Use of nitrofurantoin, amoxicillin + clavulanic acid, fusidic acid: Areas for focus

Review your prescribing : EPiC Antibiotics now online

Monday 28 November 2022, 01:26 PM

1 minute to Read

He Ako Hiringa team

Make appropriate antimicrobial choices in three key areas to reduce our risk of antibiotic resistance. EPiC Antibiotics dashboard out now.

Urinary tract infection

Nitrofurantoin is now the preferred first-line option for empiric treatment of uncomplicated UTI. Although trimethoprim is still available as an alternative option, there are significant rates of E. coli resistance in some parts of Aotearoa New Zealand.
For uncomplicated lower UTI in women, nitrofurantoin (preferably the modified release formulation) is recommended as a five-day course. However, national data for the last 12 months show that over one third (39 per cent) of all dispensings of nitrofurantoin to women for lower UTI were for a seven-day course.

Amoxicillin + clavulanic acid

There are very few first-line indications for amoxicillin + clavulanic acid, yet it is the second most dispensed antibiotic after amoxicillin. Approximately one fifth of all dispensings of antibiotics in the previous 12 months were for amoxicillin + clavulanic acid.
Rates of amoxicillin + clavulanic acid use vary by ethnicity. By proportion of population, Pacific peoples had the highest use, with 1 in 10 (just under 10 per cent) being dispensed amoxicillin + clavulanic acid in the last 12 months.
There is unwarranted seasonal variation in antibiotic use, 32 per cent between summer and winter over the last year. This is likely, at least partially, to reflect inappropriate use of antibiotics for winter viral illnesses.

NEW: He Ako Hiringa resources now online

Consider antibiotic stewardship in your learning goals. The following new resources are now available, free, at He Ako Hiringa:

EPiC Antibiotics - national, practice and prescriber data dashboards on three key data themes
Antimicrobial stewardship: It's time for collective action (recording of 22 November webinar with Dr Sharon Gardiner and associate professor Matire Harwood)
Antimicrobial stewardship: Primary care can build on recent gains (clinical article)

Topical antibiotics

There are very few indications that require topical antibiotics. If a skin infection requires an antibiotic, it should be given orally.
Wide use of fusidic acid in New Zealand has led to high rates of resistance. Use has declined over the last few years, but it is possible to reduce this further.
There are still some groups in our population who have inappropriately high rates of fusidic acid dispensing including increasing use in children under five years and continued high use in people aged over 75 years.

How to Treat

+How to treat

Polypharmacy

For older people and frail people, the long-term benefit of medicines reduces and the potential for harm from adverse effects increases. When the benefit–risk balance changes in this way, medicine review and optimisation are important to simplify the therapeutic regimen, reduce inappropriate medicines and minimise risks. In this article, pharmacist prescriber Linda Bryant uses two case studies to illustrate important considerations during medicine reviews

Wednesday 28 May 2025, 12:50 AM