The NHS Specialist Pharmacy Service (SPS) has issued guidance on using solid oral dosage form antibiotics 'off-label' in place of oral suspensions – including in cases of Group A streptococcal infections in children.

In guidance published today, it said that where possible, children should be encouraged to swallow oral solid dose forms (tablets and capsules), and pointed to guidance from Medicines for Children and Health Education England about teaching children to swallow pills.

SPS has also provided advice on how to give doses by dispersing or crushing tablets, or opening capsules – a use which is outside of the product license and therefore ‘off-label’.

It said that many tablets can be crushed and mixed with liquid or soft food, or capsules opened and the contents tipped out and mixed with liquid or soft food, and that a strongly flavoured drink or food could be used to mask the bitter taste.

This includes phenoxymethylpenicillin (Penicillin V) tablets and amoxicillin capsules, but that this should not be undertaken by anyone with a penicillin allergy.

This also applies to cefalexin tablets and capsules, although this should not be performed by anyone with a penicillin or cephalosporin allergy.

Azithromycin tablets and capsules can also be crushed or opened and mixed with a liquid or soft food.

For some medicines, only certain formulations can be crushed and mixed with liquid or food. For example, clarithromycin immediate-release tablets can be crushed and mixed with liquid or soft food, but that the modified-release tablets must not be crushed.

Film-coated Erythromycin tablets can also be crushed and mixed with liquid or soft food, but eteric coated tablets should not be crushed, and crushing these tablets should not be undertaken by anyone with a macrolide allergy.

The guide contains information on how to make up the appropriate dose, as well as instructions on how to open capsules and crush tablets.

Prescribers and pharmacists have been working to find alternative antibiotics formulations, as pharmacists report 'patchy' supplies.