1. 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.

2. 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

3. Why?!
What?!
How?!

4. UHW Broad spectrum abx DDDs

5. MAU audit

6. 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,

7. First gen ceph cefalexin and cephradine

8. c.Diff 2013/14

9. 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

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

11. 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

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

13. 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

14. Requiring careful dosing and monitoring

16. 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)

17. Remember remember the 5th November

18. Countdown to the 5th November

20. 20

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

25. Available from Microbiology and Pharmacy

26. Thank you for listening
Any questions?