Table 1. Elements of education on prudent antibiotic prescribing.
Topic | Concept, understanding | Field, discipline | Principles, learning outcomes, competencies* |
---|---|---|---|
Bacterial resistance |
Selection, mutation |
(Micro) biology, genetics |
• Extent, causes of bacterial resistance in pathogens (low antibiotic concentration, longtime exposure of microorganisms to antibiotics is driving resistance) • Extent, causes of bacterial resistance in commensals and the phenomenon of overgrowth (e.g., Clostridium difficile infection, yeast infection) |
Epidemiology |
• Epidemiology of resistance, accounting for local variations and importance of surveillance (differences between wards, countries...) |
||
Hygiene |
Infection control—mostly microbiology |
• Spread of resistant organisms |
|
Antibiotics |
Mechanisms of action of antibiotics/resistance Toxicity |
Pharmacology |
• Broad vs. narrow-spectrum antibiotics, preferred choice of narrow-spectrum drugs • Combination therapy (synergy, limiting emergence of resistance, broaden the spectrum) |
Costs |
Ethics, public health, pharmacology |
• Collateral damage of antibiotic use (toxicity, cost) • Consequences of bacterial resistance • Lack of development of new antibiotics (limited arsenal) |
|
Diagnosis of infection |
Infection/inflammation |
Physiology/microbiology/immunology/infectious diseases |
• Interpretation of clinical and laboratory biological markers • Fever and C-Reactive Protein (CRP) elevation are also a sign of inflammation, not per se of an infection |
Isolation, identification of bacteria, viruses and fungi |
(Micro) biology |
• Practical use of point-of-care tests (e.g., urine dipstick, streptococcal rapid antigen diagnostic test in tonsillitis...) • Importance of taking microbiological samples for culture before starting antibiotic therapy |
|
Susceptibility to antibiotics |
Microbiology/infectious diseases |
• Interpretation of basic microbiological investigations (Gram stain, culture, PCR, serology...) |
|
Treatment of infection |
Indication for antimicrobials |
Clinical microbiology/infectious diseases organ specialty |
• Definitions and indications of empiric/directed therapy vs. prophylaxis • Clinical situations when not to prescribe an antibiotic: ○ Colonization vs. infection (e.g., asymptomatic bacteriuria) ○ Viral infections (e.g., acute bronchitis) ○ Inflammation vs. infection (e.g., fever without a definite diagnosis in a patient with no severity criteria) |
Prevention of infection |
|
Pharmacotherapy, surgery, anesthesiology, clinical microbiology/infectious Diseases |
• Surgical antibiotic prophylaxis: indication, choice, duration (short), timing |
Medical record keeping |
Choice Duration Timing |
Clinical medicine |
• Documentation of antimicrobial indication in clinical notes • Recording (planned) duration or stop date |
Prescribing antibiotics: initially |
Empiric therapy (local guide, antibiotic booklet...) Diagnostic uncertainty |
Clinical microbiology/infectious diseases/organ specialists Clinical pharmacology |
• Best bacteriological guess for empiric therapy • Choice in case of prior use of antibiotics when selecting an antibiotic for empiric therapy • Choosing the dose and interval of administration (basic principles of PK/PD) • Estimating the shortest possible adequate duration |
Prescribing antibiotics: targeted therapy |
Communication with the microbiology laboratory Value of specialist consultation in infectious diseases or microbiology |
Clinical microbiology/infectious diseases/organ specialists Hospital pharmacy |
• Reassessment of the antibiotic prescription around day 3 • Streamlining/de-escalation once microbiological results are known • IV-oral switch (bioavailability of antibiotics) • Therapeutic drug monitoring to ensure adequate drug levels (e.g., vancomycin) |
Prescribing antibiotics: standard of care |
The importance of guidelines in clinical practice |
Clinical medicine, organ specialists |
• Prescribing antibiotic therapy according to national/local practice guidelines |
Quality indicators of antibiotic use |
Quality institute |
• Audit and feedback assessing prescribing practice using quality indicators |
|
Communication skills | Discussion techniques | Psychology, clinical medicine | • Explaining to the patient the absence of an antibiotic prescription • Education of patients regarding prudent antibiotic use (comply with the doctors’ prescription, no self-medication...) |
A competency is a quality or characteristic of a person that is related to effective performance. Competencies can be described as a combination of knowledge skills, motives and personal traits.22