Rationale Antibiotikaverordnung in der Humanmedizin

Leitthema
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Zusammenfassung

Rationale Antibiotikaverordnung ist zu einer Priorität in der medizinischen Fort- und Weiterbildung und Qualitätssicherung geworden. Optimierungsbereiche liegen vor allem in der kritischen Indikationsstellung, der vermehrten gezielten Therapie und Therapiedauerverkürzung. Sie betreffen niedergelassene Ärzte und auch die Krankenhausmedizin. Sie sind teilweise durch Defizite in der klinischen Forschung bedingt, aber auch Fehlentwicklungen in der fachärztlichen Weiterbildung, in der Strukturierung und im Vergütungssystem der verschiedenen Sektoren im Gesundheitssystem tragen zu Problemen in diesen Bereichen bei. Antibiotic-Stewardship(ABS)-Programme auf verschiedenen Ebenen können Maßnahmen zur Verbesserung der Antibiotika-Verordnungsqualität bündeln. Erfahrungen gibt es dazu vor allem bezüglich Schulung und Fortbildung von ärztlichem Personal und Apothekern sowie Etablierung von ABS-Teams vor Ort und von infektiologischen Konsiliardiensten im Krankenhaus. Eine gute Interaktion und Verzahnung mit der mikrobiologischen Diagnostik sind dabei wichtig und verstärken die Effekte auf die Verordnungsqualität. Notwendig sind politische Unterstützung und Investitionen, um solche neuen Strukturen nachhaltig etablieren zu können und diese auch für die Schnittstellen zwischen stationär und ambulant sowie für die ambulante Medizin weiterzuentwickeln.

Schlüsselwörter

Antibiotikaresistenz Qualitätsmanagement Antibiotikaverschreibung Antibiotic Stewardship 

Rational prescription of antibiotics in human medicine

Abstract

Rational prescription of antibiotics has become a priority in undergraduate and continued professional medical education and in quality management systems. Areas for optimization have been identified, above all, in critically establishing the indication for therapy, in increasing targeted therapy, and shortening treatment duration, and affect both outpatient and inpatient settings. They are partly related to deficiencies in clinical research, but aberrations in the development of the postgraduate training system, in the infrastructure, and in the reimbursement system of the various healthcare sectors in Germany contribute to problems in these areas. “Antibiotic stewardship” (ABS) programmes at different levels are capable of efficiently combining interventions to improve the quality of prescription. Progress has been made and experience gained in the professional training of physicians and pharmacists in antibiotic prescribing and with the hospital-wide establishment of ABS teams and specialist infectious disease consultation services. Close interaction and collaboration with diagnostic microbiology services are important and greatly enhance the impact of ABS programmes on the quality of prescription. Political support and investment are required for this new infrastructures to be sustainable and to further develop it for the cross-section between inpatients and outpatients, and for the outpatient setting.

Keywords

Antimicrobial resistance Quality management Antibiotic prescribing Antibiotic Stewardship 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

W.V. Kern ist als Mitglied im Vorstand der Deutschen Gesellschaft für Infektiologie für den Bereich Fort- und Weiterbildung zuständig.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Abteilung Infektiologie, Klinik für Innere Medizin II, Universitätsklinikum und Medizinische Fakultät FreiburgAlbert-Ludwigs-UniversitätFreiburg im BreisgauDeutschland

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