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Journal of Tropical Pediatrics 1995 41(2):103-108; doi:10.1093/tropej/41.2.103
© 1995 by Oxford University Press
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research-article

Caretaker Compliance with Different Antibiotic Formulations for Treatment of Childhood Pneumonia

Edward Ellerbeck, MD*,**, Nagwa Khallaf, MD***, K. S. El Ansary, MD***, Salama Moursi, MD{dagger} and Robert Black, MD**

*Johns Hopkins School of Medicine, Department of Internal Medicine Baltimore, MD, USA
**Johns Hopkins School of Hygiene and Public Health, Department of International Health, Baltimore, MD USA
***Child Survival Program, Ministry of Health Cairo, Egypt
{dagger}Ministry of Health Ismailiya, Egypt

To determine the effect of antibiotic formulations on compliance, 400 children, aged 2 months to 5 years, with a presumptive diagnosis of pneumonia, were randomly assigned to receive one of the following formulations of cotrimoxazole:

  1. syrup accompanied by a 10-ml measuring cup;
  2. syrup accompanied by a 5-ml measuring spoon;
  3. tablets;
  4. single-dose sachets of antibiotic powder.

A research assistant visited the child's home on the fourth day of therapy, asked the care-giver about compliance, and observed the care-giver prepare a dose of the medication. The remaining amount of medicine was measured, and when possible (n=151), a urine specimen was tested for the presence of sulphamethoxazole.

All of the care-givers reported giving at least one dose on the first day of therapy. By the fourth day, 82 per cent of those receiving syrup were still taking their medication compared to 71 and 55 per cent of those receiving sachets or tablets, respectively (P < 0.01). Of those who received syrup accompanied by a spoon, 38 per cent under-dosed the medicine by at least 30 per cent. Overall, compliance was highly correlated with the care-giver's report of difficulty in administering the medication. Additional research is needed to understand the obstacles encountered by care-givers in administering sachets and tablets. Meanwhile, the use of antibiotic syrup, accompanied by an appropriately sized measuring cup, appears to offer the greatest probability of medication compliance in the treatment of Egyptian children with pneumonia


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