Re: Augmentin Mg 375
Phyllis Sterlin
190 isolates from clinical specimens were tested in vitro to determine their susceptibility pattern against augmentin. Of the 132 strains of Enterobacteriaceae tested, 109 (82.6%) were susceptible. 41 (93.2%) of the 44 gram-positive bacteria tested were also susceptible to augmentin. Strains of Pseudomonas aeruginosa and Serratia marcescens were resistant to augmentin. However, augmentin showed increased activity against Escherichia coli, and Staphylococcus aureus when compared with ampicillin.
A few years ago my clinic colleagues and I got fed up with our students wanting to give every patient amoxicillin clavulanate,available in New Zealand as augmentin; no matter what sort of infection they had, bacterial or viral!
Amoxicillin clavulanate and third generation cephalosporins are important medications. If they continue to be overused,bacteria will become resistant to them. We want to preserve these antibiotics for occasions they are really needed. Inour clinic, we were aware that there is usually a good alternative to amoxicillin clavulanate and came up with the conceptof the augmentin-free office.
In our clinic you now 'need' to ask a colleague if it is okay to give a prescription for amoxicillin clavulanate beforeprescribing it. We even have a former trainee who calls me to get 'permission' to use amoxicillin clavulanate. Clearlyour policy is not an absolute prohibition and we are not entirely augmentin-free, but it does control the amount we use.
The augmentin-free office idea is being kept alive by frequent mentioning that this is an augmentin-free office. Beingasked if it is appropriate to use amoxicillin clavulanate or asking someone else if it is appropriate, also reinforcesthe message.
My clinic colleagues feel pleased to be working in an augmentin-free clinic. They feel they are making a contributionto mankind. We have been 'overwhelmed' at the acceptance by parents that antibiotics are no longer routinely given. Onepatient did get very upset that we were 'augmentin-free.' She clearly had been very medicalised by overuse of augmentin.
When I talk to groups of doctors there are usually a few horrified faces in the audience. This suggests to me theyare high users of amoxicillin clavulanate. There is usually someone who gives a challenge, such as the child with impetigowho cannot take oral flucloxacillin. My response is that the augmentin-free office concept is not an absolute and thatit is quite reasonable to give amoxicillin clavulanate in such a situation. I do suggest that discussion occurs withparents so that they know that diarrhoea is a potential problem with amoxicillin clavulanate versus difficulty with palatabilityof oral flucloxacillin.
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