Available dosage forms

Swallowing whole solid dose forms is preferred

Children should be encouraged to swallow oral solid dose forms (tablets and capsules) where possible:

• Medicines for Children has useful guides on how to give medicines, including giving tablets and giving capsules.
• KidzMed is an e-Learning resource from Health Education England for healthcare professionals teaching children to swallow pills.

Other options

Paediatric antibiotic suspensions and some whole oral dosage forms are licensed for use in children at a variety of ages.

Where children are unable to swallow whole oral dosage forms, we provide advice on how to give doses by dispersing or crushing tablets or by opening capsules. Use in this way may be outside the product licence and is thus “off-label”.

Phenoxymethylpenicillin (Penicillin V) tablets

Phenoxymethylpenicillin tablets are available in a 250mg strength.

Dispersing or crushing

They are film-coated but can be dispersed in water, or crushed and mixed with liquid or soft food. Crushing tablets should not be undertaken by anyone with a penicillin allergy.

Dispersing tablets

To disperse the tablet:

• place the tablet in the barrel of a 10mL oral syringe
• replace the plunger
• draw up approximately 5mL of water and 2mL of air
• shake well and allow to disperse (this may take up to 10 minutes)
• ensure all contents of the syringe are given

Alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well.

Masking the taste

The dispersed or crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:

• use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
• it might be helpful to use an oral syringe for liquids
• after mixing the crushed tablet with food or drink, give it straight away

Phenoxymethylpenicillin would normally be given half an hour before food as food slightly decreases the peak plasma concentration of the drug; however, the manufacturer acknowledges food does not appear to affect the extent of absorption.

Clarithromycin tablets

Clarithromycin immediate-release tablets are available as 250mg and 500mg strengths.

Dispersing or crushing

They are film-coated but can be crushed and mixed with liquid or soft food. Crushing tablets should not be undertaken by anyone with a macrolide allergy. The modified-release tablets must not be crushed.

Dispersing tablets

To disperse the tablet:

• place the tablet in the barrel of a 10mL oral syringe
• replace the plunger
• draw up approximately 5mL of water and 2mL of air
• shake well and allow to disperse (this may take up to 10 minutes)
• ensure all contents of the syringe are given

Alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well.

Masking the taste

The crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:

• use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
• it might be helpful to use an oral syringe for liquids
• after mixing the crushed tablet with food or drink, give it straight away

Erythromycin tablets

Erythromycin tablets are available as 250mg and 500mg strengths. Some are film coated and some are enteric coated.

Dispersing or crushing

The film-coated tablets can be crushed and mixed with liquid or soft food. Crushing tablets should not be undertaken by anyone with a macrolide allergy. Enteric coated tablets should not be crushed and will not disperse in water.

Dispersing tablets

To disperse the tablet:

• place the tablet in the barrel of a 10mL oral syringe
• replace the plunger
• draw up approximately 5mL of water and 2mL of air
• shake well and allow to disperse (this may take up to 10 minutes)
• ensure all contents of the syringe are given

Alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well.

Masking the taste

The crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:

• use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
• it might be helpful to use an oral syringe for liquids
• after mixing the crushed tablet with food or drink, give it straight away

Note that some generic products advise to give one hour before food, however this may not be necessary and is not practical in this situation.

Amoxicillin capsules

Amoxicillin capsules are available in 250mg and 500mg strengths.

Opening and dispersing

The capsules can be opened and the contents tipped out and mixed with liquid or soft food. However, this should not be undertaken by anyone with a penicillin allergy.

Masking the taste

The capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:

• use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
• it might be helpful to use an oral syringe for liquids
• after mixing the powder with food or drink, give it straight away

Azithromycin capsules

Azithromycin capsules are available in a 250mg strength.

Opening and dispersing

They can be opened and the contents tipped out and mixed with liquid or soft food. However, this should not be performed by anyone with a macrolide allergy.

Masking the taste

The capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:

• use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
• it might be helpful to use an oral syringe for liquids
• after mixing the powder with food or drink, give it straight away

Absorption of azithromycin capsules (but not tablets or oral suspension) can be decreased by food; however, it is not clear whether absorption of opened capsules is affected.

Azithromycin tablets

Azithromycin tablets are available as 250mg and 500mg strengths.

Dispersing or crushing

They are film-coated but can be crushed and mixed with liquid or soft food. Crushing tablets should not be undertaken by anyone with a macrolide allergy.

Dispersing tablets

To disperse the tablet:

• place the tablet in the barrel of a 10mL oral syringe
• replace the plunger
• draw up approximately 5mL of water and 2mL of air
• shake well and allow to disperse (this may take up to 10 minutes)
• ensure all contents of the syringe are given

Alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well.

Masking the taste

The crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:

• use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
• it might be helpful to use an oral syringe for liquids
• after mixing the crushed tablet with food or drink, give it straight away

Cefalexin capsules

Cefalexin capsules are available as 250mg and 500mg strengths.

Opening and dispersing

They can be opened and the contents tipped out and mixed with liquid or soft food. However, this should not be performed by anyone with penicillin or cephalosporin allergy.

Masking the taste

The capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:

• use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
• it might be helpful to use an oral syringe for liquids
• after mixing the powder with food or drink, give it straight away

Cefalexin tablets

Cefalexin tablets are available as 250mg and 500mg strengths.

Dispersing or crushing

They are film-coated but can be crushed and mixed with liquid or soft food. Crushing tablets should not be undertaken by anyone with a penicillin or cephalosporin allergy.

Dispersing tablets

To disperse the tablet:

• place the tablet in the barrel of a 10mL oral syringe
• replace the plunger
• draw up approximately 5mL of water and 2mL of air
• shake well and allow to disperse (this may take up to 10 minutes)
• ensure all contents of the syringe are given

Alternatively, the tablet may be mixed with 5 to 10mL of water in small glass or medicine cup and stirred well.

Masking the taste

The crushed tablet will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:

• use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
• it might be helpful to use an oral syringe for liquids
• after mixing the crushed tablet with food or drink, give it straight away

Flucloxacillin capsules

Flucloxacillin capsules are available as 250mg and 500mg strengths.

Opening and dispersing

They can be opened and the contents tipped out and mixed with liquid or soft food. However, this should not be performed by anyone with penicillin allergy.

Masking the taste

The capsule contents will taste bitter so it can be helpful to use a strongly flavoured drink (e.g. blackcurrant cordial) or food (e.g. jam, apple sauce, yoghurt) that the child likes:

• use a small amount of food or drink (e.g. a teaspoonful) so you can be sure the child eats it all and swallows the whole dose
• it might be helpful to use an oral syringe for liquids
• after mixing the powder with food or drink, give it straight away

Although flucloxacillin is generally given on an empty stomach, a study in children found there was no difference in absorption when flucloxacillin was given with or without food.

Further advice on preparing medicines

Our additional advice on preparing medicines was written with adults in mind, but can be applied for use in children too.

Advice on repackaging medicines

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