Don’t be unAWaRe – issues of selected ‘watch’ antibiotics on FP10 prescriptions from Midlands hospitals

The World Health Organization emphasises key antibiotics to safeguard through its ‘AWaRe’ classifications. NHS England has adapted these and requires a 10% reduction in use of ‘watch’ and ‘reserve’ agents in English hospitals by March 2024. Antibiotics may be prescribed in hospital using FP10 (green) prescriptions for convenient community dispensing. However, this bypasses review by hospital pharmacists who typically benefit from better access to relevant clinical information and prescribers than community colleagues. The extent to which this happens is unclear, so this project aimed to quantify FP10 issues for the three most common oral ‘watch’ antibiotics at all Midland NHS hospitals.

Consumption data in defined daily doses (DDD) for co-amoxiclav, clarithromycin and ciprofloxacin for the period 01/12/2022 to 31/05/2023 was available on Rx-Info’s ‘Define’ platform. Permission to use this was sought from Midlands antimicrobial pharmacists representing 23 Trusts. Eleven consented and data was extracted for analysis in Microsoft Excel.

FP10 issues from eleven participating Trusts accounted for 33548 of 674969 DDDs (5%) for co-amoxiclav, 21924 of 224937 DDDs (9.7%) for clarithromycin and 8862 of 157000 DDDs (5.6%) or ciprofloxacin. Trust median proportions deviated slightly at 1.9%, 5.2% and 3% respectively with considerable variation evident (respective IQRs 1.5-11, 3.2-13.7, 1.1-13). Regionally, FP10s represent a substantial portion of the total oral consumption of these agents. High variation likely reflects operational differences in medication supply mechanisms. As FP10s bypass many secondary-care antimicrobial stewardship approaches optimisation could be significant in delivery of NHS standard contract obligations and in slowing development of antimicrobial resistance.