1. Acta Clin Belg. 2013 Mar-Apr;68(2):81-6.

Evaluation of the appropriateness of intravenous amoxicillin/clavulanate
prescription in a teaching hospital.

Artoisenet C, Ausselet N, Delaere B, Spinewine A.

Université Catholique de Louvain, CHU Mont-Godinne, pharmacy, Yvoir, Belgium.
charline.artoisenet@uclouvain.be

BACKGROUND: Despite the implementation of strategies aiming at improving
antimicrobial utilisation, inappropriate use remains an increasing problem with
important consequences on both antibiotic resistance and hospital costs.
OBJECTIVE: To evaluate the appropriateness of prescribing the intravenous
amoxicillin/clavulanate combination (Augmentin).
METHODS: Prospective observational five-week study in a Belgian teaching
hospital. Patients receiving prophylactic or therapeutic intravenous
amoxicillin/clavulanate were enrolled. Data were collected by a pharmacist and
the appropriateness of antibiotic treatment was analysed in collaboration with an
infectious disease specialist according to local recommendations. The primary
outcome measure was the appropriateness of indication, dosage, intravenous to
oral switch and duration of therapy.
RESULTS: One hundred and six patients were evaluated. The most common indications
for amoxicillin/clavulanate prescriptions were: respiratory tract infections
(38%), surgical/interventional prophylaxis (28%) and intra-abdominal infections
(11%). Overall, 43% of intravenous amoxicillin/clavulanate prescriptions were
fully appropriate. Indication for use was appropriate in 87% and dosage in 74% of
cases. In contrast, the timing of intravenous to oral switch and duration of
therapy were inappropriate in 64% and 53% of cases, respectively.
CONCLUSIONS: This study identified two main areas for improving
amoxicillin/clavulanate prescribing: (1) the intravenous to oral switch, which is
often too late or nonexistent and (2) the duration of therapy, which is too long 
particularly in respiratory tract infections. The results have been presented to 
clinicians and specific interventions for optimisation are being discussed and
implemented.

PMID: 23967713  [PubMed - indexed for MEDLINE]