Martijn Sijbom

207 English summary E determinants from multiple domains (patients, practice, society and GPs) influence prescribing behaviour and reinforce each other, especially in the "over-prescribing" of antimicrobials. Quality and quantity of antimicrobial prescriptions during the COVID-19 pandemic In recent years, a new viral respiratory infection known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a significant burden of disease and has become a pandemic. It is likely that other new respiratory infections will emerge in the coming decades. These infections tend to influence doctors' antimicrobial prescribing behaviour. In the early stages of an epidemic or pandemic, effective treatment, morbidity, and mortality are often unknown. Due to the uncertainty surrounding infections, doctors may prescribe antimicrobials in the hope of altering the infection's course and preventing complications such as bacterial superinfection, pneumonia, or hospitalization. It is crucial to comprehend prescribing behaviour to provide targeted feedback to GPs. In an observational cohort study (chapter 4), we investigated the effect of the COVID19 pandemic on the number of antimicrobial prescriptions in primary care practice. The frequency of antimicrobial prescriptions for patients during SARS-CoV-2 infection was compared with the frequency of antimicrobial prescriptions for patients during influenza or influenza-like infection in four influenza seasons. Furthermore, the association between antimicrobial prescriptions and risk factors on an unfavourable course of SARS-CoV-2 infection was assessed. Our study showed that fewer antimicrobials were prescribed to patients during COVID-19 infections than during similar influenza or influenza-like infections in four influenza seasons. This is consistent with results from other studies that have shown a decrease in antimicrobial prescriptions during the COVID-19 pandemic compared to previous years. The reduced prescribing of antimicrobials to patients during SARSCoV-2 infections may have been due to intensive testing for SARS-CoV-2 during the COVID-19 pandemic, while no such testing was conducted for influenza during flu seasons. It became evident to patients and GPs that SARS-CoV-2 was the cause of the symptoms and that antimicrobials were unnecessary. Patients with risk factors for a more severe course were prescribed antimicrobials more frequently than those without risk factors. Reducing diagnostic uncertainty regarding the causative agent of respiratory infections could potentially result in fewer antimicrobial prescriptions.

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