Don’t be unAWaRe – Supply of selected ‘watch’ antibiotic pre-packs in Midlands hospitals

The UK 5-year national action plan on antimicrobial resistance aims to reduce broad spectrum (WHO Watch and Reserve categories) antimicrobial use in English hospitals by 10% by March 2024. Pre-packs are products prepared with template labels to allow legal supply directly from clinical areas – bypassing pharmacy. Pre-packs are typically used to expedite discharge out of hours and on high turnover wards. However, this often circumvents pharmacists’ medicines and AMS checks – and the contribution of prepacks to overall antimicrobial supply is poorly explored. We aimed to quantify consumption of the three most common ‘watch’ antibiotic pre-packs at Midlands NHS hospitals.

Midland antimicrobial pharmacists representing 23 Trusts were invited to contribute. Twelve Trusts provided consumption data for oral formulations of co-amoxiclav, clarithromycin and ciprofloxacin in defined daily doses (DDD) for the period 01/12/2022 to 31/05/2023. Data were collated and analysed in Microsoft Excel.

Prepack use from participating Trusts accounted for 198521 of 738492 DDDs (26.9%) for co-amoxiclav, 21118 of 256298 DDDs (8.2%) for clarithromycin and 23479 of 184064 (12.8%) for ciprofloxacin. Trust median proportions were similar at 25%, 6.6% and 11% respectively but with considerable variation (respective IQRs 15.5-32.6, 5.6-9.5, 6.2-16.5). High variation likely reflects operational differences between organisations. Interventions into pre-pack use may support hospitals meeting the 10% reduction in broad-spectrum antibiotics.

Research is needed to fully understand whether prepacks are used appropriately in terms of choice, and whether they contribute to extended durations of therapy.