title: Antibiotic prescribing in hospitals: a social and behavioural scientific approach.
abstract: Antibiotics have dramatically changed the prognoses of patients with severe infectious diseases over the past 50 years. However, the emergence and dissemination of resistant organisms has endangered the effectiveness of antibiotics. One possible approach to the resistance problem is the appropriate use of antibiotic drugs for preventing and treating infections. This Review describes how the volume and appropriateness of antibiotic use in hospitals vary between countries, hospitals, and physicians. At each specific level-cultural, contextual, and behavioural-we discuss the determinants that influence hospital antibiotic use and the possible improvement strategies to make it more appropriate. Changing hospital antibiotic use is a challenge of formidable complexity. On each level, many determinants play a part, so that the measures or strategies undertaken to improve antibiotic use need to be equally diverse. Although various strategies for improving antibiotic use are available, a programme with activities at all three levels is needed for hospitals. Evaluating these programme activities in a way that provides external validity of the conclusions is crucial.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Netherlands. M.Hulscher@IQ.UMCN.nl
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
authors.forename: Richard P T M
authors.initials: RP
authors.lastname: Grol
authors.forename: Jos W M
authors.initials: JW
authors.lastname: van der Meer
mesh_terms: D000900:Anti-Bacterial Agents / Q000145:classification / Q000592:standards / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods; D001294:Attitude to Health; D003469:Culture; D004282:Documentation; D024881:Drug Resistance, Bacterial; D004352:Drug Resistance, Microbial; D006291:Health Policy; D006761:Hospitals / Q000592:standards; D006801:Humans; D008826:Microbial Sensitivity Tests; D012919:Social Behavior; D012922:Social Change; D035501:Uncertainty
chemical_list: D000900:Anti-Bacterial Agents