children.

Methods: Pilot online survey of Atlanta area and National Community Pharmacists Association pharmacists or pharmacy technicians that self-reported dispensing amoxicillin suspension. Questions regarding liquid amoxicillin dispensing practices and other open comments were asked about suggestions to decrease amoxicillin waste from March 13 to April 5, 2023.

Results: Among 68 pharmacy staff that participated, over 90% reported dispensing extra liquid amoxicillin to patients for more than 10% of the doses they dispensed. Twenty-seven respondents (39.7%) felt that amoxicillin waste was a problem; waste was most often due to package/bottle sizing issues (n = 64 of 67 responses, 95.5%). Respondents reported instructing families to dispose of extra medication in the trash (n = 51, 75%); 11 (16.2%) instructed pour the remaining in the sink; none reported requesting return to the pharmacy, and 6 (8.8%) reported other instructions. Community pharmacists observed that computerized algorithms create odd dosing amounts and that some prescribers add to the overall amount needed routinely.

Conclusion: Community pharmacists in this pilot survey observed prescribing conventions, manufacturing, regulatory, and electronic medical record constraints that lead to liquid amoxicillin waste or confusing amounts for families to use.