Improving IV Co-amoxiclav Prescribing in Elderly Patients with Renal Impairment: A Two-Cycle Audit

Co-amoxiclav is a commonly prescribed, semisynthetic, empirical antibiotic. It is metabolised in the liver and eliminated via the kidneys. According to the trust guidelines, patients with severely reduced eGFR should receive a reduced dose of intravenous (IV) co-amoxiclav. This audit was conducted to assess whether IV co-amoxiclav dosing in elderly patients with an eGFR less than 30 ml/min was appropriately reduced in accordance with these guidelines. 

The standard dose is 1.2 g every 8 hours, but in patients with an eGFR <30, a reduced dose of 1.2 g every 12 hours is recommended. This is to prevent overdosing and potential side effects in this group of patients. Two audit cycles were completed. In the initial cycle, the prescription records of 29 elderly patients with an eGFR <30 ml/min who had received IV co-amoxiclav during their hospital stay between June and July 2024 were reviewed. A second cycle was conducted following education and sensitisation based on the initial findings, reviewing the prescription records of 28 randomly selected patients meeting the same criteria between October 2024 and January 2025. 

In the initial phase of the audit, only 55% of prescriptions included the appropriate dose reduction, with nearly half being incorrect. In the re-audit, conducted approximately three months later, compliance improved to 71% following targeted education and awareness initiatives. 

Overall, this audit and the subsequent improvement process led to a meaningful outcome, ensuring that our elderly patient group received correct doses of IV co-amoxiclav, thereby reducing the risk of potential overdosing and associated side effects.