Why Do Antibiotic Medicines Still Taste So Bad in 2024? A neurodivergent struggle

“Please, no. Dad! PLEASE”. On a recent trip to hospital the only option for my son, who lives with Autism and a Learning Disability was to fight his infection by way of antibiotic IV via canula.

The hospital visits have been a fairly regular visit since he was young. He falls ill, gets prescribed oral antibiotics, can't take them as he has oral sensitivities and then ends up in hospital as the only way to get the antibiotics in him are via IV. A route which you can probably imagine is also very distressing.

If you've ever had to take liquid antibiotics, you're probably all too familiar with the intense, often unpleasant taste. For neurodivergent individuals, who can be particularly sensitive to tastes, this experience can be especially challenging. But why, in 2024, can't we produce neutral-tasting antibiotic liquids?

Sensitivity of Taste

Neurodivergent individuals, including those with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), can often have heightened sensory sensitivities. This can make the strong, bitter taste of liquid antibiotics almost unbearable. While pills are an option for some, they aren't always suitable for many. For instance, children and adults with certain swallowing difficulties (dysphagia) might not be able to take pills safely, making liquid medication the only viable option.

The Science Behind That Awful Taste

Antibiotics are fundamentally bitter. This bitterness is a natural property of many of the compounds that make up these medications. Creating a neutral taste involves more than just masking the bitterness; it requires complex chemical alterations that can interfere with the drug's efficacy.

Why Can’t We Make Neutral-Tasting Antibiotics?

After a quick Google (apologies medical community in advance if any of this isnt exact), the challenge lies in the chemistry it seems:

1. Stability and Efficacy: Any additives or modifications to improve the taste must not compromise the drug's stability and effectiveness. Many compounds that could potentially mask the taste also interact with the active ingredients, which can reduce their effectiveness.

2. Safety Concerns: Introducing new compounds to mask the taste can introduce potential allergens or side effects. The priority in drug formulation is always the safety and efficacy of the medication.

3. Cost and Feasibility: Developing a new formulation is a costly and time-consuming process. The pharmaceutical industry needs to balance these costs against the benefits, especially when considering that the current formulations, while unpleasant, are effective.

Why Flavoured Antibiotics Aren't a Perfect Solution

Flavoured antibiotics are often used to try and make the experience more palatable, especially for children. However, creating a truly neutral-tasting antibiotic hasn't been possible. Here’s some possible reasons why:

- Flavouring Agents: While flavouring agents can mask the bitterness to some extent, they can't eliminate it completely. Many antibiotics are so bitter that even strong flavoring agents can only do so much.

- Perception of Taste: Even with flavouring, the combination of the antibiotic's inherent bitterness and the added flavours can create an unpleasant aftertaste. For neurodivergent individuals with heightened taste sensitivity, this can still be problematic.

We're not alone in this.

In the UK, it's estimated that around 1 in 100 children are on the autism spectrum, and many of these children may have sensory sensitivities that make taking bitter medications a daunting task. Additionally, a significant portion of the population, including older adults and those with certain medical conditions, may struggle with swallowing pills, making liquid antibiotics a necessity.

Despite these challenges, research and development continue to seek better solutions. Advances in pharmaceutical technology may one day offer a truly neutral-tasting antibiotic, but until then, the struggle with the bitter taste remains.

While the bitter taste of liquid antibiotics is a significant challenge, particularly for neurodivergent individuals, it stems from the complex interplay of chemistry, safety, and efficacy.

The quest for a neutral-tasting antibiotic it seems is ongoing, or is it not even on the table?

While flavoured alternatives provide some relief, they are not a perfect solution. Understanding these challenges highlights the importance of continued research and innovation in making medications more accessible and palatable for everyone.

So, I sit here today in hope that one day, a solution might just be within reach. So that no parent has to see their child in floods of tears, pleading with them not to have an intrusive canula put in them, for something that in the future could be something that could be so easily administered in the first instance and save some much needed hospital beds for the near week he stayed in hospital this time around.