Antibiotic Treatment of Respiratory Tract Infections in Ambulatory Care in Belgium

This study aims to analyse antibiotic treatment of respiratory tract infections in ambulatory care in Belgium by: a) mapping antibiotic consumption over time and breaking down antibiotic consumption by infection type; b) discussing antibiotic treatment as recommended by Belgian guidelines; and c) reviewing the current evidence on the costeffectiveness of antibiotic treatment. IMS Health data showed that the total volume of antibiotic consumption in ambulatory care in Belgium has increased over the years. Antibiotic consumption mainly originated from the use of broad-spectrum penicillins. The volume of fluoroquinolone use remains well controlled. Policy makers need to target the main drivers of inappropriate antibiotic consumption rather than a specific class of antibiotics when they aim to promote better use of antibiotics in ambulatory care. A ß-lactam-based therapy for CAP is recommended as first choice in Belgian guidelines and moxifloxacin is advocated for CAP outpatients with comorbid conditions or outpatients in whom infection with atypical pathogens needs to be considered. Because of its high eradicating power against the target organisms and because H. influenzae is the main pathogen to be covered, amoxicillin-clavulanic acid may be a first choice to treat COPD exacerbations, although this choice is subject to debate. Moxifloxacin is recommended in case of IgE-mediated ß-lactam allergy or severe intolerance to ß-lactam antibiotics for the treatment of COPD exacerbations or for the treatment of upper respiratory tract infections on the rare occasion that antibiotic treatment is warranted. One study supported the costeffectiveness of first-line treatment of CAP with moxifloxacin in Belgium.