Improving antimicrobial prescription in primary care: a multi-dimensional approach to antimicrobial resistance

Sijbom, M. (2024)

Doctoral Thesis

The prevalence of antimicrobial resistance has reached a point that it is now considered a global health crisis. The primary driver of this phenomenon is the use of antimicrobials. Physicians in primary care prescribe approximately 80-90% of all antimicrobials in a country, which makes primary care a suitable starting point for improving antimicrobial prescribing. This thesis examined the impact of antimicrobial prescribing in primary care on antimicrobial resistance and the extent to which the quality of antimicrobial prescribing can be improved. This thesis showed that the impact of antimicrobial prescribing in primary care is larger than previously assumed. The main determinants of antimicrobial overprescribing were diagnostic uncertainty, GP practice size (perhaps as a measure of time available during consultations), inability to effectively negotiate or explain antimicrobial use and GPs' assumption that patients 'expect an antimicrobial prescription'. There are three major aspects in which antibiotic prescribing in general practices can be improved. There is antibiotic overprescribing for patients with respiratory tract infections. Instead of the broad-spectrum antibiotic group macrolides, narrow-spectrum antibiotics can be chosen frequently.
Finally, antibiotics are relatively over-prescribed to patients from specific migratory backgrounds (Turkish, Dutch-Caribbean, Surinamese). In addition, registration of antibiotic allergies can be improved by educating GPs to increase awareness and knowledge of antibiotic allergies, by verifying existing registrations of antibiotic allergies and by facilitating registration in an EHR so that the different EHRs are more compatible and do not contradict each other. This may lead to a reduction in the number of antibiotic allergy registrations and thus contribute to the prescription of first-choice antimicrobials instead of second-choice (broadspectrum)
antimicrobials.

• Primary care
• Antibiotic prescription
• Antimicrobial resistance
• One health
• Feneral practitioner
• Antibiotic selection pressure
• Covid-19
• Prescription behaviour

• All authors: Sijbom, M.
• Supervisor: Numans, M.E.; Boer, M.G.J. de
• Co-supervisor: Boelens, M.
• Committee: Visser, L.G.; Bom, J.G. van der; Driel, M.L. van; Nieuwkoop, C. van; Verheij, T.J.M.
• Qualification: Doctor (dr.)
• Awarding Institution: Leiden University Medical Center (LUMC), Leiden University
• Date: 2024-10-24
• ISBN (print): 9789465061900