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Rationale Antibiotikaverordnung

Mehr Herausforderungen als Erfolge

Rational antibiotic prescribing

Challenges and successes

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Rationale und intelligente Antibiotikaverordnungsstrategien sind sowohl für den Krankenhausbereich als auch im ambulanten Sektor dringend notwendig. Voraussetzung hierfür ist die Verfügbarkeit von Verbrauchs- und Resistenzdaten sowie einer Infrastruktur und von Personal, die es ermöglichen, diese Daten in Strategien und Bewertungen sowohl auf lokaler und regionaler als auch auf nationaler Ebene umzusetzen. Diese Voraussetzungen sind in Deutschland noch nicht optimal gegeben. Ein großes Problem ist der Mangel an geschultem Personal. Initiativen und Projekte, die teilweise im Rahmen der Deutschen Antibiotika-Resistenz-Strategie gefördert werden, haben hier bereits zu bescheidenen Erfolgen geführt. Insbesondere zu nennen sind GERMAP – ein Antibiotikaverbrauchs- und -resistenzatlas aus dem Human- und Veterinärbereich, eine im Rahmen der internen Qualitätssicherung verbesserte kontinuierliche Antibiotikaverbrauchssurveillance für Akutkrankenhäuser und die sog. ABS-Fortbildungsinitiative mit Netzwerk. Weitere Pläne sind die vermehrte Prüfung der Leitliniencompliance und die Entwicklung und Evaluation geeigneter Qualitätsindikatoren. Mittel- bis längerfristig muss in die Weiterbildung von Infektiologen, Mikrobiologen, Krankenhaushygienikern und Apothekern investiert werden, um eine ausreichende Ausstattung mit geschultem und erfahrenem Personal sicherzustellen.

Abstract

Rational and prudent antibiotic prescribing strategies are important both for the hospital sector as well as for ambulatory medicine. Prerequisites are the availability of antibiotic use and antibiotic resistance data and of infrastructure and trained personnel needed for implementing and evaluating antibiotic policies. Currently, these requirements are not being met sufficiently in Germany. A major challenge in this country is the lack of adequately trained and experienced personnel. On the other hand there are several projects and initiatives supported in part within the national antibiotic resistance control program which have produced some progress and success. One example is GERMAP, the national antibiotic use and resistance atlas covering both human medicine and the veterinary field. Other examples are the recently improved program for continuous hospital antibiotic use, surveillance and feedback and the Antibiotic Stewardship (ABS) training program with establishment of an ABS expert network. Future perspectives include programs for evaluation of practice guideline adherence and the development and evaluation of quality of care indicators. Intermediate and long-term investment is needed in specialty training and certification of a sufficient number of infectious disease physicians, medical microbiologists and infection control doctors/hospital epidemiologists and hospital pharmacists.

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Danksagung

Die dargestellten eigenen Ergebnissen wurden teilweise in vom BMBF (01KI9951), der EU/DG-SANCO (SI2.325736 und 2003211) und BMG (IIA5-2009-2509FSB340) geförderten Projekten erarbeitet. Wir danken Frau Michaela Steib-Bauert für die Unterstützung beim Datenmanagement und Helmut Schröder sowie Katrin Nink, WIdO, für die langjährige Kooperation.

Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: WVK: Vortragshonorare, Reisebeihilfen und/oder Forschungsbeihilfen von Astellas, AstraZeneca, Bayer, BMG, BMBF, Boehringer, Bundesärztekammer, DFG, Deutsche Gesellschaft für Infektiologie, ESCMID, EU, Gilead, GSK, Janssen, Kassenärztliche Bundesvereinigung, MSD, Paul-Ehrlich-Gesellschaft für Chemotherapie, Pfizer, Siemens, Universität Bremen/Bertelsmann, RKI, Stiftung Warentest. KdW: Vortragshonorare, Reisebeihilfen und/oder Forschungsbeihilfen von ADKA, BMG, Deutsche Gesellschaft für Infektiologie, Paul-Ehrlich-Gesellschaft für Chemotherapie, RKI, Universitätsklinikum Hamburg-Eppendorf.

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  1. Zentrum Infektiologie und Reisemedizin, Medizinische Universitätsklinik, Hugstetterstr. 55, 79106, Freiburg, Deutschland

    W.V. Kern &  K. de With

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  1. W.V. Kern
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  2. K. de With
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Correspondence to W.V. Kern.

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Kern, W., de With, K. Rationale Antibiotikaverordnung. Bundesgesundheitsbl. 55, 1418–1426 (2012). https://doi.org/10.1007/s00103-012-1557-5

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