Over the past 10 years, many new antibiotics have been labeled for use in children. In some conditions, the indications for antimicrobial selection remain narrow and straightforward. However, some situations are more complex because several therapeutic agents are efficacious. When there are several alternatives available, issues of cost, safety, ease of administration, dosing regimen and palatability should be considered in the selection of an antibiotic. Several studies have reported palatability to be an important determinant of compliance. Angelilli and colleagues previously demonstrated that antibiotic palatability could be assessed in children with the use of a visual analog scale. They used their previously validated tool, known as a “facial hedonic scale,” to assess the palatability of four antimicrobial agents effective against beta-lactamase infections in children.

Children were enrolled through a general clinic at an urban children's hospital. The study was a single-blind taste test of azithromycin, cefprozil, cefixime and amoxicillin-clavulanic acid. Each child was given 2.5 mL of each antibiotic agent. They were not allowed to have anything to eat or drink one hour before the study. After each dose of antibiotic, the child was asked to rate the taste of the medication by using the facial hedonic scale. They were also asked to state which antibiotic tasted the best and which tasted the worst.

The study enrolled 30 children between five and eight years of age. There was an equal number of boys and girls, and the majority were black. Twenty of the 30 children had a specific antibiotic preference, with nine stating that cefixime tasted best. An equal number of children were divided in their preference for one of the other three agents. The opposite occurred with regard to the worst-tasting antibiotic. Only two children selected cefixime as the worst-tasting antibiotic, and approximately one third of the children selected one of the other three antibiotics as the worst tasting. The visual analog scale confirmed these observations. The average taste score for cefixime was 8.53 compared with 6.43 for the other three antibiotics.

The authors conclude from this study that cefixime was significantly more likely to be selected as the best-tasting agent when compared with three other medications that have efficacy against beta-lactamase–producing bacteria. In addition, this study reconfirmed the utility of a visual analog scale in assessing palatability of a medication. The authors believe that scales such as the facial hedonic scale should be used routinely to study medications being developed for pediatric use.