The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands (February 2020)

Summary

Antimicrobial resistance leads to increased morbidity, mortality and healthcare costs worldwide. In order to contain antimicrobial resistance, Antibiotic Stewardship Programs (ASP) have been developed to measure and improve the appropriateness of antimicrobial use. A common way to measure the appropriateness of antimicrobial use is by evaluating whether antimicrobials are prescribed according to local guidelines and if not available, to national or international guidelines.

Content

This study, published by Antimicrobial Resistance & Infection Control, shows that in hospital outpatient clinics, prophylaxis accounted for a quarter of the antimicrobial prescriptions and had in general a good guideline-adherence rate, with the exception of unnecessarily prescribed post-surgical/intervention prophylaxis, whereas a substantial part of the therapeutic prescriptions were inappropriate.

Amoxicillin-clavulanic acid was the most inappropriately prescribed antimicrobial agent, regarding non-adherence to the guideline and also regarding the lack of considering renal function for dosage adjustment. Altogether, it is believed that antimicrobials prescribed at the hospital outpatient clinics warrant ASP attention. The variation of the guideline adherence rate between the investigated hospitals, as well as the differences with prior studies addressing antibiotic use in ambulatory settings in general, emphasise that (hospital) outpatient antimicrobial use should be audited locally.