Episode 3 — You've missed a dose of the antibiotic. What now?

Ah, Friday evening, half seven.

Leon, he's nine, is tucked up in bed with his teddy,

explaining to me that the light has to stay on, but only a little bit.

Day three of the antibiotic, his ear.

Augmentin, three times a day, eight in the morning, two in the afternoon, eight at night.

And as I'm settling him down, I look at the orange bottle on the chest of drawers.

And it's only now that it hits me.

Two o'clock.

Two o'clock was when Leon had a temperature of 39.

I was ringing the surgery, a GP on the phone, a dose of paracetamol,

the visit to his gran cancelled, my husband at work.

And that little pink medicine syringe stayed on the kitchen worktop, untouched.

And now, half seven, he's fast asleep.

In half an hour, I meant to give him the eight o'clock dose.

Question, give a double one to make up for it?

Skip the eight o'clock one, since the two o'clock's gone anyway.

Ring the GP on a Friday night.

Hello, I'm Tomasz Schuster, and I built the Moya Pteczka app.

Isa, did this actually happen today?

Not today, but last November, yes.

Six hours went by before I'd admit to myself that I had no idea what to do.

And it wasn't the first time.

Listen, this isn't Isa's just unlucky.

This is data from the World Health Organization.

With long-term treatments, half of patients missed doses.

Half?

And for short antibiotic courses, the proportion that never get finished comes out even higher.

Different studies, different countries, all agreed on one thing.

A missed antibiotic dose isn't the exception.

It's the norm.

That doesn't help me.

Quite the opposite.

Half of all parents, me included.

And the bacteria we didn't quite finish off is busy breeding resistance.

Brilliant.

I know.

Which is why this episode isn't about why we missed doses.

It's about what to do in that moment.

Half seven on a Friday, when you've already missed one, and you don't know what's next.

All right.

Tell me.

Because the myth of double dose, we'll make it up, is stuck in the head of just about every parent.

And it's wrong.

For most medicines.

But here's the catch.

I, Tomas, I'm not going to tell you now, on a podcast, whether to double the augmenting specifically, or skip it.

Why not?

Because that is not a podcaster's call.

It's the pharmacists, or the GPs.

And that's exactly where the app can do something.

Meaning?

The app doesn't prescribe.

The app hands you the facts for the phone call you're about to make.

You open the Moira Pteczka app on the Friday at half seven.

You look at Leon's card, at the Augmentin entry.

And you see a bar.

Dose seven of twenty-one.

And next to today's times, two o'clock in red, due.

Which is exactly what the GP on the line is going to ask.

Yes.

You ring.

You say,

Hello, my nine-year-old, day three of Augmentin.

I've missed the two o'clock dose.

The last one was this morning.

The next is due at eight.

What do I do?

And the pharmacist answers straight away.

In thirty seconds.

Because you're asking something specific.

Not,

I've got in a muddle, please help me.

The app turns panic into one precise question.

So, the app is a cheat sheet for my brain.

Which, at half seven on a Friday, has well and truly clocked off.

Exactly.

And there's a second thing.

You tap Taken on the notification when you give the medicine.

Recorded immediately.

Even with no signal.

Even with no signal?

Even if you close the app or switch the phone off.

The dose is saved locally.

It syncs back the moment you've got signal again.

And if I simply don't hear the notification?

Phone on silence.

Kids in the bath.

Dinner on the hob.

My dad ringing.

That's exactly the case this record is built for.

It doesn't depend on your mood as a parent.

The app just waits.

At six the next morning, on the Saturday,

when you wake up and put the kettle on,

you open the app and you see

Yesterday.

Two o'clock.

In red.

Due.

You look at the facts.

You decide what happens next.

Tom.

I'm starting to see it like this.

The app takes the counting and the remembering off me.

But it does not take the responsibility for the decision off me.

And that's exactly the line most medical apps don't respect.

Most apps pretend they'll handle the lot.

You've missed a dose.

Take it now.

That's pseudo-medical advice with no pharmacological basis for most medicines.

Because every medicine is different.

Augmentin in a child.

Levothyroxine in an adult.

The contraceptive pill.

Blood thinners.

Each has a different rule for what to do after a missed dose.

An app that pretends to know every rule for every medicine is an app that lies.

All right.

That does sound honest.

We don't pretend to be doctors.

That's the whole point.

The edit is your memory.

The GP and the pharmacist are your knowledge.

Those are two different things.

Right.

Practical question.

Leon finishes the antibiotic.

We're going to the GP on Monday for a check-up.

What do I take with me?

You open the app.

On Leon's card, you choose Export PDF Report.

The app makes an A4 sheet landscape, laid out as a table.

And what's on it?

The medicine name with the strength.

Augmentin.

312.5 milligrams per 5 milliliters.

The active ingredient.

Amoxicillin with clavulanic acid.

The schedule.

8-2-8.

And the details.

Prescription or over-the-counter.

How much is left.

The expiry date.

So the GP doesn't have to ask, and what's the child actually been taking?

They can see it.

They see the exact schedule.

In black and white.

Not from your memory.

That's half the conversation done.

Before you've even sat down.

And how many doses we actually gave?

That's on the screen.

On the card.

The bar.

Dose 20 of 21.

One not ticked off.

That Friday, 2 o'clock.

The app doesn't put that in the PDF.

And it doesn't judge you for it.

But you can see the counter.

And you can tell the GP straight out.

20 of 21.

I missed one.

Because normally the GP asks across the desk.

So, Mum, has he been taking it properly?

And I say, yes, Doctor.

And I go home feeling like I've just told a lie.

And you know what really gets to me about that question?

That it's put as if the GP were testing me.

And I've got two children.

Leon with a temperature.

Basher at nursery with chicken pox.

And I'm supposed to sit down and admit,

Friday night I forgot.

Saturday morning I forgot.

And that's why a parent lies.

Because the shame is bigger than the fear of a second course.

And then I'm looking at the prescription for the next antibiotic.

A stronger one.

Because the course didn't work.

And a GP who doesn't know the first one was missed prescribes a second.

And the cycle feeds itself.

Stronger antibiotic.

Resistance grows.

That is a public health problem.

And it breaks in a single moment.

When, instead of shame, you've got a counter.

You say, 20 of 21, I missed one.

And the doctor looks at the fact.

Not at your face.

Alright.

And do you remember Joanna from the last episode?

Eight medicines a day.

73.

Polypharmacy.

I remember.

And that's the second layer of this.

Because for Joanna, a missed dose of ferrosamide, a water tablet for her heart,

is not the same as a missed dose of vitamin D.

The first one's dangerous.

The second isn't.

The first is clinically significant.

The second's a bruised ego, not a health problem.

And the app doesn't know which is which.

And a good thing it doesn't.

And a good thing it doesn't.

Because if it pretended to know, it'd be telling that very lie we talked about.

The app does one thing.

It shows whether today's dose is ticked off or waiting.

The daughter asks,

Mum, did you take the pink one?

Mum opens it,

sees, done, next to today's dose.

Answers, yes love.

Nobody's guessing.

It's smaller than it sounds.

And bigger than it sounds.

Both at once.

And there's a third case hardly anyone talks about.

Levothyroxine.

The thyroid tablet.

A mum, 42, every morning, on an empty stomach, half an hour before her coffee.

A simple rule, supposedly.

For 20 years, supposedly.

And what happens?

What happens is that three mornings a week she takes the tablet with her coffee.

Because she's up, making the sandwiches, someone's shouting, someone's lost a shoe.

She sips her coffee, glances at the worktop, sees the box.

Did I take it or not?

Well, I must have.

I always do.

She takes a second one to be safe.

Or she doesn't take it at all because I've probably already had it.

And that's exactly the question the app answers.

It doesn't shout, Anna, take it now.

It just, on the levothyroxine card, today's dose is either ticked off or waiting.

Did I take it today?

You look, you know.

No more guessing.

So I don't take a second one and I don't skip it out of uncertainty.

Yes, the app won't draw you an adherence chart over six months.

But every morning, it answers one question.

Did I take it or not?

And when you go to the endocrinologist to check your thyroid, your TSH, you go with the

habit of marking every single dose.

Not with, I think I've been fairly regular.

And this is a mum, not a gran.

The sandwich generation has its health too.

Exactly.

Missing doses isn't a pensioner's problem.

It's the problem of anyone who takes something every day and has children, a job, a phone,

a mum, a mother-in-law, two cats.

And there's one more feature we haven't mentioned.

Because Leon took Augmentin for seven days, but on day five, in the app I saw there were

three doses left, and in the bottle there was already half a measure.

Not enough.

And the app told you that?

A notification for the eight o'clock dose on the Saturday morning.

Augmentin.

One measure.

Only 0.8 of a measure left in your cabinet.

Remember to top it up.

I put my shoes on, drove to the chemists, bought a second bottle.

Leon finished the course.

No panic at eight on the Sunday night.

Oh no!

The antibiotics run out.

The chemists are all shut.

Exactly.

And it's a small detail, but with an antibiotic, it makes a difference.

A dose missed because the bottle ran out is the daftest missed dose you can possibly imagine.

The app steps in, so that doesn't happen.

Yes.

Yes.

The Moyab-Techa app won't finish the course for you.

You'll finish it.

Because you ring the pharmacist.

Because you open the notification.

Because you look at the bar.

20 of 21.

The app is a tool for memory.

The decision stays with you and your GP.

By the way, everything we're talking about here really is a feature in the Moyab-Techa app.

This isn't an advert, just for context, to be clear.

If you're listening to this with a poorly child on antibiotics at home,

or an elderly parent on a pile of medicines,

or yourself on levothyroxine,

the Moyab-Techa app is free and works offline.

You'll find the link in the episode description.

And if you liked the episode,

share it with someone who gets up in the morning thinking,

today I won't forget.

And forgets.

One more thing before we go.

This podcast is made with the help of artificial intelligence.

I wrote the dialogue myself,

but the voices you're hearing aren't ours.

They're AI-generated synthetic voices.

We're telling you this straight out because

we think it should be the standard for any podcast made this way.

Full details are in the show notes and in every episode description.

Until next time.

Until next time.