title: Evaluation of the appropriateness of intravenous amoxicillin/clavulanate prescription in a teaching hospital.
abstract: BACKGROUND
  Despite the implementation of strategies aiming at improving antimicrobial utilisation, inappropriate use remains an increasing problem with important consequences on both antibiotic resistance and hospital costs.
  
  
  OBJECTIVE
  To evaluate the appropriateness of prescribing the intravenous amoxicillin/clavulanate combination (Augmentin).
  
  
  METHODS
  Prospective observational five-week study in a Belgian teaching hospital. Patients receiving prophylactic or therapeutic intravenous amoxicillin/clavulanate were enrolled. Data were collected by a pharmacist and the appropriateness of antibiotic treatment was analysed in collaboration with an infectious disease specialist according to local recommendations. The primary outcome measure was the appropriateness of indication, dosage, intravenous to oral switch and duration of therapy.
  
  
  RESULTS
  One hundred and six patients were evaluated. The most common indications for amoxicillin/clavulanate prescriptions were: respiratory tract infections (38%), surgical/interventional prophylaxis (28%) and intra-abdominal infections (11%). Overall, 43% of intravenous amoxicillin/clavulanate prescriptions were fully appropriate. Indication for use was appropriate in 87% and dosage in 74% of cases. In contrast, the timing of intravenous to oral switch and duration of therapy were inappropriate in 64% and 53% of cases, respectively.
  
  
  CONCLUSIONS
  This study identified two main areas for improving amoxicillin/clavulanate prescribing: (1) the intravenous to oral switch, which is often too late or nonexistent and (2) the duration of therapy, which is too long particularly in respiratory tract infections. The results have been presented to clinicians and specific interventions for optimisation are being discussed and implemented.
authors: Université Catholique de Louvain, CHU Mont-Godinne, pharmacy, Yvoir, Belgium. charline.artoisenet@uclouvain.be
authors: C
authors: C
authors: Artoisenet
authors: N
authors: N
authors: Ausselet
authors: B
authors: B
authors: Delaere
authors: A
authors: A
authors: Spinewine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001530:Belgium; D002648:Child; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination