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

2. 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

3. 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

4. 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

5. 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

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

7. 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

8. 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

9. 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

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

11. 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)]

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

13. Comments:
Criteria 2: dose and duration correct
Good outcome

14. 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

15. 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?

16. Thanks!