Willie Chan flips through his recipe book, trying to decide. Watermelon? Orange? Cherry? How does one make penicillin palateable?
Actually, Chan, a pharmacist at Primary Children's Medical Center, doesn't have to decide. He knows that there are 10 fruit flavors that can convince a child to take penicillin.Biaxin, another antibiotic, requires a three-flavor fruit salad to get tykes to taste it, much less finish an entire course of the medication. Vanilla sweetens the drug. Watermelon makes it more fruity. And a bit of cherry is added "for the final touch."
It's all right there in the recipe book, which tells a pharmacist how to "decorate" cough syrup with root beer or butterscotch, peach or grape or even bubblegum flavoring.
The brainchild of Washington, D.C., father-and-son team Harold and Kenneth Kramm, the recipe formulary lists 42 different flavorings that can be used to make medication bearable for picky young children. And it tells which ones, in which quantities, work with the liquid medications most commonly subscribed for young children. They knew that it's critically important that children take the full course of medication prescribed for them.
To come up with the book, the Kramms turned their pharmacy into a tasting kitchen. For three years, they tested and tasted, mixed and matched, rejected and approved their concoctions so that pharmacists like Chan, some thousands of miles away, can make it a little easier for parents to give children their medicine.
Pharmacists subscribe to the formulary system. The goal is to find combinations that "do not taste so much like candy that children will be tempted to take too much," Chan said. "We want it to be better, though, so that children will tolerate the horrible taste of some of the medications doctors order for them."
Best of all, the flavor combinations are "guaranteed not to inhibit the medication but just to enhance compliance."
That doesn't mean that children should have to have flavoring added to every medication. The flavoring process targets children who have to take a lot of medicine and can't finish unless cajoled, Chan said.
The flavorings are by request only, because the prescription costs more with them. At Primary's pharmacy, signs tell parents they are available for $4 more, which can't be billed to insurance.
It's a bargain, said one mother, adding she's seen more than one prescription wasted when a child batted it away and it spilled on the ground.