[Antibiotic therapy in Bielefeld (AnTiB)-a local project for the promotion of rational antibiotic prescribing in the outpatient pediatric sector]

Abstract

Background: Antimicrobial resistance is an increasing problem - a consequence of uncritical use, especially of "last-resort" antibiotics. Approaches towards a more rational use of antibiotics have so far focused on the inpatient sector, whereas the majority of antibiotics are prescribed in the outpatient sector. Therefore, there is demand for innovative approaches for the latter sector. The project Antibiotic Therapy in Bielefeld ("AnTiB"), founded in 2016 by pediatricians active in the outpatient pediatric sector, developed respective structures and measures at the local level.

Objectives: The development of local recommendations, suitable for everyday practice, for antibiotic prescription in frequent infectious conditions, are described.

Materials and methods: In order to develop these recommendations, evidence from the literature and practice guidelines was collected. In a structured process, mainly via quality circles, the contents were consented locally and then put under external expert review. Together with the Association of Statutory Health Insurance Physicians of Westphalia-Lippe (KVWL), antibiotic prescription data were collected exemplarily for 2016.

Results: The first version of the respective pediatric recommendations was published in January 2017. Meanwhile, comparable recommendations for outpatient gynecologists and adult GPs were released. Antibiotic prescription data from 2016 show an important spread of antibiotic prescription prevalences in general as well as with respect to single agent classes.

Conclusions: Locally consented practical recommendations may contribute to a local "culture" of antibiotic prescription behavior. The pediatric recommendations locally have so far gained good coverage and high acceptance. Transfer to other regions or medical disciplines seems possible and reasonable. In the future, the effects of such projects on the prescription behavior will be measurable by the comparison of prescription data.

Keywords: Anti-bacterial agents; Antimicrobial stewardship; Bacterial drug resistance; Local consent; Outpatient care.