Dosing Accuracy of Oral Extemporaneous Suspensions of Antibiotics: Measuring Procedures and Administration Devices

Abstract

Extemporaneous suspensions are often marketed with several administration devices that can be freely used by patients/caregivers. The homogeneity of suspensions requires shaking before use. Hence, it is crucial to assess the precision of all devices and the users’ awareness of the shaking procedure. This study was conducted at University Institute Egas Moniz with 40 pharmacy students who were asked to measure 2.5 and 5 mL of two extemporaneous azithromycin suspensions. Formulation A is marketed with a double-dosing spoon and oral syringe, whereas B includes a transparent dosing spoon. Both have a reconstitution cup. The user’s preference for administration devices, the degree of compliance with the ‘shake before use’ instruction and the accuracy of the manipulation were assessed. The double-dosing spoon was the preferred device. The “shake before use” instruction was overlooked by most volunteers. The average measured volumes obtained with the double-dosing spoon were significantly different from the ones obtained with the oral syringe (p < 0.001) and significantly lower than the reference dose (p < 0.001). The oral syringe originates significantly higher values than the reference dose (p < 0.001). The dosing spoons values were significantly different from each other (p < 0.001). Liquid medicines containing several administration devices may be a challenge since they are nonequivalent.

Formulation Optimization of Extemporaneous Oral Liquids Containing Naloxone and Propranolol for Pediatric Use

“…The type of dosing device can affect dosing accuracy and studies have shown that using a syringe is generally better than a cup, dropper or spoon to accurately dispense a dose [47][48][49][50] but the suitability of a dosing device was also shown to be dependent on the viscosity of the liquid [47]. Furthermore, dosing accuracy is also related to consumer use and education of the consumer on the correct way to use a dosing device [47][48][49][50]. A high dosing accuracy of the formulation together with a, for the formulation, suitable dosing device is crucial in order ensure that a correct dose is administered [51,52].…”

Assessment of the Availability and Accuracy of Dosing Devices Packaged with Oral Liquid Medications in the Ho Municipality of Ghana

“…Most studies on dosing devices describe dosing accuracy by caregivers [ 15 , 17 , 18 ]. In terms of dosing by caregivers, previous research has generated varied conclusions on measuring spoon accuracy.…”