Objectives Medicines account for 25% of NHS carbon emissions; switching to ‘low-carbon alternatives’ is required to achieve Net Zero by 2045.¹ Many paediatric medicines are prescribed as liquids despite evidence that children can swallow pills from age four.² Prescribing pills over liquids leads to significant financial savings, yet little research exists comparing the carbon footprint of different medicinal formulations. This study aims to address this. We are limited by lack of information on the carbon emissions of pharmaceutical excipients; therefore we aim to calculate the carbon footprint for packaging, distribution and waste disposal of capsule and liquid formulations of amoxicillin (see figure 1). Methods We chose a common clinical problem as a functional unit of comparison: management of group A streptococcal tonsillitis in a 6 year-old child (500mg amoxicillin TDS for 7 days). A pharmaceutical company supplying both liquid and capsule amoxicillin was identified. Individual packaging materials were isolated and weighed. The carbon footprint of producing each material was calculated using UK Government greenhouse gas conversion factors³ and added together to give a total for each formulation of amoxicillin. The carbon footprint of waste disposal for each individual material was calculated in the same way, assuming 100% was domestically recycled. Carbon emissions for distribution were quantified using average distances from continent of origin (Europe) and average emissions for mode of transport (HGV) by weight for each item. Results Figure 2 displays total carbon emissions for the packaging, distribution and waste disposal of each item. Carbon emissions (in kg CO2e) for treating group A streptococcal tonsillitis in a 6 year-old child were 0.093 for 250mg capsules, 0.066 for 500mg capsules and 0.307 for 250mg/5ml oral suspension. Conclusions The carbon footprint of packaging, distribution and waste disposal of liquid amoxicillin is more than double that of capsules for individually packaged items. The difference in carbon emissions increases to three-fold for a 7-day course of treatment. This is largely explained by increased wastage due to the requirement to dispense whole bottles of liquid formulations as opposed to partial packets of capsules. The accuracy of this study is limited by lack of data on pharmaceutical excipients. We assumed that equivalent doses of active ingredients have a similar carbon footprint, but excipients vary widely between different formulations. Cooperation of the pharmaceutical industry is needed to produce accurate carbon footprints which can inform low-carbon prescribing decisions. References NHS England. ‘Delivering a ‘Net Zero’ National Health Service’, 2022. Tse, et al. ‘The KidzMed project: teaching children to swallow tablet medication’, 2019. ‘UK Government GHG Conversion Factors for Company Reporting’, Department for Business, Energy & Industrial Strategy, 2022.
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Parker et al. (2023) studied this question.