Amoxicillin-clavulanic acid prescriptions at the Greater Paris University Hospitals (AP-HP).
I Fusier, O Parent de Curzon, S Touratier, L Escaut, M Lafaurie, S Fournier, M Sinègre, P Lechat, D Vittecoq, Anti-Infective Drug Committee (COMAI) of the public hospital system of the city of Paris (AP–HP)
Author Information
I Fusier: Service évaluation pharmaceutique et bon usage, agence générale des équipements et produits de santé (AGEPS), Assistance publique-Hôpitaux de Paris, Paris, France. Electronic address: isabelle.fusier@aphp.fr.
O Parent de Curzon: Service évaluation pharmaceutique et bon usage, agence générale des équipements et produits de santé (AGEPS), Assistance publique-Hôpitaux de Paris, Paris, France.
S Touratier: Pharmacie, hôpital Saint-Louis, Paris, France.
L Escaut: Service des maladies infectieuses et tropicales, hôpital de Bicêtre, Le Kremlin Bicêtre, France.
M Lafaurie: Maladies infectieuses tropicales, hôpital Saint-Louis, Paris, France.
S Fournier: Équipe d'hygiène hospitalière, direction de l'organisation médicale et des relations avec les universités, Assistance publique-Hôpitaux de Paris, Paris, France.
M Sinègre: Service évaluation pharmaceutique et bon usage, agence générale des équipements et produits de santé (AGEPS), Assistance publique-Hôpitaux de Paris, Paris, France.
P Lechat: Direction recherche clinique et développement, hôpital Saint-Louis, Paris, France.
D Vittecoq: Service des maladies infectieuses et tropicales, hôpital de Bicêtre, Le Kremlin Bicêtre, France.
OBJECTIVE: We aimed to document amoxicillin-clavulanic acid prescription to improve the proper use of antibiotics in hospital settings. We used three criteria: quality of medical charts, adequacy of indications, and adequacy of treatment duration. METHOD: This study was designed as a one-day point prevalence survey carried out by antibiotic lead specialists. RESULTS: We included 387 prescriptions from 32 hospitals. Immunodeficiency was recorded as a risk factor in 30% of patients. Computerized prescriptions were observed in 79% of cases. The indication was mentioned in 73% of cases and a 48/78-hour re-assessment of the antibiotic therapy was performed in 54% of cases. The antibiotic indication was primarily for pneumonia and was deemed appropriate in 75% of patients. Adult mean treatment duration was 11.1 days. Use of dual combination therapy and/or treatment duration exceeding two weeks accounted for the main reasons for an inappropriate use of antibiotics. Prescriptions recorded as having been made by senior physicians were of the shortest treatment duration (P=0.0163). CONCLUSION: Medical charts should be better filled in. Reinforcing the role of senior physicians in supervising antibiotic prescriptions is likely to result in a better control of treatment duration and ultimately in a reduced antibiotic consumption. By reinforcing the collaboration between pharmacists and antibiotic lead specialists, the improvement of computerized prescriptions at hospital level should help better detect the "at risk" prescriptions, namely those exceeding seven days or those combining antibiotics.
