(2005; 6 pages) [French] [Spanish]
Surveillance of antimicrobial use
Antimicrobial use should be monitored in terms of the type and degree of irrational use and several well-established methods exist. Aggregate antimicrobial drug consumption data can be used to identify the most expensive and highly used antimicrobials, or to compare actual consumption with expected consumption (from morbidity data). Anatomical Therapeutic Classification (ATC) / Defined Daily Dose (DDD) methodology can be used to compare antimicrobial consumption across institutions, regions and countries. Indicators can be used to investigate antimicrobial use in primary health care, e.g.:
• % patients prescribed antibiotics;
• % of upper respiratory tract cases (usually viral) treated with antibiotics;
• % of diarrhoeal cases (usually viral) treated with antibiotics;
• % cases with infections treated in accordance with clinical guidelines.
Focused antimicrobial use evaluation (drug utilization review) can identify problems concerning the use of specific antimicrobials or the treatment of specific infections, particularly in hospitals.
Reasons underlying inappropriate use should be investigated intermittently and include diagnostic insecurity, prescriber knowledge and habit, unrestricted availability of antimicrobials, overwork, inappropriate promotion of antimicrobials, profit motives and fear of litigation. Understanding such reasons allows appropriate, effective corrective strategies to be chosen.