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Group urges caution on the use of broad-spectrum antibiotics

05 Nov 2013

By Catherine Reilly.

The Health Care-Acquired Infection and Anti-Microbial Resistance (HCAI AMR) Clinical Advisory Group is concerned that prescribers may use other broad-spectrum agents rather than alternative narrow-spectrum agents in the absence of co-amoxiclav (Augmentin).

A letter from ICGP Lead HCAI AMR Dr Nuala O’Connor to GP colleagues referred to the Clinical Advisory Group’s concern in the context of an expected “significant shortfall” in co-amoxiclav this winter after the HSE received notification from GlaxoSmithKline of an international long-term shortage of co-amoxiclav 250mg/125mg (375mg) tablets and 500mg/125mg (625mg) tablets.

However, the letter underlined that although co-amoxiclav was a commonly-prescribed antimicrobial in primary care, it was “rarely recommended” as the first-choice antibiotic.

Dr O’Connor informed GPs it would be “of huge help” in the fight to reduce antimicrobial drug resistance to ensure that “your prescribing practice is using first-line, narrow-spectrum antibiotics when you decide an antibiotic is clinically indicated”.

Referring to the Advisory Group’s concern about broad-spectrum agent use, Dr O’Connor wrote that this would not just increase the risk of antibiotic resistance, but also potential side-effects such as clostridium difficile infection: “Antibiotics are a precious resource and have facilitated many of the medical advances that we now take for granted, e.g. organ transplantation and chemotherapy.”

She advised that GPs should use narrow-spectrum antibiotics to treat bacterial infections when there was a clinical indication and restrict the prescribing of macrolides (erythromycin, clarithromycin) to situations where mycoplasma was present or suspected, penicillin allergy was present, or where sensitivity indicated their use.

Primary care antibiotic guidelines are available at, the letter informed GPs.

Meanwhile, the IMB has prioritised developing a list of interchangeable medicinal products containing amoxicillin and clavulanic acid (co-amoxiclav) due to the public health concerns presented by the pending Augmentin shortage.

“Due to a legal requirement to complete a four-week consultation process with relevant marketing authorisation holders prior to adding substances to the list, it may not be possible to complete the inclusion before the end of next month,” said a spokesperson.

5 November 2013

Click here to view the full article which appeared in Irish Medical Times