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Madelon Engel

Tuesday 7 May 2013

Improving appropriateness of antibiotic prescribing for lower respiratory tract infections The physician’s decision

Promotor: Prof. dr. Andy Hoepelman
Defence: 7 May 2013

The evident rise in antimicrobial resistance has become an increasingly relevant issue over the last decades, as the development of new antimicrobials stagnates. Several studies report a relationship between the volume of antibiotic use and increased resistance rates. This suggests that increasing appropriate use of antimicrobials, such as early de-escalation of antibiotic therapy, may lead to a reduced pressure on the development of antimicrobial resistance. Antimicrobial stewardship programs are institutional programs aimed at enhancing appropriate selection, dosing, route and duration of antimicrobial therapy. The main aim of antimicrobial stewardship improvement studies is to make current prescriptions more appropriate, often by altering physician behaviour.

Inappropriate use of antimicrobials in CAP patients is wide spread which makes it a suited subject for antimicrobial stewardship improvement studies. In primary care, excessive prescription in patients suspected of having CAP is common, while hospitalised patients often receive prolonged intravenous and/or broad spectrum antibiotic treatment unnecessarily. This high incidence condition has a heterogeneous presentation ranging from self limiting to lethal and initial antibiotic treatment is dependant on the severity at presentation. In the Netherlands, over 3,5 thousand CAP patients are admitted annually; CAP is the number one cause of death due to infection in western countries and a major burden on health care and financial resources. In this thesis we evaluate several different strategies with the aim to improve antibiotic prescribing for CAP