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You may refer this for more details.

Paracetamol  - dose mentioned in the prescription is incorrect for age. In addition, there is no formulation specified. Pharmacist as a prescriber they could change the dose. They could also supply the paracetamol for free without discussing the change in the dose under the Minor Ailments schemes.

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Paracetamol is a common painkiller for children. It's often used to treat headaches, stomach ache, earache, and cold symptoms. It can also be used to bring down a high temperature ( fever).

Paracetamol for children is available as tablets or as a syrup.

Paracetamol also comes as suppositories (medicine that you push gently into your child's bottom). Suppositories are useful to relieve pain and a high temperature in children who find it difficult to swallow tablets or syrup, or who are being sick a lot.

You can give your child a suppository from the age of 3 months.

Paracetamol tablets (including soluble tablets), syrup and suppositories are available on prescription and to buy from shops and pharmacies.

For over-16s, find out more about paracetamol for adults.

Key facts

Paracetamol for children comes in different strengths, including 2 strengths of syrup. The strength and dosage depends on your child's age (and sometimes weight), so always check the instructions carefully.

Your child should start to feel better about 30 minutes after taking tablets or syrup. Suppositories can take up to 60 minutes to work fully.

Do not give your child any other medicines that contain paracetamol. These include some cough and cold medicines, so check the ingredients carefully.

Paracetamol for children is a common medicine, but it can be dangerous if your child takes too much. Be careful to keep it out of your child's reach.

Give paracetamol to your child if they are in pain.

You can give paracetamol to your child if they have a high temperature and they feel distressed or unwell.

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Paracetamol is a common painkiller for children. It's often used to treat headaches, stomach ache, earache, and cold symptoms. It can also be used to bring down a high temperature ( fever). Paracetamol for children is available as tablets or as a syrup. Paracetamol also comes as suppositories (medicine that you push gently into your child's bottom).

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The calpol might taste a bit better than the generic (It is a sweet, viscous, strawberry-flavored syrup).  No harm will be done to the child if they get the generic but can supply as part of minor ailments scheme (see next section).

You can supply the paracetamol for free without discussing the change in the dose under the Minor Ailments schemes.

As a pharmacist, you need to understand  how paracetamol works and what are the risk of overdose due to liver metabolism. Explain PRN clearly to the patients/parent. Efficacy, duration  and maximum dose allowed is a point worth to mention.

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1. Tonsillitis- the patient has all the symptoms of tonsillitis- presence of pus on tonsils implies it is more likely to be bacterial cause.

The main symptoms in children and adults are:

a sore throat

problems swallowing

a high temperature of 38C or above

coughing

a headache

feeling sick

earache

feeling tired

Sometimes the symptoms can be more severe and include:

swollen, painful glands in your neck (feels like a lump on the side of your neck)

pus-filled spots on your tonsils

bad breath

2. Helps exclude differential diagnosis such as measles, mumps, rubella, influenza (if flu season) covid.

3. Course of action: Patient requires antibiotics. Not improving after 3 days therefore not self limiting. As it is an bacterial tonsillitis, it can be treated using  antibiotics.  As a prescribing pharmacist you could consider prescribing these yourself. However, it is a busy pharmacy and you are the only pharmacist on that day and therefore wouldn’t have someone else to screen the prescription- best course of action would be try to ring to refer to GP.

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Phenoxymethylpenicillin -  other formulations

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Phenoxymethylpenicillin -  other formulations

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Pen V does come in 2 different strength liquids. Could consider alternative strength as will taste different. Depending on what strength supplied initially it might increase the volume (likely to be less successful) or decrease the volume (can make it a lot easier to administer).

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Phenoxymethylpenicillin 250mg - dose is correct. Would need to confirm if he can swallow the tablets- some 8 year olds can but not most. if he can't swallow, you need to think about liquid formulation.

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Dosage and strength

The amount of phenoxymethylpenicillin you need depends on your age and how bad the infection is, and whether you're taking it to treat or prevent an infection.

Phenoxymethylpenicillin comes as 250mg tablets and as a liquid.

