The chemist and druggist, 18/25. December 2010 (issue 6778)

OPINION Got a view that you want to get off your chest? Your Shout Whether you want to share your experiences, get something off your chest, or ask C+D to put your questions to the industry's experts, Your Shout is your opportunity to do so. Get in touch with us by emailing haveyoursay@chemistanddruggist.co.uk and we'll make sure your views are heard Should dose times be on labels? A C+D comment on the information pharmacists should provide about dosing intervals provoked a debate at www.chemistanddruggist.co.uk/cpdzone. We look at some of the best responses Last month pharmacist Molica Kraszkoova wrote to C+D, suggesting antibiotic prescriptions should be labelled by hourly intervals rather than the number of times the drugs need to be taken each day. This, Ms Kraszkoova suggests, would make sure plasma levels stay in a therapeutic range. C+D's clinical & CPD editor Chris Chapman wasn't so sure, wondering what impact the change would have on compliance. Here's what you thought of the idea: ® Isn't compliance the most important factor? Without it, there is less chance of achieving therapeutic plasma levels. Gastric upset is an issue in some patients, which may be alleviated by taking the antibiotic with or after food. The easiest time for this patient group to comply is mealtime. We could put both sets of instructions on the label - for example 'take one every eight hours (three times daily)'. This covers both bases. Eoghan O'Brien ® I agree that putting the timing of medications on prescriptions is vitally important. I do it for all slow- release opiates, for example. However, imagine a child needing penicillin V liquid. Are we really going to instruct the parent to dose at 6am, 12pm, 6pm and midnight? I suspect that we would do better to take each patient individually, then counsel appropriately with regard to dose timing to ensure the best level of concordance. Sean Whelan a We used to have an additional time label with the following times on it which we considered nearest possible without disrupting normal life: 7am, 12 noon, 3pm, 6pm, and bedtime. If it was three times a day we would cancel out 12 noon and 6pm (to make it 7am, 3pm and bedtime), and if it was four times a day we would cancel out 3pm (hence the times would be 7am, 12 noon, 6pm and bedtime). I hope this will be useful to all. Mayur Shah «■ I have always found reminding patients verbally that doses should be spaced as evenly as possible over 24 hours to be most effective, giving suggested times if I receive a quizzical look. This often has the most impact when the medication is for a child, when I suggest the last dose be given at the parent's bedtime so the bacteria do not have such a long time to 'build back up'. I am a firm believer in the power of conversing with patients, and find those moments when the penny drops to be truly wonderful, as it is then that I am as sure as I can be that the medication will be used effectively. JemPharm © A constant plasma level for antibiotics is surely not always a benefit. Bacteria are most vulnerable when they divide (and multiply - clever things bacteria!) as the cell wall is weak. A period where the plasma level is low will allow the bacteria to start multiplying again and thus render the next rise in plasma level more effective than would otherwise be the case Mike Field ® I usually try and put both times per day and the time of day on a label if I can, and the pharmacy I work in does 600+ items a day. I find in the UK if you put 'every 12 hours' people invariably ring up when they get home and ask what it means, so in the long run it saves me time to write out both on the label. Susan Warman • In a busy pharmacy, [antibiotics] are one group of drugs I do make time for counselling patients about. Although I was trained in the UK, I have worked most of my life on the other side of the pond and we always labelled antibiotics 'every eight hours' or 'every 12 hours', not 'three times a day' or 'two times a day'. I was rather shocked when I started working here to see prescriptions from CPs as 'three times a day' rather than 'every eight hours'. However, we rarely used antibiotics that require four doses a day; that is a huge compliance nightmare and requires extra counselling. A constant plasma level is essential, otherwise you are encouraging resistance to develop. We should all be using 'every eight hours' or 'every 12 hours' and reinforcing with counselling. The same goes for opiates such as MST. Change it to time intervals. Hilary Evans-Turner o Would using a seven-day monitored dosage pack with printed dosage times help? John Jones • My dad (a lecturer in instrumental methods of analysis) always said that penicillin V had such a short half-life (30 minutes) it didn't make any difference. Other antibiotics have a longer half-life, but still not enough for the dosing interval to be critical in many cases. Judith Hible Have your say Do you think prescriptions should start including time intervals? What effect do you think it would have on compliance? Let us know what you think: email haveyoursay@chemistand druggist.co.uk Ethical Dilemma Last month's Ethical Dilemma on confidentiality and November 27's Practical Approach on assisted dying saw hot debate on C+D's website and by email. A new Ethical Dilemma has now been posted on the website - and we want to know what you would do. Join the debate at www.chemistand druggist.co.uk/ethicaldilemma or send in your suggestions to haveyoursay@chemistand druggist.co.uk. The best suggestions will be published along with expert legal opinion in the New Year.