14 Chapter 1 potentially induce development of AMR. In addition, second choice antimicrobials - in general - tend to cause more side effects (23-26). Although adequate registration of antimicrobial allergies is essential to prevent rare but potentially life-threatening reactions upon re-exposure, up to 90% of antibiotic allergy registrations are incorrect (27-29) and lead to many avoidable broad-spectrum antimicrobial prescriptions. Understanding the reasons for incorrect antibiotic allergy registrations would assist general practitioners (GP) in improving these registrations. This in turn would help reduce prescribing of second choice antimicrobials, lowering or avoiding consequent adverse effects and development of AMR. Novel viral respiratory tract infections Novel viral respiratory tract infections (RTI), such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have emerged in recent years and others are expected to emerge over the coming decades (30). Novel viral RTIs tend to change the antimicrobial prescription behaviour of physicians. Initially, little is known about effective treatment, morbidity and mortality. Due to this uncertainty, physicians sometimes prescribe antimicrobials hoping to change the course of the infection and prevent complications such as a bacterial superinfection, pneumonia or hospital admission (31, 32). Therefore, close surveillance of antimicrobial use and prescription behaviour is needed during a pandemic. Antimicrobial stewardship To prevent further increase of AMR, antimicrobial stewardship (AMS) initiatives have been designed and implemented. In brief, AMS is a coherent set of actions which promote the responsible use of antimicrobials. This definition can be applied to actions at the individual level as well as the national and global level, and spans human health, animal health and the environment (1). These actions are coordinated through an antimicrobial stewardship (AMS) programme, which is an organizational or systemwide health care strategy to promote appropriate use of antimicrobials through the implementation of evidence-based interventions. The One health approach is incorporated in AMS programs. the World Health Organisation has made decreasing AMR a priority and has promoted the development and implementation of AMS programmes on a national level (14). Worldwide implementation of AMS programs has started, but not all countries are making progress at the same speed (18).
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