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Amoxicillin clavulanate is a broad spectrum antibiotic that should be reserved for specific
indications. The only first-line indications for amoxicillin clavulanate are bites (mammalian–including human),
diabetic foot ulcers and mastitis in males and non-lactating females.1
This report uses data from the pharmaceutical collection to provide an update on the use of
amoxicillin clavulanate between April, 2014 and March, 2015
Amoxicillin vs amoxicillin clavulanate
Clavulanate possesses little antibacterial activity, but significantly extends the spectrum of activity of amoxicillin
when given with it, leading to increased antimicrobial resistance. Amoxicillin clavulanate can also cause diarrhoea
and hepatotoxicity, which occur more frequently than with amoxicillin alone.2 The national data shows that in
2014/15 amoxicillin clavulanate accounted for 37% of all penicillin prescribing.
Sample Practice
|
All antibiotics vs penicillins
701 patients registered to your practice were dispensed a penicillin between April 2014 and March 2015
This accounts for 64% of the 1096 registered patients who were dispensed any
antibiotic. Nationally, 72% of all patients dispensed any antibiotic received a penicillin
|
 |
Penicillins vs amoxicillin clavulanate
20% of the 701 registered patients who were dispensed a penicillin received amoxicillin
clavulanate (141 patients)
|
High use of amoxicillin clavulanate by older patients
Table 1 below shows amoxicillin clavulanate dispensing as a proportion of total penicillin dispensing by age for your
practice, ten practices with a patient population similar to yours and nationally.
Nationally the use of amoxicillin clavulanate is higher in those aged 50 years and older (43% of all penicillin
prescribing) – with limited indications it is reasonable to suggest that this use is too high.
Table 1. Amoxicillin clavulanate dispensing by age
Sample Practice
| % of registered patients (in each age band) who were dispensed a penicillin and received amoxicillin clavulanate |
Your practice %
(number of patients) |
Similar Practices %*
(a comparator) |
National % |
| <5 years |
9 (7) |
27 |
29 |
| 5–9 years |
18 (8) |
29 |
30 |
| 10–49 years |
24 (70) |
36 |
36 |
| 50–74 years |
20 (42) |
44 |
43 |
| 75+ years |
25 (14) |
43 |
42 |
In the vast majority of cases a narrow spectrum antibiotic such as amoxicillin should be
first-line. Undertaking an audit using your practice management software to identify why
amoxicillin clavulanate has been prescribed (i.e. indications) may help determine the
appropriateness of prescribing in your practice – www.bpac.org.nz/audits
- bpacnz. Antibiotics, choices for common infections, 2013. Available from: www.bpac.org.nz (Accessed Sep, 2015).
- eTG complete. Melbourne: Therapeutic Guidelines Limited; 2015 (Accessed Sep, 2015).