Improving effective antimicrobial resistance (AMR) prevention in ambulatory care: lessons from secondary appraisal of Belgian anti-infectious treatment care guidelines

The emergence of antimicrobial resistance (AMR) has been designated as a global threat by the World Health Organization. To combat AMR in Belgium, the Belgian Antibiotic Policy Coordination Committee (BAPCOC) has, among others, developed guidelines for the appropriate use of antimicrobials in the ambulatory practice. We aim to assess the current guidelines from an antimicrobial stewardship perspective and procide suggestions for improving the ambulatory antibiotic guidelines for first-line healthcare providers. The 2022 BAPCOC guidelines were independently evaluated by 7 antimicrobial stewardship experts based on the five "Ds" of antimicrobial stewardship. The results were aggregated, summarized, and consensus was sought. Recommendations improving the guidelines were formulated. A total of 52 recommendations were made, covering 16 different (sub)chapters. The most frequently covered topics were urinary tract infections, followed by skin and soft tissue infections. Among the top five recommendations deemed to have the greatest impact on antimicrobial stewardship outcomes, three were related to the diagnosis or treatment duration of urinary tract infections. Tailoring infectious disease and antibiotic treatment guidelines to antimicrobial stewardship principles and the latest literature is essential in combating antimicrobial resistance. Implementing our proposed recommendations in the Belgian ambulatory treatment guidelines could significantly enhance rational and judicious antibiotic use while minimizing the risk of 'antibiotic undertreatment. The proposed 'Choosing Wisely' recommendations have the potential to be applied to a broader (European) context.