Antibiotic adherence is an important issue in all patients, but specifically so in children.

There are a number of factors influencing a doctor’s choice of antibiotic, however, taste is not usually one of them.

Research has indicated the importance of palatability when selecting medicines for paediatrics, so let's take a closer look at its influence, and what we can do to help.

The tongue can distinguish five different components of taste: bitter, salty, sour, sweet and umami. Each of these excites a specific neural pathway and is processed along with other olfactory, visual and somatosensory inputs, as well as those from memory.

It has been proposed that our ability to taste has evolved over time as a way to recognise foods that are helpful or harmful to us. For example, being able to taste sweet helps us to recognise energy-rich foodstuffs, while bitter tastes may indicate substances that are unsuitable for consumption.

Unfortunately, it is fairly difficult to measure palatability in children, especially in those below five years of age. Unsurprisingly, it can be quite difficult for parents to persuade their children to take bitter medicines.

Studies undertaken in Japan, Saudi Arabia and Israel have all identified palatability as a significant contributor of noncompliance to an antibiotic prescription in children. Traditionally unpalatable medications have been disguised with sugar, however, regulatory agencies in both Europe and the USA have recommended the avoidance of sugar in paediatric medicines.

Artificial sweeteners are being used as a substitute, but these have their own adverse effects. Palatability should, therefore, be considered when doctors are prescribing antibiotics.

The palatability of certain medicines is so poor that literature suggests these medicines not be prescribed to children in suspension form at all unless the child has been observed swallowing it prior to full prescription.

Drug companies are certainly aware of the challenges in providing palatable medications and are working on methods to improve tastes in children’s medication. Unfortunately, the lack of stability in certain medicines such as erythromycin, a particularly grimace-inducing medicine, is limiting positive results.

Health professionals, however, can play an active role in improving paediatric compliance to an antibiotic schedule through both taste testing and introducing a 'pill school' to parents. In a hospital setting, the parent should be observed giving all doses of oral medication to the child prior to discharge.

Pill school is a method that parents can use to help children (older than six) practice swallowing medicines. Widely available confectionary can be used, along with water or some diluted juice. Children can practice swallowing small pills (e.g. tic tacs), medium pills (e.g. smarties) and even large pills (e.g. chocolate or yoghurt covered raisins).

It is important to emphasise that this should be fun, and should not be a forced issue. Practising a little bit each day can make a big difference for children when it comes to swallowing proper medication.

Palatability correlates so strongly with adherence to a paediatric medicine regime that it is of absolute importance for doctors to consider it when prescribing medication.

Where possible, the child should be witnessed swallowing the medication before a full prescription is given. Nursing professionals can help by properly educating parents on the medicine and through teaching methods such as the pill school method to aid with compliance.

References

• Baguley, D, Lim, E, Pallet, A & Faust, S 2011, 'Prescribing for Children – Taste and Palatability Affect Adherence to Antibiotics: A Review', Archives of Disease in Childhood, vol. 97, no. 3, pp. 293-7, viewed 4 Sepetember 2018, https://www.ncbi.nlm.nih.gov/pubmed/22088684
• Menella, J A, Roberts, K M, Mathew, P S & Reed, D R 2015, 'Children's Perceptions About Medicines: Individual Differences and Taste', BMC Pediatrics, vol. 15, no. 130, viewed 4 September 2018, https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-015-0447-z
• The Pharmaceutical Journal 2018, ' 'Pill School' Project Launched to Teach Children How to Swallow Tablets', The Pharmaceutical Journal, 27 February, viewed 4 September 2018, https://www.pharmaceutical-journal.com/news-and-analysis/news/pill-school-project-launched-to-teach-children-how-to-swallow-tablets/20204470.article