ABSTRACT Control measures for the use of antibiotics are essential because of the potential harmful consequences of side effects. Various methods have been developed to help curb undesirable antibiotic prescription. We performed a survey in Dutch secondary care hospitals (response rate 73%) to make an inventory of these measures and elucidate possible shortcomings. Almost every hospital was using an anti- biotic formulary (97%), sometimes supported by extra restrictions in antibiotic choice (55%). Local practice guide- lines (95%) were commonly present, but effective imple- mentation, for example using intranet applications, could be improved (21%). National guidelines had received little attention in the composition process of local guidelines (19%). Other measures such as educational programmes for specialists (11%) and feedback on antibiotic prescription (52%) remained largely underused, although their effective implementation may optimise antibiotic prescription in hospitals. INTRODUCTION Many studies have shown that the irrational prescription of antibiotics is an extensive problem world-wide. 1,2 Control measures for the use of antibiotics are essential for reasons including the potential harmful consequences of un- necessary exposure to toxic side effects 3,4 and the increase in healthcare costs. The cost of antibiotics consumes a significant part of hospital budgets all over the world. 5,6 The use of antibiotics in Dutch hospitals, expressed as defined daily dose (DDD) per 100 bed-days, has gradually increased from 37.2 DDD per 100 bed-days in 1991 to 42.5 DDD per 100 bed-days in 1996. 7 By far the most important danger of irrational antibiotic prescription is the increase in antimicrobial resistance. There is a considerable body of evidence that micro- organisms become resistant due to antibiotic (over)use. 8 In the Netherlands, antimicrobial resistance seems to be lower than that in most European countries, 9 and this has been related to the low use of antibiotics. Nevertheless the resistance of several indicator micro-organisms has shown a slow but steady increase. 10,11 Clearly, a rational policy for the prescription of antibiotic therapy is warranted. Various methods have been developed to curb undesirable antibiotic prescription. Generally, these can be classified into educational strategies (e.g. dissem- ination of antibiotic guidelines, educational meetings, feedback and reminders), organisational measures (e.g. presence of an antibiotic committee, presence of an infec- tious disease physician at ward meetings) and restrictive strategies (e.g. publication of a formulary, restriction of antibiotic choice). 12 Research has been performed into the content of Dutch antibiotic formularies and guidelines. 13,14 The present study made an inventory of measures, including formularies and guidelines, which are used to improve antibiotic prescription in Dutch secondary care hospitals. The aim was to elucidate possible shortcomings in this field and promote successful strategies to improve the quality of antibiotic prescription behaviour. JANUARY 2005, VOL. 63, NO. 1 © 2005 Van Zuiden Communications B.V. All rights reserved. 24 ORIGINAL ARTICLE Antibiotic control measures in Dutch secondary care hospitals J.A. Schouten 1,2* , M.E.J.L. Hulscher 1 , S. Natsch 3 , R.P.T.M. Grol 1 , J.W.M. van der Meer 2** 1 Centre for Quality of Care Research (229), Departments of 2 Internal Medicine and 3 Clinical Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands, tel.: +31 (0)24-361 53 05, fax: +31 (0)24-354 01 66, e-mail: J.Schouten@aig.umcn.nl, * corresponding author **J.W.M. van der Meer was not involved in the handling and review process of this paper.