Antibiotic stewardship Studies on measuring guideline adherence and expediting the IV-oral switch

‘‘But I would like to sound one note of warning. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” Alexander Fleming, Nobel Prize speech in 1945
Due to the widespread use of antimicrobials since 1950 the resistance rate has accelerated, leading to: 1) decreased possibilities to treat common infectious diseases and thereby increasing infection-related mortality once again, 2) an increase of societal healthcare costs, 3) a threat to the safety of interventions such as surgery, organ and bone marrow transplantation and chemotherapy. Antimicrobial resistance has therefore become a growing public health threat, for which global action needs to be taken. In order to contain resistance, Antibiotic stewardship programs have been developed. Antibiotic guideline adherence and switching IV administered antibiotics to oral administered antibiotics are two quality indicators that aid ASP in determining whether antibiotics are appropriately used. This thesis contributes to answering the following questions: 1) What are the possibilities to more efficiently measure guideline-adherence of antimicrobial therapy for treatment of an infection, using the Electronic Patient Record? 2) Is it possible to shorten the currently recommended duration of IV therapy in non-critically ill patients admitted to general wards without negatively affecting effectivity?