Ruth McAleer Antimicrobial Pharmacist Cardiff and Vale UHB Arrivederci ……….……….. Ruth McAleer Antimicrobial Pharmacist Cardiff and Vale UHB 10 minute presentation on an intervention their HB has introduced to support antimicrobial stewardship. It can be guidance, formulary, audits, apps, charts, working groups etc. Anything that you have undertaken around stewardship that you can share with the group.

Co-amoxiclav Restricted in adults in CAV secondary care Primary care and paediatrics unaffected…for now Removed from empirical treatment guidelines Animal bites, obstetrics, some ENT, some surgical prophylaxis Removed from ward stock

Why?! What?! How?!

UHW Broad spectrum abx DDDs

MAU audit

Change in CAVUHB antibiotic guidelines Reduce the use of Co-amoxiclav (Augmentin®) The main aims of this change are to reduce the current number of c.difficile cases,

First gen ceph cefalexin and cephradine

c.Diff 2013/14

Change in antibiotic guidelines Reduce the use of Co-amoxiclav (Augmentin®) The main aims of this change are to reduce the current number of c.difficile cases, to reduce resistance towards co-amoxiclav and

Co-amoxiclav Resistance of E Co-amoxiclav Resistance of E.coli isolated from blood cultures: UHW: 37% UHL: 58% All Wales: 42%

Change in antibiotic guidelines Reduce the use of Co-amoxiclav (Augmentin®) The main aims of this change are to reduce the current number of c.difficile cases, to reduce resistance towards co-amoxiclav and to improve overall antimicrobial stewardship -removing a default “one size fits all” antibiotic option New guidelines will recommend replacing co-amoxiclav with different antibiotics, depending on the indication Doxycycline Amoxicillin Metronidazole Gentamicin Co-trimoxazole

ONE SIZE Fits all-antibiotic/ no brainer! WE NEED to promote better STEWARDSHIP!

Change in antibiotic guidelines Reduce the use of Co-amoxiclav (Augmentin®) The main aims of this change are to reduce the current number of c.difficile cases, to reduce resistance towards co-amoxiclav and to improve overall antimicrobial stewardship -removing a default “one size fits all” antibiotic option New guidelines will recommend replacing co-amoxiclav with different antibiotics, depending on the indication Doxycycline Amoxicillin Metronidazole Gentamicin Co-trimoxazole

Requiring careful dosing and monitoring

Co-trimoxazole (Septrin®) Off licence use Co-trimoxazole 960mg bd (reduced to 480mg bd in renal impairment egfr<30mL/min) Very good oral absorption Available in tablets, liquid and IV (IV restricted to those NBM or with sepsis) Interactions Trimethoprim and sulfamethoxazole- BNF lists separately Warfarin, MTX, 6MP, AZA, ciclosporin, clozapine, amiodarone Potential side effects Nausea, vomiting, diarrhoea Rash (usually minor but rare cases of SJS,TEN so stop if suspect rash 2° Septrin) Reversible small increase in creatinine (monitor U&Es) Blood dyscrasias (watch FBC) Hyperkalaemia (monitor U&Es)

Remember remember the 5th November

Countdown to the 5th November

20

Tools ANTIMICROBIAL (Approved Name) Indication: PRESCRIBER’S SIGNATURE Bleep No. PHARM D/W MICRO Y / N 48hr rv consultant signature: Duration/ review date: SUPPLY

Available from Microbiology and Pharmacy

Thank you for listening Any questions?