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<h3>Background and Importance</h3> The appropriate use of antibiotics in emergency departments (EDs) is critical to combat antimicrobial resistance and ensure optimal patient outcomes. Co-amoxiclav, a commonly prescribed broad-spectrum antibiotic, is frequently included in TTA (To Take Away) prepacks to facilitate early treatment of infections after ED discharge. However, its use must align with established clinical guidelines to prevent unnecessary exposure and resistance development. In our Trust, the prescribing of co-amoxiclav has increased threefold over the past decade, reflecting a significant rise in its use (Define (C) and Antimicrobial Usage Reports, NHS Digital, 2023-2024). This surge underscores the importance of evaluating adherence to local and national guidelines in the ED setting. Studying compliance with these guidelines will help identify gaps in practice, optimise antibiotic stewardship, and improve patient safety. <h3>Aim and Objectives</h3> To identify guideline compliance when prescribing oral Co-amoxiclav to take home after emergency department admission. <h3>Material and Methods</h3> Retrospective analysis of adult patients admitted and discharged from two emergency departments over a consecutive 7-day period, who were prescribed oral co-amoxiclav. Inclusion criteria: Adult patients admitted to and discharged from the emergency department with a prescription for oral co-amoxiclav as part of their antibiotic therapy. The clinical indication and rationale for selecting co-amoxiclav from the antimicrobial storage cabinet were reviewed. Prescribing decisions at discharge were evaluated against current antimicrobial guidelines to assess compliance. <h3>Results</h3> A total of 100 patients were identified, 50 in QEQM and 50 in WHH (acute sites of East Kent University Hospitals NHS Foundation Trust. Guideline’s compliance was found in 34% of the prescriptions. The main indication Co-amoxiclav was prescribed for was for community acquired pneumonia (40%), followed by facial injury prophylaxis (12%) and intra-abdominal infection (12%). Over 20% of the indications showed no guidelines were available and 46% of the prescriptions did not follow microbiology guidelines. Community acquired pneumonia is an indication with clear microbiology guidelines in the Trust and only 23% of the prescriptions followed guidelines Between 12-15 different indications were found in each site. . <h3>Conclusion and Relevance</h3> A collaborative approach is required to understand the lack of guidelines compliance. Pharmacy presence in emergency departments could help guidelines compliance. <h3>References and/or Acknowledgements</h3> ESPAUR report 2023 to 2024 <h3>Conflict of Interest</h3> No conflict of interest