Taking twice daily amoxicillin clavulanate increases adherence to treatment

In Spain, a non-randomized observational study was carried out to study the compliance of patients in the treatment of amoxicillin / clavulanate with the drug twice a day (Augmentin XR, GlaxoSmithKline) and 3 times by day (Augmentin, GlaxoSmithKline). Study participants (n = 240) received amoxicillin / clavulanate therapy for lower respiratory tract infections and other community-acquired infections in one of the dosage regimens: 2000 mg / 125 mg twice daily for 1 week (n = 73 [30.4%]) or at a dose of 500 mg / 125 mg 3 times a day for 8 days (n = 167 [69.6%]).

Compliance was assessed using an electronic recording system for each case of opening a bottle of tablets.

Although a gradual decrease in compliance was recorded in both groups after the second day of antibiotic therapy, patients taking the drug twice a day showed less adherence to treatment (day 3: 82.2% vs 66.5% [P less than 0.05]; day 4: 76.7% vs 51.8% [P less than 0.01]; day 5: 73.9% vs 42.8% [P less than 0.001]; day 6 68.5% vs 33.7% [P less than 0.001]; day 7: 52.1% vs 28.3% [P less than 0.001]). The percentage of doses taken was higher when using amoxicillin / clavulanate 2 times a day (84.5% ± 22.8%) compared to patients taking the drug three times a day (72.7% ± 20.1%, P less than 0.001) More than 80% of the doses of the drug were received by 72.6% of patients taking the drug twice a day, compared with 47.3% in the triple administration group. antibiotics (P less than 0.001). 40% of patients in the twice daily drug administration group opened the container every 12 ± 6 hours for at least 80% of the course (54.8%), while only 19.6% of patients distributed in the 3- several doses, does this every 8 ± 4 hours (P less than 0.001). The percentage of patients who opened the medication bottle the number of times required per day was statistically significantly higher in patients taking the medication twice a day, on day 3 (82.2% vs 66 , 5%; P less than 0.05), day 4 (76.7% vs 51.8%; P less than 0.01), day 5 (73.9 vs 42.8%; P less than 0.001), day 6 (68.5% vs 33.7%; P less than 0.001) and day 7 (52.1% vs 28.3%; P less than 0.001).

A daily dose of the drug was missed by 47.1% of patients who followed a triple regimen of amoxicillin / clavulanate. This can be explained by the fact that patients who continue to work, despite the disease, note organizational disadvantages in taking the drug during working hours.

According to study leaders, poor adherence to treatment regimens when prescribing antibiotics is considered the main cause of treatment failure and unsatisfactory disease results. The recent practice of self-medication, often accompanied by incomplete courses of taking antibacterial drugs, promotes the development of resistance to antibiotics. Compliance with the time interval between doses of the drug was much more often recorded in patients receiving an amoxicillin / clavulanate dosage form taken twice daily. Researchers noted an increase in adherence when taking the drug 2 times a day. In most clinical situations, including those associated with taking antibacterial drugs, respecting the time interval between taking drugs is particularly important. The lengthening of the time interval between doses is not only accompanied by a decrease in the effectiveness of treatment, but also contributes to the selection of resistant strains.

According to the researchers, increasing adherence to antibiotic treatment is possible taking into account the patient's behavior. One possible strategy is to use simplified dosing schedules. A double regimen of taking amoxicillin / clavulanate is not only economically more beneficial, but also helps to reduce the number of missed doses of the drug.

The limitations of this study were its non-randomized design and the lack of focus on the therapeutic effect of treatment, as well as the lack of comparison of compliance and drug concentration in the blood, which potentially allows patients not to take the medicine or to take more than one tablet when opening the bottle.