Co-Amoxiclav Prescribing in Renal Impairment

Intro: Co-amoxiclav use in Forth Valley Royal Hospital is significantly higher than any other acute hospital site in Scotland. The drug is metabolised and excreted renally and its dosage is dependent on renal function. Methods: An online questionnaire was sent to clinicans to ascertain their prescribing knowledge in renal impairment. Following this a review of all prescriptions of Co-Amoxiclav over a one month (19/02/19-19/03/19) period was reviewed and cross matched with patients renal function to determine those with a degree of kidney injury. Standard of dosing was compared against the BNF as most clinicians replied that this was their main prescribing resource. Results: 774 patients were prescribed Co-Amoxiclav; 11.8 % (92) of these with a degree of renal impairment. Only 54% (50) of these patients were prescribed the correct dose of Co-Amoxiclav. 78 patients had an acute kidney injury (AKI) with 58% (45) prescribed the correct dose. In comparison 51% (47) of patients had a Chronic Kidney Injury (CKD) with only 33% (15) prescribed the correct dosage. This number is equally low in patients with an acute on chronic kidney injury; 35.8 % (33) patients with 30% (9) on the correct dose. Conclusion: 46% of patients with a degree of kidney injury are being prescribed the wrong dosage of Co-Amoxiclav which may potentially result in patient harm or under treatment of their condition. Further education is required within the trust to ensure prescribers use correct sources including the Renal Handbook and consider alternative antibiotics in patients with renal impairment.