Although cardiovascular disease, predominantly coronary heart disease (CHD) and stroke, is still the leading cause of mortality in Europe (around 47% of deaths), deaths from CHD have more than halved since the 1980s. There have been steady reductions in mortality from the disease in both genders and in most European countries, largely due to tests that allow timely diagnosis, as well as treatment with the new anti-thrombotic drugs. The major concern now, though, is that this steady reduction in mortality is beginning to plateau in many EU countries, particularly in younger people, and even more alarming is that an actual rise in mortality has recently been demonstrated in populations in Romanian, Greece and Lithuania. The danger is that such increases will be sustained and will begin to occur in other European countries, fuelled by the diabetes and obesity

Globally, rising antibiotic resistance is mainly due to the increasing use of antibiotics [1]. There are several reasons for this increased use, such as ageing of the patient population, increased use of medical devices and increased possibilities for extensive surgery. However,  it is also known that 50% of all medical antibiotic use is incorrect, that is in terms of indication, choice, way of administration and /or duration [2]. In this article, the focus is on the empiric choice and steps to be taken to make an optimal choice.

Dr C. van der Donk, Dr C. den Heijer and Dr E. Stobberingh

An example of wrong indication is the use of antibiotics in case of a respiratory tract infection which is caused by a viral agent. An incorrect way of administration is the topical use of an antibiotic in case of a severe wound infection. An example of an incorrect − too short − duration is a one-day therapy with amoxicillin for the treatment of an uncomplicated urinary tract infection; likewise, a 14-day therapy for the same indication indicates a too long duration. An incorrect choice would focus mainly on the empiric choice of an antimicrobial agent. An empiric antibiotic choice means to make a choice without knowing the causative agent of the infection to be treated and/or the antibiotic susceptibility pattern of this putative agent.

Before making an optimal empiric choice
Most infections are caused by the patient