There are 2 strengths of liquid available. The lower strength is 125mg/5ml and the higher strength is 250mg/5ml. Both strengths can also come as a sugar free liquid.

Adults and children 12 years old and over will usually take:

500mg 4 times a day for treating infections

500mg 2 times a day for preventing infections

The dose for children under 12 years old depends on their age and weight.

The usual dose for treating infections in younger children is:

children aged 1 month to 11 months have 62.5mg, taken 4 times a day

children aged 1 to 5 years have 125mg, taken 4 times a day

children aged 6 to 11 years have 250mg, taken 4 times a day

The dose for preventing infections is usually taken twice a day. The strength depends on which infection is being prevented.

How to take it

Try to space the doses evenly throughout the day. If you take phenoxymethylpenicillin 4 times a day, this could be first thing in the morning, around midday, late afternoon and at bedtime.

If you're taking it twice a day, leave 12 hours between each dose. For example you could take it at 8am and 8pm.

It's best not to take phenoxymethylpenicillin at mealtimes because food can stop it from working well. Take it 30 minutes before a meal or at least 2 hours after you have eaten.

Swallow phenoxymethylpenicillin tablets whole. Do not chew or break them.

If you or your child are taking phenoxymethylpenicillin as a liquid, your pharmacist will make it up for you.

The medicine will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.

How long to take it for

How long you take it for depends on the type of infection you have.

The usual course of phenoxymethylpenicillin lasts for 5 to 10 days.

If you're taking phenoxymethylpenicillin to prevent infection (for example, if you have sickle cell disease or have had chorea, rheumatic fever or your spleen removed), you may have to take it for the rest of your life.

Important

Carry on taking this medicine until you have completed the course, even if you feel better. If you stop your treatment early, the infection could come back.

If you forget to take it

If you forget to take a dose, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Taking an extra dose of phenoxymethylpenicillin is unlikely to harm you or your child.

Taking more than 1 extra dose could make you feel sick and cause vomiting and diarrhoea. Rest and take it easy until these side effects get better. Speak to your pharmacist or doctor if you're worried.

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How and when to take phenoxymethylpenicillin

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The amount of phenoxymethylpenicillin you need depends on your age and how bad the infection is, and whether you're taking it to treat or prevent an infection. Phenoxymethylpenicillin comes as 250mg tablets and as a liquid. There are 2 strengths of liquid available. The lower strength is 125mg/5ml and the higher strength is 250mg/5ml.

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·       Can we supply an alternative formulation of the antibiotic?

-amoxicillin,500mg , 3 times a day

·       What other questions might you want to ask?

-ask do they want to change formulation

-how sick he was

-bowel movement, urination problem, chances of diarrhoe , ask habits, how does he feel

·       What is the best course of action for this patient and why

-line up all the options

-refer them to GP

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·       Review the prescription and think about anything that might need to be changed for you to safely dispense the prescription

-14/7 : 14 days

-QDS: 4 times a day

PRN: when required

Phenoxymethylpenicillin(antibiotics for the infection)

-last for 5-10 days

-ONLY give the patient tablets of 7-10 days, otherwise will have antibiotics resistance

-ask mum whether choose tablet or liquid, as liquid is more expensive ,

Paracetamol : 250-500mg

-if get better than don’t have to increase the dose

-if the infection does not heal, can increase dose up to 500mg

Difflam: sore throat

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·       What is the most likely diagnosis for this patient?

-bacterial infection, tonsilitis

·       Why is it important to check his immunisation status?

-check whether its recurring problem

-check whether its viral infection

-check enough antibodies inside the body to fight against the infection

·       What is the appropriate course of action for this patient?

-can be self-limiting

-only give antibiotics for patient if over 7 days

-15mg/kg --paracetamol

·       What can you say to mum about the difference in the paracetamol

-Calpol(50ml) as anagelsics , although its cheaper (3.49) .

-80ml 1ml-50mg total amount 4000mg,

-we just 350-375 mg, 4 times a day, --most 2 days

-200ml can last for almost 5 days, so preferrable paracetamol oral suspension 200ml