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Published on: August 30, 2018
Quality of antimicrobial drug prescription in hospital
J W van der Meer1, I C Gyssens
1Department of General Internal Medicine, University Medical Center St Radboud, Nijmegen, The Netherlands. j.vandermeer@aig.azn.nl
Abstract:
There is worldwide concern about the development of antimicrobial resistance [1]. Selective pressure by antimicrobial drugs is by far the most important driving force for the development of resistance. Antimicrobial drugs are among the most commonly prescribed drugs in hospitals. In developed countries, some 30% of the hospitalized patients will be treated with these drugs. It is generally accepted that antimicrobial prescribing is often suboptimal, even in a country like the Netherlands, where both antibiotic consumption and microbial resistance rates are low [2,3]. The major problem with inappropriate prescribing is because of insufficient education in infectious diseases and antimicrobial therapy. Often, the prescription of these drugs with little toxicity is unjustified because of insecurity about the diagnosis of the clinician; 'drugs of fear' [4]. In our surveys, some 15% of the antibiotic prescriptions in surgical and internal medicine wards were considered unjustified [5,6]. Many prescribers are not yet fully aware that their justified or unjustified prescription adds to the resistance problem. In this paper, aspects of the quality of antimicrobial prescribing in the hospital setting will be discussed.
Insights
Antimicrobial resistance is a global health threat. Suboptimal prescribing practices in hospitals, often due to inadequate education, contribute significantly to this problem, necessitating improved antimicrobial stewardship.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Pharmacy
Background:
- Antimicrobial resistance (AMR) is a significant global health concern.
- Antimicrobial drugs are widely used in hospitals, with suboptimal prescribing being common.
- Inappropriate prescribing, driven by factors like diagnostic uncertainty and insufficient education, exacerbates AMR.
Purpose of the Study:
- To discuss the quality of antimicrobial prescribing in hospital settings.
- To highlight the contribution of prescribing practices to antimicrobial resistance.
- To identify areas for improvement in antimicrobial stewardship.
Main Methods:
- Review of existing literature on antimicrobial prescribing.
- Analysis of survey data on antibiotic prescription justification.
- Discussion of factors influencing prescribing decisions in hospitals.
Main Results:
- A substantial proportion of antibiotic prescriptions in hospital wards were deemed unjustified.
- Prescribers often lack awareness of their role in the development of antimicrobial resistance.
- Suboptimal prescribing is prevalent even in regions with low antibiotic consumption and resistance rates.
Conclusions:
- Improving antimicrobial stewardship is crucial to combat antimicrobial resistance.
- Enhanced education in infectious diseases and antimicrobial therapy is needed for healthcare professionals.
- Addressing diagnostic uncertainty and 'drugs of fear' can reduce unjustified antimicrobial use.
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