Efficacy and Safety of Amoxicillin/Clavulanic acid in Routine Daily

Clinical Practice in Dentistry: An Indian Real-life Scenario

Details of Health Care Professional (HCP):
Name: ______________________ Qualification: ______________State:____________ Place: _____
Approximate Number of patients requiring Amoxicillin/Clavulanic acid in one month:
___________|Age profile of Patients (% of patients): < 18 Yrs: _____%| >18 40 Yrs: ____%|
>40 65 Yrs: _____%|>65 Yrs: ___%
Instruction for filling the form:
Fill with black point ball pen. Questionnaire entries should be legibly written so that all
information is readable. Capture in applicable response fields with a mark.

1) In

your

clinical

practice

for

which

Amoxicillin/Clavulanic acid?
a) Periapical Infections
b) Dental Abscess
c) Prophylactic for endodontic procedures
d) Any other, please specify__________________
2) In
your
routine
clinical
practice,

indication(s),

whether

you

you

prefer

preferred

Amoxicillin/Clavulanic acid as first line agent?

a) Yes, preferred as first line agent
b) No, Not preferred as first line agent
c) Preferred as second line agent in non responders to first line agents
3) In your opinion, what is the current clinical utility of Amoxicillin/Clavulanic
acid as an antimicrobial agent in daily clinical practice?
a) Robust Clinical utility
b) Average clinical utility
c) Limited clinical utility
4) What is the usual duration of Amoxicillin/Clavulanic acid therapy required
for clinical cure?
3 5 days

>5 7 days

>7 10 days

> 10 day
5) Do

you

prefer

Amoxicillin/Clavulanic

acid

over

other

antibiotics

in

management of infections in your day today clinical practice? Why?

a) Preferred due to superior efficacy
b) Preferred due to superior tolerability
c) Preferred due to superior efficacy and tolerability
d) Not preferred over other antibiotics
6) In your opinion, how will you rate the efficacy of Amoxicillin/Clavulanic acid
in routine clinical practice?
a) Excellent
b) Good

c) Average

d) Poor

7) As per your clinical experience, how will you rate the tolerability of
Amoxicillin/Clavulanic acid in routine clinical practice?
a) Excellent
b) Good

c) Average
d) Poor

Confidential/ For the use of Registered Medical Practitioner only

Page 1

Efficacy and Safety of Amoxicillin/Clavulanic acid in Routine Daily

Clinical Practice in Dentistry: An Indian Real-life Scenario
8) In your opinion, what is the most common adverse event reported with
Amoxicillin/Clavulanic acid?
a) Diarrhea/loose stools
b) Nausea/ Vomiting
c) Skin rash/hypersensitivity reactions
d) Any other please specify________________________
9) In your clinical practice, in which following patient profiles you use
Amoxicillin/Clavulanic acid?
a) Paediatric population
b) Geriatric population
c) Pregnancy and lactation
d) Patients with impaired liver/renal function
10)
In
your
clinical
practice,
what

of

patient

reports

no

response/resistance to Amoxicillin/Clavulanic acid?

a) 0-25%
b) 26-50%
c) 51-75%
d) > 75%
I have reviewed and understood the program proposal entitled Efficacy and Safety of
Amoxicillin/Clavulanic acid in Routine Daily Clinical Practice in Dentistry: An Indian Reallife Scenario. I am voluntarily sharing my clinical experience with Unichem Laboratories
Ltd. Whatever information shared is best as per my knowledge and based on my clinical
practice. I confirm that I am not sharing any patient related information to anyone
(including Unichem Laboratories Ltd.) through this program.
Name & Address of HCP: _________________________________________Signature: ____________
Date:______________Place:__________________ Official Stamp: ____________________________

Confidential/ For the use of Registered Medical Practitioner only

Page 2