Penicillin VK oral suspension
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* Nevio Cimolai

In response to Gilles and colleagues research article,1 I would like to point out that regardless of the adverse effects associated with amoxycillin use, it is among the most commonly used antibiotics for respiratory infection in Canada. It is often prescribed as a substitute for penicillin VK in the treatment of presumed or established streptococcal pharyngitides. There may be some justification for amoxycillin or cephalexin use in select streptococcal pharyngitides, but these antibiotics carry a larger spectrum of antimicrobial activity than penicillin and, as such, raise greater concern for driving antibiotic resistance.

Underlying this dilemma, is the lack of availability for oral penicillin VK suspension for pediatric use in Canada. The oral suspension (in contrast to the available tablet form) is an orphan drug and would need to be compounded specially. Greater availability of penicillin VK oral suspension could play a small role in diminishing antibiotic resistance in the community and in diminishing some of the adverse effects attributed to the larger spectrum amoxycillin.

## Reference

1.  Gillies M, Ranakusuma A, Hoffmann T, et al. Common harms from amoxicillin: a systematic review and meta-analysis of randomized placebo-controlled trials for any indication. CMAJ 2015; 187:21–31.
    
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