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Clinical Case 040: Quit QID?

This is a quickie.

My 2 yo recently developed a purulent toenail / cellulitis / paronychia.  So we decided to start him on some oral ABs – it is always staph – so flucloxacillin seemed like a good option.

Now in this case series of n=1, where both parents are highly-trained medical professionals, have good insight into the pharmacodynamics and were highly motivated to comply with the prescribed treatment regime.  Here is the outcomes:

Mum’s days = average 2.2 doses out of the recommended 4 completed

Dad’s days = average 1.7 doses out of 4 completed.

So what conclusions can I draw from this slightly underpowered, retrospective, case-series study.  Well I think there are 2 possibilities:

  1. I am a bad parent
  2. Prescribing QID medicine (to kids in particular) is a futile exercise.

I have long held this suspicion (option 2, that is), but not until this week did I have the chance to do a real-world trial – and I have to say, I think that it is nigh on impossible to do QID in vivo.

Love to hear your thoughts.  I think I will change to meds which are TDS at worst, BD even better.

Casey

 

Comments

  1. Spot on… And of course, BD dosing is only sensible way to go if the kids are in school.

  2. Rob Millar says:

    Compliance in this age group is a combination of child psychology, parental persistence and taste. Assuming the first two were not a problem, I decided to taste-test the flucloxacillin suspension that my toddler was uncharacteristically spitting back at me – horrible!!! Since then it’s cephalexin all the way for my family… and my patients. BD dosing of flucloxacillin (assuming you’re doubling the dose) is just asking for 0/2.

    Rational narrow-spectrum prescribing be damned when you have a screaming toddler in front of you!

  3. Minh Le Cong says:

    had to laugh at this, sorry. I stopped prescribing QID dosing a fair while ago, at least for ambulatory outpatients. In kids, its bd or daily or monthly dosing, in my book. if I am concerned about staph skin infections, its cephalexin bD or amoxycillin clavulanate bd. Unless they have CMRSA, and clindamycin is needed, then tds or qid is the go. But I rarely find CMRSA skin infections in kids around my neck of the woods.
    Its a good point you make though in regard to medication compliance and motivation. i have pondered for some time, why antibiotics cant be prepared in chocolate formulation, like the chocolate Deworming squares that Combantrin family packs come in? My kids have no trouble gorging themselves on them! maybe thats a research project we could tackle as rural docs…flucloxacillin in chocolate squares..which two yo would refuse chocolate from a parent??

  4. Roger smith says:

    I had staph septicemia last yr. had 2w. IV fluclaxacillin qid in hosp then further 2w oral qid at home. To do the latter I had to set my phone to remind me. Certainly if the stakes are high you can do it but it does take some effort

    Roger
    Gp. Cranbourne Vic. In jabiru doing 2w stint in local gov clinic

  5. Or you could go to the ophthamologist’s extreme….use these drops hourly knowing that it will probaly be used only four times a day!!!

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