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Timeliness of administration of amoxicillin-clavulanic acid and meropenem in a large tertiary care centre

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Abstract

Background For amoxicillin-clavulanic acid and meropenem to be effective, concentrations must exceed the minimum inhibitory concentration of infecting pathogens. Objective To retrospectively evaluate time windows between both scheduled prescription and administration and reconstitution-preparation and end of administration of intravenous amoxicillin-clavulanic acid and meropenem prescriptions. Setting 37 hospital wards at a tertiary hospital, Belgium. Method All adult hospital stays with at least one amoxicillin-clavulanic acid or meropenem administration in 2018 were reviewed. Time windows were deemed acceptable if < 30 min between prescription and administration and < 90 or < 150 min between reconstitution-preparation and end of administration for amoxicillin-clavulanic acid and meropenem, respectively. Main outcome measure Time windows between prescription and administration and between reconstitution-preparation and administration. Results For 50 273 administered prescriptions, both time windows were acceptable in 53.7% of first dose and 56.4% of follow-up dose administrations. 43.7% of first doses did not respect the time window between reconstitution-preparation and administration (2.8%) or between prescription and administration (40.9%). These discrepancies equalled 11.1% and 26.3% for follow-up doses, respectively. Large variation across hospital wards was observed. After the first five consecutive administrations, 93.1% of patients had not received their antibiotics within the time windows allowed. The most striking predictor of timely administration with respect to both prescription and reconstitution-preparation time was prescription synchronisation with nursing administration rounds. Conclusion For amoxicillin-clavulanic acid and meropenem, timeliness of reconstitution-preparation and administration was appropriate in approximately half of administrations. Evaluating and safeguarding the timeliness of antibiotic administration should be considered an important aspect of antibiotic stewardship.

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Data availability

A data sample is available upon request. All SAS syntaxes are available upon request.

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Acknowledgements

The authors would like to express their gratitude to the IT department at University Hospitals Leuven, with in particular Karin Gilis and Pieter Vanautgaerden, for providing them with a workable dataset derived from the clinical work station at the hospital. In addition, the authors are thankful for Miss Abigail Moore, who proofread the manuscript.

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Author notes

  1. Astrid Van Wilder and Luk Bruyneel are joint first authors

Authors and Affiliations

  1. Leuven Institute for Healthcare Policy, KU Leuven - University of Leuven, Kapucijnenvoer 35, Leuven, Belgium

    Astrid Van Wilder , Luk Bruyneel, Charlotte Decock, Nel Ten Haaf  & Kris Vanhaecht

  2. Department of Quality Improvement, University Hospitals Leuven, Kapucijnenvoer 35, Leuven, Belgium

    Luk Bruyneel & Kris Vanhaecht

  3. Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium

    Willy E. Peetermans

  4. Department of Immunology and Microbiology, KU Leuven - University of Leuven, Herestraat 49, Leuven, Belgium

    Willy E. Peetermans

  5. Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium

    Yves Debaveye

  6. Department of Cellular and Molecular Medicine, KU Leuven - University of Leuven, Herestraat 49, Leuven, Belgium

    Yves Debaveye

  7. Pharmacy Department, University Hospitals Leuven, Leuven, Belgium

    Isabel Spriet

  8. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven - University of Leuven, Herestraat 49, Leuven, Belgium

    Isabel Spriet

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  1. Astrid Van Wilder
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Correspondence to Astrid Van Wilder .

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Van Wilder , A., Bruyneel, L., Decock, C. et al. Timeliness of administration of amoxicillin-clavulanic acid and meropenem in a large tertiary care centre. Int J Clin Pharm 43, 1651–1659 (2021). https://doi.org/10.1007/s11096-021-01297-0

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  • DOI: https://doi.org/10.1007/s11096-021-01297-0

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