Quality measures of antimicrobial drug use.
Antimicrobial use is the major determinant in the development of resistance. Many parameters of importance for optimal quality of antimicrobial therapy have already been defined. Maximal efficacy of the treatment should be combined with minimal toxicity at the lowest cost. Quality of antimicrobial drug use is dependent on knowledge of many aspects of infectious diseases. Considering efficacy, many of our indications for antimicrobial use need critical evaluation. Irrational use should be discouraged. Avoidance of the development of resistance is a quality parameter that will need increasing attention. This paper reviews the well-established factors that may influence the appropriateness of pharmacotherapy with antimicrobial drugs. It cites recent evidence supporting principles of prudent prescribing and gives an overview of audits that have addressed these parameters. Measures relating to resistance are discussed.
Gyssens
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Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. gyssens@bacl.azr.nl
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D003133:Commission on Professional and Hospital Activities; D003141:Communicable Diseases / Q000188:drug therapy*; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D004363:Drug Utilization / Q000331:legislation & jurisprudence; D006801:Humans; D011787:Quality of Health Care; D013997:Time Factors
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents