Antibiotic Stewardship in Community-acquired Pneumonia

In hospitals between a quarter to half of the prescriptions for antibiotic therapy are considered inappropriate or unnecessary. Inappropriate or unnecessary use of antibiotics contributes to selection of antibiotic resistance, increases healthcare costs and risk of complications (for example more risk for side effects). Since 2015 Antibiotic (A)-team are mandatory in every Dutch hospital with the aim to guide appropriate use of antibiotics. In recent years several scientific articles have been published on certain A-team tasks to show if they are performing well in increasing appropriateness of antibiotic use. However, most articles are based on so-called observational studies. The results from these studies can be sensitive to errors by something called: ‘confounding by indication’. In this thesis we provide an overview of the published articles on different A-team tasks and we give recommendations how to improve these studies in the future. An example of an A-team task is to decrease broad-spectrum antibiotic use in patients with pneumonia. In the Dutch guideline the main advice for most patients is treatment with narrow-spectrum antibiotics. However, in practice patients are more frequent treated with broad-spectrum antibiotics. Therefore a trial was performed in 9 Dutch hospitals, and with education and feedback on antibiotic prescriptions by A-teams, we decreased the use of broad-spectrum antibiotic by 27% without any adverse effects for the individual patient.