I had an interesting discussion with one of the pharmacy technicians that really awakened me to the reality of working in a poor, rural area… “When reconstituting powered antibiotics for children, what water do you use and how do patients store the medication once reconstituted?”
Now, admittedly, I haven’t practiced as a dispensing pharmacist for a long, long time (my most recent 15 year was spent at a biotech drug company and before that I was a clinical pharmacist) so I always feel a little out of place when these types of questions arise. But for this one, isn’t the answer simply reconstitute with purified water and tell the person to store it in the refrigerator?
I quickly realized this may be a more complex question than I had initially thought. In some of our clinics we have electric kettles which are used to boil water which is then stored in a plastic container for the purpose of reconstitution. In the other clinics tap water is used for reconstitution. While the water in Swaziland is considered safe to drink, it isn’t a best practice for reconstitution of medications. What I heard next reminded me of the reality of the region in which I am working… if the patient is sent home with the powder not reconstituted, they may reconstitute it themselves with river water. In the clinics where we have full-time pharmacy assistants I am assured this does not happen but in the other clinics when the staff is busy and dispensing (and therefore reconstituting) is only one of their long list of responsibilities, this can be a reality.
Then there is the storage aspect… While storage in the refrigerator is the expectation when we talk about expiration dating for reconstituted medications, many of our patient’s families do not have electricity, never mind a refrigerator. The recommendation of storing the medication in a cool, dark place is the best we can advise.
Ideally we would use syrups to help avoid these issues, and we do (when available), but syrups can be more expensive and more difficult to access. Each day is an eye opening experience and reminds me of the blessings I have and the importance of having dedicated, trained personal in the pharmacy.