Prescribers, including pharmacist and nurse prescribers, can use the EPiC dashboard to freely access their own prescribing data. They can compare their data with practice data and national data. Non-prescribers can also access the online EPiC dashboard to explore national dispensing data.
Amoxicillin + clavulanic acid dispensing is high
The addition of clavulanic acid to amoxicillin extends amoxicillin’s spectrum of activity, adding cover against anaerobic and gram-negative bacteria. In primary care, amoxicillin + clavulanic acid is recommended first-line for only a small number of clinical indications.6 Generally, these are:
- human and animal bites
- diabetic foot ulcer
- mastitis in males and non-lactating females.
Given these few first-line indications, low levels of amoxicillin + clavulanic acid dispensing in the community would be expected. However, data from the EPiC Antibiotics dashboard clearly show high use of amoxicillin + clavulanic acid in Aotearoa New Zealand. In fact, this drug combination remains the second most used antibiotic after amoxicillin.7
There is a seasonal shift in prescribing
The EPiC dashboard also shows a seasonal shift in antibiotic prescribing, indicating they are likely being used inappropriately, and possibly for viral illnesses, over the winter months.7
Amoxicillin + clavulanic acid should not be used to treat community-acquired pneumonia; this condition is most commonly a result of gram-positive bacteria. Treatment guidelines suggest community-acquired pneumonia can usually be sufficiently treated with amoxicillin alone.6
Including indications on prescriptions may reduce use
Before prescribers provide a script for amoxicillin + clavulanic acid, they should be considering whether this extended cover is required for the infection they are treating.
One of the World Antimicrobial Awareness Week recommendations, from a WHO initiative, is for prescribers to add a meaningful indication to a prescription for antibiotics. This prompts the prescriber to reflect on their choice of antibiotic and facilitates communication between healthcare providers and patients.8
Infectious diarrhoea is more likely
Nearly all antibiotics can increase susceptibility to colonisation and overgrowth of toxin-secreting Clostridioides difficile (previously called Clostridium difficile) but amoxicillin + clavulanic acid along with cephalosporins, fluoroquinolones and clindamycin increase risk to the greatest extent.9