Antibiotic stewardship Prerequisites, objectives and strategies

In this thesis we report on several aspects of antibiotic stewardship. The increased consumption and the misuse of antibiotics have led to bacterial resistance, and therapeutic options for treating bacterial infections are being limited more and more. A post-antibiotic era lies in wait if action is not taken, as few new antibiotics have been developed in the past decades. To counteract this precarious development, antibiotic stewardship has been developed with the aim to ensure effective treatment while minimizing unintended consequences including resistance. We report on three domains: prerequisites, objectives and strategies. This entails the content and use of a national antimicrobial guide, an elaborate systematic review on the evidence behind several antimicrobial stewardship objectives, the effect of an antibiotic restriction program, stewardship improvement strategies for the long term care setting and how knowledge and use of antibiotics differ by ethnicity and whether knowledge on antibiotics is associated with antibiotic use.