Metrics to assess the quantity of antibiotic use in the outpatient setting: a systematic review followed by an international multidisciplinary consensus procedure

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Versporten, Ann | Gyssens, Inge | Pulcini, Céline | Monnier, Annelie | Schouten, Jeroen | Milanič, Romina | Stanić Benić, Mirjana | Tebano, Gianpiero | Le Maréchal, Marion | Zanichelli, Veronica | Huttner, Benedikt | Vlahović-Palčevski, Vera | Goossens, Herman | Hulscher, Marlies | Adriaenssens, Niels | Beović, Bojana | Bavestrello, Luis | Cohen, Jon | Cortoos, Pieter-Jan | Dhillon, Harpal | Drew, Richard | Fernandes, Prabhavathi | Findlay, David | Friedland, Ian | Gould, Ian | Hicks, Lauri | Longshaw, Christopher | Llor, Carl | Mcgeer, Allison | Okeke, Iruka | Plachouras, Diamantis | Poulakou, Garyfallia | Rex, John | Tängdén, Thomas | Saust, Laura Trolle | Richon, Claudine | Roblot, France | Stichele, Robert Vander | Verweij, Marcel | Wertheim, Heiman

Edité par CCSD ; Oxford University Press (OUP) -

International audience. Background:The international Innovative Medicines Initiative (IMI) project DRIVE-AB (Driving Reinvestment in Research and Development and Responsible Antibiotic Use) aims to develop a global definition of 'responsible' antibiotic use.Objectives:To identify consensually validated quantity metrics for antibiotic use in the outpatient setting.Methods:First, outpatient quantity metrics (OQMs) were identified by a systematic search of literature and web sites published until 12 December 2014. Identified OQMs were evaluated by a multidisciplinary, international stakeholder panel using a RAND-modified Delphi procedure. Two online questionnaires and a face-to-face meeting between them were conducted to assess OQM relevance for measuring the quantity of antibiotic use on a nine-point Likert scale, to add comments or to propose new metrics.Results:A total of 597 articles were screened, 177 studies met criteria for full-text screening and 138 were finally included. Twenty different OQMs were identified and appraised by 23 stakeholders. During the first survey, 14 OQMs were excluded and 6 qualified for discussion. During the face-to-face meeting, 10 stakeholders retained five OQMs and suggestions were made considering context and combination of metrics. The final set of metrics included defined daily doses, treatments/courses and prescriptions per defined population, treatments/courses and prescriptions per defined number of physician contacts and seasonal variation of total antibiotic use.Conclusions:A small set of consensually validated metrics to assess the quantity of antibiotic use in the outpatient setting was obtained, enabling (inter)national comparisons. The OQMs will help build a global conceptual framework for responsible antibiotic use.

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