Common errors in reconstituting oral antimicrobials: A survey of caregivers

Abstract

Antimicrobial resistance (AMR) is a growing global health threat, particularly in low- and middle-income countries (LMICs). Inappropriate use of antimicrobials, including incorrect reconstitution of oral suspensions, contributes to AMR. This study investigates reconstitution practices among caregivers in Nigeria and their potential impact on AMR. A cross-sectional field-laboratory study was conducted in Abuja, Nigeria, involving 200 breastfeeding mothers who reconstituted two commonly used pediatric oral suspensions (artemether/lumefantrine and cefuroxime) using different water sources. The physicochemical properties of the reconstituted suspensions were analyzed, and the accuracy of reconstituted volumes was assessed. The study found significant variability in the physicochemical properties of the reconstituted suspensions, depending on the water source used. Only 17% of caregivers achieved correct reconstitution, with the majority (83%) committing errors that could lead to sub- or supra-therapeutic dosing. The patient-reported errors were often due to under- or over-dilution, resulting in deviations from the
recommended final volumes. The study highlights the need for targeted interventions to address incorrect reconstitution practices among caregivers in Nigeria.