Usefulness of quality indicators for antibiotic use: case study for the Netherlands.
OBJECTIVE
Inappropriate antibiotic use drives development of antimicrobial resistance. Worldwide, guideline adherence for antibiotic treatment of infectious disease is far from optimal. Insight in prescribing quality is pivotal for healthcare professionals and policy makers to intervene appropriately.


METHODS
European countries uniformly monitor antibiotic use, which is reported yearly by the European Centre for Disease Prevention and Control. Unfortunately, this has not had enough impact to decrease prescribing and resistance levels.


METHODS
Quality indicators (QIs) could provide better insight in prescribing quality and enable benchmarking to other countries; this could trigger action to improve antimicrobial prescribing. European Surveillance of Antimicrobial Consumption (ESAC) proposed 12 antibiotic QIs.


METHODS
Trends in use of antibiotic subgroups and the 12 ESAC QI values were determined for Dutch primary care (2004-2013); outcomes were compared to other European countries. Dutch antibiotic use is low within the European context. Nitrofurantoin use is higher than the European average, use of small-spectrum antibiotics lowers. Use of macrolides, quinolones and amoxicillin/clavulanate declined, which was not supported by the broad/narrow QI results.


RESULTS
QIs expressing antibiotic subgroup use in Defined Daily Doses/1000 inhabitants/day, particularly small-spectrum and non-first choices, provide proper insight in prescribing quality and are useful for benchmarking purposes. QIs measuring percentages were not considered useful. The broad/narrow ratio could be more informative when adjusted to national guidelines, or when more antibiotic subgroups are included based on better European consensus.


CONCLUSIONS
Benchmarking the above mentioned Dutch QI values to other countries provides direction for three specific strategies to further improve Dutch antibiotic prescribing practice.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (STR 6.103), Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
Alike W
AW
van der Velden
Department of Pharmacy, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
Monique
M
Roukens
Department of Pharmaceutical Science, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CAUtrecht, the Netherlands.
Ewoudt
E
van de Garde
Service Pharmacy Malden, Schoolstraat 8, 6581 BG Malden, the Netherlands.
Marco
M
Lourens
Department of Pharmacy, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
Stephanie
S
Natsch
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019985:Benchmarking; D017723:Drug Utilization Review / Q000592:standards; D005060:Europe; D019983:Guideline Adherence; D006801:Humans; D009426:Netherlands; D019982:Organizational Case Studies; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D019984:Quality Indicators, Health Care
D000900:Anti-Bacterial Agents
European Centre for Disease Prevention and Control, prescribing; antimicrobials; outpatient use; policy; quality indicators