Co-amoxiclav prescribing: York House Medical Practice Dr. Emma Garde (GPST2) Parveen Ahmed (Pharmacist)

Introduction 2 previous audits done on cephalosporins and quinolones Reduction in prescribing of these over last 3-4 years but co-amoxiclav rates are still high Aims To assess whether prescribing of co-amoxiclav is in line with the Worcestershire Primary Care Trust anti-microbial Guidelines both for indication, dose and duration

Criteria and Standards Exclusions All prescribing of co-amoxiclav is compliant with the indication recommended within the guidelines 100% Patient allergic/intolerant/contra-indications to all other possible antibiotics Dose and duration of co-amoxiclav are compliant with he guidelines None

140 patients identified: 30 randomly selected 30 patients included January to March 2015 Identified using Emis Assessed by looking through prescribing and clinical records; checked against Worcestershire Anti-microbial Guidelines

Results: Criteria 1 Criteria Exclusions Number not compliant with guidance % (n) Number compliant with guidance % (n) Standard % Achieved % (n) Prescribing of co-amoxiclav for each indication compliant with the guidelines 53 (16) 47 (14) 100 47 Indications: higher UTI/pyelonephritis; upper UTI in children; uncomplicated UTI in catheterised patients; COPD acute exacerbation; chronic sinusitis; human&animal bites; mastitis; diverticulitis; cholangitis; diabetic foot infections; orbital or facial cellulitis

Criteria 1: Is indication of co-amoxiclav compliant with current antibiotics guidelines?

Criteria 1: Examples not compliant with guidelines Emis Date of script Prescriber Indication Dose Duration 13416 03/03/2015 SM Holiday cover 500/125 7 DAYS 13310 23/03/2015 KP Parotitis 21995 19/01/2015 SP Simple UTI 12663 15/01/2015 AM Hand cellulitis 7 days 21745 11/03/2015 HS Sebaceious cyst 38163 26/02/2015 AC 250/125 5 days 31274 24/03/2015 CW 10 days 37835 20/03/2015 Cough 125/31 18316 KT 15796 ongoing LH UTI prophylaxis Ongoing 13166 12/01/2015 facial cyst/simple UTI 500919 27/03/2015 IA impetigo 250/62 12415 06/02/2015 LRTI 16174 08/01/2015 UTI 13006 16/01/2015 33274 NC Abdo discomfort

Criteria 1: Examples compliant with guidelines Emis Date of script Prescriber Indication Dose Duration 14266 24/02/2015 SR Orbital/facial cellulitis 500/125 7 days 37428 12/02/2015 SP Higher UTI 34742 03/02/2015 SM COPD acute exacerbation 8845 20/01/2015 AM Diverticulitis 16243 02/01/2015 Human and animal bites 26776 05/01/2015 13013 19/01/2015 17244 17006 02/03/2015 20719 26/01/2015 16890 08/01/2015 11990 AC 10 days 5030 29234 IA

Results: Criteria 2 A B C Criteria No of patients prescriptions compliant with guideline No of prescriptions from A whos dose and duration were compliant with guideline Standard achieved Is the dose and duration adherent with the guideline recommendations? 100 (14) 100

Criteria 2: Of those prescribed with correct indication, is dose and duration adherent with antibiotic guidelines?

Results: Other 4/30 (13%) prescriptions preceded by culture&sensitivity 1prescribed as per guideline 2/30 (6%) COPD resistant risk factors 100% prescribed correctly Co-morbid disease; severe COPD; frequent exacerbation; abx in the last 3/12 5/30 (16%) Abx related outcomes 2 prescribed as per guideline abx related diarrhoea (2), whether co-amoxiclav (or any other abx) was re-prescribed for same indication (2), hospital admission (1), other abx related adverse affect (0)]

Comments: Criteria 1 : prescribed as per indication Poor outcome Incorrect prescription (simple UTI) Sparse criteria (e.g. parotitis/lymphadenitis/recurrent UTI) Incorrect coding

Comments: Criteria 2: dose and duration correct Good outcome

Comments: Other results: - Details gathered about 1st/2nd/3rd line but guidelines not comprehensive enough - Re culture/sensitivities – not appropriate for specified diagnoses COPD risk factors change guideline

Recommendations Re-audit Awareness of COPD risk factors – these change guidance! Locum/NP to be aware of abx guidelines Careful coding (COPD as LRTI, diverticulitis as lower abdo pain) Recent change to guidelines *Guidelines updated Oct 15, due for review Oct 18 Practice or partnership wide abx guidance for other indications which are not included? Thoughts?

Thanks!