I am allergic to amoxicillin. Reconstituting hundreds of amoxicillin suspensions through my early years as a community pharmacist is how I feel that I sensitized myself. That was back in the days of Trimox, Wymox, and Amoxil. I remember the great deals we used to get buying these products directly from the manufacturer, with prices way below AWP, and getting six months to pay. Some companies would even give free gifts, from teddy bears to TVs!
Back to that pesky allergy. I had some dental work done and the dentist ordered some amoxicillin for me and shortly after the first dose, I developed a bight red, very itchy rash over most of my body. I had no prior problems with any of the penicillin family of antibiotics, taken years earlier. We found an alternative and time and Benadryl cleared up the rash. I thought back to mixing all those pediatric suspensions when the water was added and a little pink cloud of powder rose out of the bottle like smoke from a chimney. Occasionally, I could even taste or smell it, so I know it was getting into my body. A certified technician is now my preferred method of reconstituting any of the penicillins. Either that or I hold my breath!
Much more recently, I have had the “opportunity” to do much more product dispensing (counting and pouring) than usual and another concern became apparent. No, not the lack of technician staffing. I addressed that 2 or 3 blog posts ago.
Moving from the pharmacist work station to the dispensing counter, I often inherited an incredibly dusty counting tray and spatula. I think this is a pretty common situation in most retail pharmacies and perhaps in other types of practice sites as well. How much of this drug-laden dust are we passing on to the next patient?
I’ve always been pretty meticulous about using a clean tray, wiping it down frequently with a paper towel damp with alcohol. Obviously, others are not so rigorous. The tray in the picture may be an extreme example of a dusty tray, but it is something I find from time to time at a variety of practice sites. Are we increasing the incidence of drug allergies within our patient population by not frequently cleaning the apparatus we use to move the “pills from the big bottle to the little bottle,” as Jerry Seinfeld has described community pharmacy practice? I think it is entirely possible. Exposure to these minute amounts of drug may not only lead to new allergies that could potentially cause harm or confound future treatment plans, there may be other biological consequences to this low level exposure. Just look at the changes to our animals friends that are caused by drug contamination of the environment.
In our busy workdays, we rarely have the time to contemplate issues such as this, which may seem inconsequential, but are actually overlooked problems with easy solutions.