Revisiting Guidelines and Inappropriate use of Ticarcillin/ Clavulanate at an Australian Teaching Hospital

Aim: To assess adherence to local ticarcillin/clavulanate prescribing guidelines; to examine the appropriateness of non-compliant prescribing; and to identify patterns of prescribing that could be improved. Method: A convenience sample of patients prescribed ticarcillin/clavulanate was prospectively identified by ward pharmacists over a 9-week period. Their medication charts were retrospectively reviewed by the drug use evaluation pharmacist and data collected on patient demographics, diagnosis, previous penicillin allergy, microbiology, treatment type and compliance with local guidelines. Ticarcillin/clavulanate use that was considered inappropriate was analysed for costs. Results: Of the 100 patients included in the audit, half were prescribed ticarcillin/clavulanate outside of local guidelines. In this non-compliant group, approximately two-thirds (65%) of patients were considered to have been treated appropriately. The majority of these patients were being managed for diabetic foot infections. Prescribing in only 18% of cases was considered to be neither compliant with the guidelines or appropriate. Pharmacoeconomic analysis suggests that efforts to improve prescribing may result in cost savings. Conclusion: There was widespread use of ticarcillin/ clavulanate outside of the local guidelines. In many cases, non-compliant prescribing was considered appropriate.