You are doing the further training "Antibiotic Stewardship". What motivated you?
Kunstmann: There is often lack of practical knowledge about the rational use of anti-infectives and the prevention of nosocomial infections. "Rational" means targeted and economical. Both serve the well-being of the patient and that of the hospital.
That means in everyday clinical practice?
Kunstmann: The patient should be given the drug with the greatest prospect of effectiveness as long as necessary, but as short as possible, with low risk of the pathogen developing resistance. In acute pyelonephritis, for example, therapy with an intravenous beta-lactam instead of an oral fluoroquinolone can be useful if high and increasing quinolone resistance occurs. Even if the intravenous application means loss of comfort for the patient compared to the oral one. Avoiding complicated infection, but also using expensive reserve resources, reduces costs. Another principle is to switch from broad-spectrum to narrow-spectrum antibiotics as quickly as possible and whenever possible.
The way to the goal?
Kunstmann: The way is to address all actors: with arguments and diplomacy. We don't want to complain, we want to advise and contribute to the establishment of guidelines within the clinic. The young assistant doctor who is on duty at night needs decision support. And we create network with contacts and thus the culture of discussion that is urgently needed in this area.