Improving the quality of use of antimicrobial drugs Assessments and interventions
Promotores: J.W.M. van der Meer, Y.A. Hekster. Co-promotor: B.J. Kullberg |
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| In a series of studies, specific topics concerning the quality of use of antimicrobial drugs have been addressed. Several methods of assessment have been applied to clinical practice. And in two studies, the implementation of interventions to improve the quality is assessed. In chapter I, the results are presented of a study aimed at reducing the use of amoxicillin-clavulanate, after high-resistance rates in Escherichia coli were detected. In chapter II, a comparison of the use of quinolones in different patient populations is presented. To do so, the Anatomical Therapeutical Chemical Classification/Defined Daily Doses (ATC/DDD) system developed by the World Health Organisation was applied. In chapter III, the results of a target drug program are presented. One hundred courses of fluconazole treatment in a university hospital and 81 courses in a non-university teaching hospital are analysed in a prospective audit to evaluate prescribing practices. In chapter IV, the analysis of a process of care is presented: the interval from the time of admission to the emergency room until the administration of antibiotics in 50 patients presenting with a serious infectious disease is analysed. A median interval from time of admission to administration of antibiotics of 5 hours was determined (range 0.6-13.3 h) but this was significantly shorter in patients admitted at night than in patients admitted during office hours (3.7 vs. 6.0 h, P<0.05). In chapter V, the results of the implementation of a series of educational and organisational interventions designed to improve the process of care as described in chapter IV are presented. Guidelines and educational programs were developed to facilitate timely antibiotic administration. |
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