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