Intravenous amoxicillin-clavulanic acid: prescribing practices in Australian hospitals

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2024-07-04 DOI:10.1002/jppr.1930

Alexandros Chronas BBioMed, MD, Karin Thursky MBBS, BSc, MD, FRACP, FAHMS, FAIDH, Simone Mo BBioMed, MD, Lisa Hall BTech(BiomedSci) (Hons), PhD, Rodney James BMedSci, BMed, MPHTM, FRCPA, Courtney Ierano BPharm(Hons), GradCertPharmPrac, PhD

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Abstract

Background

Oral amoxicillin-clavulanic acid, a broad-spectrum antimicrobial and one of the most commonly prescribed antimicrobials in Australia, has demonstrated poor prescribing guideline compliance and appropriateness. This may have inadvertent impacts on patient care and safety, from adverse drug reactions to antimicrobial resistance. Intravenous (IV) amoxicillin-clavulanic acid was first registered in Australia in 2017, reflecting a subsequent and immediate increase in use. There is a need to assess the quality of such prescribing.

Aim

To describe the quality of IV amoxicillin-clavulanic acid prescriptions through assessing guideline compliance and appropriateness of use in Australian hospitals.

Method

A retrospective data analysis of IV amoxicillin-clavulanic acid prescriptions from the Hospital National Antimicrobial Prescribing Survey database between 2013 and 2021. The main outcomes measured were guideline compliance and appropriateness. Ethical approval was granted by the Melbourne Health Human Research Ethics Committee (HREC/74195/MH-2022).

Results

The proportion of prescriptions for IV amoxicillin-clavulanic acid, compared to all other antimicrobials, increased from 0.02% (2013) to 2.3% (2021). Guideline compliance and appropriateness have overall decreased (by 18.9% and 16.7%, respectively). Over time, national guidelines predominantly replaced local guidelines as the primary guideline source for prescribing. The most common reason for inappropriateness was unnecessarily broad spectrum of activity (39.5%).

Conclusion

Intravenous amoxicillin-clavulanic acid prescribing continues to increase throughout Australian hospitals, with notable reductions in guideline compliance and appropriateness. Since 2019, the increase in these outcomes coincided with updated national prescribing guidelines, evident by prescribers utilising national over local guidelines. These findings reinforce the concept that antimicrobial stewardship initiatives, including auditing, robust national guidelines and education, are crucial to optimise IV amoxicillin-clavulanic acid prescribing.

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静脉注射阿莫西林-克拉维酸：澳大利亚医院的处方做法

口服阿莫西林-克拉维酸是一种广谱抗菌药，也是澳大利亚最常用的处方抗菌药之一，但其处方指南的合规性和适当性却很差。这可能会对患者护理和安全造成意外影响，包括药物不良反应和抗菌药耐药性。静脉注射（IV）阿莫西林-克拉维酸于 2017 年首次在澳大利亚注册，反映出使用量随之立即增加。通过评估澳大利亚医院使用阿莫西林-克拉维酸的指南合规性和适当性，描述静脉注射阿莫西林-克拉维酸处方的质量。对2013年至2021年间医院全国抗菌药物处方调查数据库中的静脉注射阿莫西林-克拉维酸处方进行回顾性数据分析。与所有其他抗菌药物相比，静脉注射阿莫西林-克拉维酸的处方比例从0.02%（2013年）增至2.3%（2021年）。指南的合规性和适宜性总体上有所下降（分别下降了 18.9% 和 16.7%）。随着时间的推移，国家指南主要取代了地方指南，成为处方的主要指南来源。不适当的最常见原因是不必要的广谱活动（39.5%）。在澳大利亚的医院中，静脉注射阿莫西林-克拉维酸的处方量持续增加，但指南的合规性和适当性明显下降。自2019年以来，这些结果的增加与国家处方指南的更新相吻合，处方者使用国家指南而非地方指南的情况显而易见。这些研究结果强化了一个概念，即抗菌药物管理措施（包括审计、健全的国家指南和教育）对于优化静脉注射阿莫西林-克拉维酸处方至关重要。

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来源期刊

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.