[Inventory and comparison of guidelines for antibiotic utilization in Dutch hospitals]. / Inventarisatie en vergelijking van richtlijnen voor antibioticagebruik in Nederlandse ziekenhuizen.

In 1976 the Dutch Health Council advised hospitals to formulate guidelines for use of antibiotics. These guidelines and their use should improve the quality of care in terms of medical effectiveness and cost-effectiveness. In 1988 the Peer Review Council held a survey among all (140) Dutch hospitals to collect data about these guidelines. Thirty-seven sets of guidelines used in 71 hospitals were obtained. We analysed these sets of guidelines as to the following general aspects: the status of the guidelines in the hospitals, the problem-oriented approach, the topics dealt with in the guidelines and the authors of the guidelines. Four specific aspects related to rational use of antibiotics were analysed as well: the use of cephalosporin, the use of different antibiotics for prophylaxis and therapy and the cost-effectiveness of antibiotic treatment in relation to urosepsis. Results of these analyses show that guidelines are too often formulated in a noncommittal way and that there is a need for a more functional registration system to link information about the clinical working diagnoses, the bacteria isolated and the sensitivity to the antibiotics used. These linkages are essential for feedback to clinicians, microbiologists and pharmacists and a prerequisite for management of the quality of care with respect to use of antibiotics.

Successful single antibiotic therapy in Actinomyces septicemia and liver abscess.

We are reporting on a 36-year-old man with septicemia and a liver abscess due to Actinomyces sp. The infection was most probably acquired while eviscerating a deer he had shot. The possibility of an infection involving Actinomyces bovis is discussed. The liver abscess was diagnosed on the basis of non-invasive procedures. Therapy consisted of high-dose penicillin without surgical drainage of the abscess. The infection did not recur during the three-and-a-half year follow-up period. No previous reports of successful antibiotic therapy for actinomycotic liver abscess without surgical procedures are known.