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Clin Microbiol Infect. 2015 Apr;21(4):354-61. doi: 10.1016/j.cmi.2014.11.015. Epub 2014 Nov 22.

European survey on principles of prudent antibiotic prescribing teaching in undergraduate students.

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Service de Maladies Infectieuses, CHU Nancy and EA 4360 Apemac, Université de Lorraine, Université Paris Descartes, Nancy, France. Electronic address:
Department of Medicine, Radboud University Medical Center and Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Department of Clinical Microbiology, Rigshospitalet (Copenhagen University Hospital), Copenhagen, Denmark.
Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital, Freiburg, Germany.
Infection Unit, Ninewells Hospital and Medical School, Dundee, United Kingdom.
Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, y Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain.
Department of Microbiology and Infection Control, University Hospital of North-Norway and Research group for Host-Microbe Interactions, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
Department of Clinical Pharmacology, University Hospital Rijeka and Department of Pharmacology, University of Rijeka Medical Faculty, Rijeka, Croatia.
Department of Medicine, Radboud University Medical Center and Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; Hasselt University, Hasselt, Belgium.


We surveyed European medical schools regarding teaching of prudent antibiotic prescribing in the undergraduate curriculum. We performed a cross-sectional survey in 13 European countries (Belgium, Croatia, Denmark, France, Germany, Italy, Netherlands, Norway, Serbia, Slovenia, Spain, Switzerland, United Kingdom) in 2013. Proportional sampling was used, resulting in the selection of two to four medical schools per country. A standardized questionnaire based on literature review and validated by a panel of experts was sent to lecturers in infectious diseases, medical microbiology and clinical pharmacology. In-depth interviews were conducted with four lecturers. Thirty-five of 37 medical schools were included in the study. Prudent antibiotic use principles were taught in all but one medical school, but only four of 13 countries had a national programme. Interactive teaching formats were used less frequently than passive formats. The teaching was mandatory for 53% of the courses and started before clinical training in 71%. We observed wide variations in exposure of students to important principles of prudent antibiotic use among countries and within the same country. Some major principles were poorly covered (e.g. reassessment and duration of antibiotic therapy, communication skills). Whereas 77% of the respondents fully agreed that the teaching of these principles should be prioritized, lack of time, mainly due to rigid curriculum policies, was the main reported barrier to implementation. Given the study design, these are probably optimistic results. Teaching of prudent antibiotic prescribing principles should be improved. National and European programmes for development of specific learning outcomes or competencies are urgently needed.


Antibiotic stewardship; curriculum; education; medical school; medical student; questionnaire

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