title: Antimicrobial stewardship using pharmacy data for the nurse-led school-based clinics in Counties Manukau District Health Board for management of group A streptococcal pharyngitis and skin infection.
abstract: OBJECTIVE
  To evaluate antimicrobial usage in the school-based clinics against operating guidelines.
  
  
  METHODS
  Antimicrobial prescribing data (2014) from 10/18 participating pharmacies serving 14,153/23,588 primary school children of the programme were accessible. Prescriptions from 5/10 pharmacies were available for identifying type, amount, and indication of the medicine. One pharmacy serving a defined population (n=3,513) with single healthcare provider delivering the school programme was selected for detailed evaluation and identifying individuals receiving multiple treatments.
  
  
  RESULTS
  Data from 10 pharmacies (n=7,889 prescriptions) showed 91.2% of prescriptions were for group A streptococcal-positive throat swab, 8.8% for skin infections. More detail from 5/10 pharmacies showed only 2% of group A streptococcal pharyngitis treatments (107/4,672) were not first-line (56 cephalexin and 51 rifampin prescriptions). Fusidic acid (159/452, 35.18%) or cephalexin (169/452, 37.39%) were most commonly used for skin infection. Analysis in the defined population showed &lt;4% (151/4,325) of assessed skin conditions received antimicrobials, and only 6 individuals received more than one course of oral antimicrobial over the year.
  
  
  CONCLUSIONS
  Antimicrobial administration demonstrates high compliance with the protocol. There was very limited use of second-line antimicrobials for recurrent pharyngitis. Most skin infections did not require antimicrobial treatment. Repeated antimicrobials for individuals were rare.
authors.affiliation: Centre for Public Health Research, Massey University, P O Box 756, Wellington, New Zealand. r.t.firestone@massey.ac.nz.
authors.forename: Ridvan
authors.initials: R
authors.lastname: Tupai-Firestone
authors.affiliation: Research Fellow, Department of Molecular Medicine and Pathology, The University of Auckland, Grafton Campus, School of Medical Sciences, Private Bag 92019, Auckland, 1023, New Zealand. j.tsai@auckland.ac.nz.
authors.forename: Jia-Yun Catherine
authors.initials: JY
authors.lastname: Tsai
authors.forename: Philippa
authors.initials: P
authors.lastname: Anderson
authors.forename: Laura
authors.initials: L
authors.lastname: Broome
authors.forename: Tracy
authors.initials: T
authors.lastname: McKee
authors.forename: Diana R
authors.initials: DR
authors.lastname: Lennon
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D062313:Databases, Pharmaceutical; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D008485:Medical Audit; D009520:New Zealand; D010612:Pharyngitis / Q000188:drug therapy* / Q000382:microbiology; D015397:Program Evaluation; D012572:School Health Services; D012573:School Nursing; D012874:Skin Diseases, Infectious / Q000188:drug therapy* / Q000382:microbiology; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013297:Streptococcus pyogenes
chemical_list: D000890:Anti-Infective Agents