Why is penicillin supplied as dried granules

This practice was followed by most mothers Regarding the use of left over suspensions, 26 6. Another study showed that As it is well known, the medications should not be given to other individuals, this practice was followed by A Malaysian study showed that Storage conditions of drugs are important as drugs are chemicals that may react with external environment such as temperature, humidity, and light.

This leads to changes in drugs concentration properties and therapeutic effects. Many people stored medications in kitchen or bathroom cabinet, that speeds up medication breakdown process; as in both conditions drugs may be exposed to humidity and high temperature. Instead medicinal cabinet should be placed in a cool and dry place, away from direct sun light, and out of reach from children. In this study a good percentage of mothers In both cases around half of the mothers followed the correct practice.

These results are close to results from another Palestinian study which showed that Regarding this point, more education and counseling is recommended because many people store medications in inappropriate places.

To achieve higher level of awareness and correct practice regarding antibiotic suspensions use, cooperation between drugs companies, pharmacists, and doctors is needed. Drugs companies are recommended to write instructions in a simple way, and may draw the directions on bottle, in addition to providing suitable dose administration devices. The prescribers should inform mothers the correct instructions also and confirm that antibiotic suspensions should not be shared between children.

It is the responsibility of pharmacists to explain instructions to mothers and confirm on them by writing, and to provide mothers with syringes, also it is important to concentrate on duration of use and storage conditions. The first limitation of this study is that the answers reported by the respondents cannot be validated and recall bias is possible, but this cannot be avoided in survey studies.

Another limitation is the study was performed in one city only so it might not be representative to the practice in other places. However, these results can give a baseline data that can be useful in designing and implementing suitable educational programs and performing other related studies. The pharmacists are recommended to explain the correct directions, to supply a syringe with suitable calibration for dose administration, and to counsel parents about suitable storage conditions, frequency of dosing and duration of use.

RR and AZ participated in the design of the study, in the sequence alignment, the statistical analysis and helped to draft the manuscript. HA carried out the data collection, statistical analysis, and participated in the sequence alignment and drafted the manuscript. All authors read and approved the final manuscript.

The authors would like to thank the mothers who accepted to participate in the study. Al-Ramahi, Phone: , Email: ude. Abd Al Naser Zaid, Email: ude. Haya Anabousi, Email: moc. National Center for Biotechnology Information , U. BMC Res Notes.

Published online Dec 9. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Jun 25; Accepted Nov This article has been cited by other articles in PMC. Methods This study was a questionnaire based cross sectional descriptive study. Results The results showed that Conclusion The results reflect a good level of correct practice. Keywords: Antibiotic, Suspension, Pediatrics, Palestine. Background Pediatric infectious diseases either viral or bacterial remain a very common community health problem with an average occurrence of 6—8 times a year [ 1 ].

Results Socio-demographic characteristics Among mothers approached, women accepted to participate in the study giving a response rate of Table 1 Socio-demographic characteristics of the mothers.

Characteristics Frequency Percentage Mothers age Less than 20 years 13 3. Open in a separate window. Prescribed antibiotics and indications During the study period the doctors were mainly visited due to throat infection pharyngitis Table 2 Indications for used antibiotics. Indication Frequency Percentage Throat infection pharyngitis Table 3 The most commonly prescribed antibiotics.

Prescribed antibiotic Frequency Percentage Amoxicillin Reading and understanding the instructions Among the mothers, Characteristics Frequency Percentage Read instructions Yes Reconstitution of antibiotic suspensions In order to reconstitute dry powder antibiotic, most mothers Administration of antibiotic doses Most of the mothers Storage conditions for antibiotic suspensions Mothers were asked about the storage of dry powder; Discussion When infection is caused by bacteria then antibiotic is the drug of choice [ 1 ].

Acknowledgements The authors would like to thank the mothers who accepted to participate in the study. Competing interests The authors declare that they have no competing interests. References 1. Parental knowledge, attitudes and antibiotic use for acute upper respiratory tract infection in children attending a primary healthcare clinic in Malaysia.

Singapore Med J. Parents can dose liquid medication accurately. How much antibiotic suspension is enough? Ogeden S.

Reconstitution of powder and liquid. This article analyzes these parameters by classifying them as extrinsic or intrinsic and examines how they contribute to the variability of reconstitution time of PI drugs see Figure 1. Intrinsic parameters are inherent to an active pharmaceutical ingredient API or a formulation and include the molecular-, particle-, and bulk-level solid-state properties of the API. Any added excipients also influence the inherent reconstitution properties of the product. Particle-size distribution.

Powder dissolution is a kinetic phenomenon that depends primarily on the surface area exposed to the solvent, which in turn is a function of particle size. Particle size, therefore, influences reconstitution time. Coarser particles lower the dissolution rate because of their lower specific surface area in accordance with the Noyes Whitney equation 6. Conversely, very fine particles agglomerate because they are more cohesive 7 and therefore show longer wetting time, resulting in prolonged reconstitution 8.

Therefore, particle size must be optimized and controlled to obtain short and reproducible reconstitution times. Particle shape and size affect the closeness of the powder packing, which in turn affects the penetration of water into interstitial spaces of the powder bed 9. Water penetration promotes wetting of each particle that is required before dissolution. Small particle size and symmetrical shape enhance close packing of particles, thus preventing the required penetration of water.

Larger particles are usually more irregular in shape and therefore provide more space in the interstices for wetting. The porosity of dry powder may have a significant effect on its reconstitution.

Haeger et al. Several methods for determining the porosity of powder by means of mercury intrusion porosimetry 11—14 , nitrogen gas adsorption 14, 15 , and X-ray tomography 16 have been reported.

Solid-state form. A drug can exist in crystalline, solvate, or amorphous form. Polymorphism, the existence of several crystalline forms of a single compound, affects dissolution properties of the drug Different pseudopolymorphic forms also have different dissolution rates.

For example, acyclovir exists as a hydrate and as an anhydrate, with each form having significantly different dissolution rates The amorphous form of a drug has higher kinetic solubility compared with the crystalline form as a result of its inherent high-energy state. Amorphization is, therefore, used to enhance a drug's dissolution properties in PI formulations. Bornstein et al. Degree of crystallinity. The degree of crystallinity, which is the percentage of crystalline form of any compound in the amorphous matrix, can markedly affect dissolution properties.

Analytical techniques used to determine the degree of crystallinity include powder X ray diffractometry 20 , near infrared spectroscopy 21 , Raman spectrometry 22 , solid-state nuclear magnetic resonance 23 , dynamic vapor sorption 24 , and thermoanalytical techniques such as isothermal microcalorimetry 24—26 , differential scanning calorimetry 27 , modulated temperature differential scanning calorimetry 28 , and solution calorimetry Reliability of the results may improve if several techniques are used in parallel Powder wettability.

Wetting is the primary step in the reconstitution process that is followed by the submergence, dispersion, and dissolution of the particle Wettability, is a measure of the ability of a bulk powder to imbibe the liquid under the influence of capillary forces, and it depends on variables such as particle size, density, porosity, surface charge, surface area, and surface activity Although, several techniques are available to determine the wettability of a powder, it is difficult to accurately assess powder wettability because of the complexity of this phenomenon in powder systems.

Wettability is largely reflected by the contact angle between the powder surface and the penetrating diluent The commonly used contact angle measurement on solid surfaces is influenced not only by the physicochemical properties of the powder, but also by factors such as surface roughness, chemical heterogeneity, sorption layers, molecular orientation, swelling, and partial dissolution of the solid in the liquid Consequently, there is no universal test to measure the wettability of powders and each powder—liquid pair must be examined on a case-by-case basis to select the most appropriate method Methods to determine wettability of powders have been classified according to the size of the sample and the mechanism of wetting as shown in Figure 2 Details of each method can be found in the cited literature 9, 34— Formulation factors.

The inherently low aqueous solubility of an API in formulation may contribute to incomplete reconstitution. Several formulation interventions are used in such instances, including the use of cosolvents, cyclodextrin complexation, lipidic systems, and amorphization by freeze drying. Freeze drying is an important technique to formulate PI because it enhances the solubility and stability of the final product High moisture content in the end product adversely affects not only the stability but also the reconstitution properties.

Excipients used during freeze drying also have an impact on reconstitution time. Using organic-aqueous mixtures instead of only aqueous solution during freeze-drying generates amorphous cakes with a large surface area, resulting in enhanced reconstitutability. Freeze drying of sucrose and lactose solutions from a tert -butanol and water mixture demonstrated rapid reconstitution, which was attributed to higher cake porosity 48, Degradation products. The presence of excess moisture in the formulation can sometimes accelerate chemical and physical degradation, which results in the formation of less-soluble degradation products that slow the reconstitution process.

Similar observations were made for recombinant human albumin, insulin, and tetanus toxoid In such cases, special attention should be given to the choice of rubber plugs because it is the most potential source of ingress of moisture to the product Foaming during reconstitution is a serious problem for biopharmaceutical drugs because it may lead to protein denaturation and a consequent loss in their activity.

This situation necessitates determination of the protein activity that is lost as a result of shaking, which may further assist in setting specifications for reconstitution time. Kanavage et al. Minimal changes observed in activity of the antivenom formulation, even with severe intentional foaming, obviated the need for any special reconstitution specifications Apart from product stability, foaming also causes problems during administration, requiring it to be dissipated before use.

In case of lyophilized palivizumab Synagis, MedImmune , a rapid spurt of water into the vial may cause immediate and prolonged foaming that will require up to 2 h to dissipate Gel formation.

Formation of a gelatinous mass lump during reconstitution is a major reason for a long reconstitution time. The gel layer that forms immediately after drug—diluent contact is highly viscous and sticky and adversely influences dissolution kinetics, thereby causing extreme difficulties in measuring reconstitution time Farina et al.

A new formulation i. Extrinsic parameters include variables related to the container of the product and the conditions used on the product in storage and during the reconstitution process. Method of reconstitution.

Subjects who have received acute operative care e. Note that subjects that are unable to participate in the consent process e. High-potency antibiotic powder or solution applied to the wound prior to enrollment.

Simple ointment i. Documented allergies or serious reactions to vancomycin. History of uncomplicated "red man syndrome" will not be considered a reason for exclusion. Pregnant subjects. If the subject is a female of childbearing potential, and she states that she is likely to be pregnant, a pregnancy test will be performed; if negative, the subject will be eligible for enrollment. Participation in other clinical research involving investigational antimicrobial products within 30 days of randomization.

Contacts and Locations. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials. More Information. All sharing of data will conform to currently established DOD HRPO Department of Defense Human Research Protection Office human subject protection practices and will be in compliance with all appropriate state and federal confidentiality requirements and privacy guidelines.

The limitations on this policy are that data will not generally be available until such a time that it is submitted for publication. While data will be provided in a timely fashion, the actual timelines of availability of requested data will be specific to the data requested and any special sensitivity of the requested data set.

Layout table for additional information Studies a U. National Library of Medicine U. National Institutes of Health U. Department of Health and Human Services. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators.

Open Fracture. Drug: Vancomycin. Phase 4. Study Type :.