From the Guidelines
It's generally not recommended to crush antibiotic tablets unless specifically instructed by your healthcare provider or pharmacist. Many antibiotics have special coatings or time-release formulations that are designed to work in specific ways in your body. Crushing tablets can interfere with how the medication is absorbed, potentially making it less effective or causing side effects.
Key Considerations
- Some antibiotics like amoxicillin or azithromycin may be available in liquid form if swallowing pills is difficult.
- Extended-release formulations like Augmentin XR or Biaxin XL should never be crushed as this would release all the medication at once rather than gradually.
- If you're having trouble swallowing pills, speak with your healthcare provider about alternatives such as liquid formulations, different dosage forms, or proper techniques for swallowing pills.
- Some antibiotics can irritate your esophagus or stomach if their protective coating is removed by crushing, as seen with certain medications in patients with short bowel syndrome 1.
Administration Through Feeding Tubes
While there is guidance on administering certain medications through feeding tubes, such as apixaban, rivaroxaban, and edoxaban, where crushed tablets may be suspended in water for administration 1, this does not directly apply to antibiotic tablets.
Recommendation
Always consult your healthcare provider before altering the form of any medication, including antibiotic tablets, to ensure safe and effective treatment. Completing the full course of antibiotics as prescribed is crucial, even if symptoms improve, to fully treat the infection and prevent antibiotic resistance.
From the FDA Drug Label
Swallow clarithromycin extended-release tablets whole; do not chew, break or crush clarithromycin extended-release tablets. The answer is no, you should not crush antibiotic tablets, specifically clarithromycin extended-release tablets, as indicated in the dosage and administration instructions 2.
From the Research
Crushing Antibiotic Tablets
- Crushing antibiotic tablets can have serious consequences, including alteration of the drug's absorption, which can result in overdose or underdosing, rendering the treatment ineffective 3.
- The practice of crushing tablets or opening capsules can also disrupt a drug's sustained-release properties, leading to overdose, or destroy a gastro-resistant layer, resulting in underdosing 3.
- Additionally, the active ingredient released may degrade on contact with light, moisture, or food, and the person crushing the tablets or opening the capsules may be exposed to drug particles that can be carcinogenic, teratogenic, or fetotoxic 3.
Risks Associated with Crushing Medications
- Crushing or splitting medications can be harmful and potentially dangerous, especially for older adults who may have difficulty swallowing pills 4.
- Clinicians should discuss medication administration with patients, clarify the dosing schedule, and clearly indicate the route of administration to avoid any potential risks 4.
- A survey revealed that crushing tablets or opening capsules is a common practice, especially among elderly people, but alternative forms exist and can be prescribed 5.
Impact of Recommendations on Crushing Medications
- Regional and national recommendations have led to an overall improvement in practices for crushing drugs, including a reduction in the number of patients receiving crushed drugs and the number of crushed drugs 6.
- Technical improvements are still possible, in association with appropriate pharmacological studies, to ensure safe and effective medication administration 6.
Specific Antibiotic Tablets
- There is no specific evidence provided on crushing antibiotic tablets, such as clarithromycin or amoxicillin, but it is essential to follow the recommended administration instructions to ensure efficacy and safety 7.