208 English summary Improving antibiotic allergy registration Allergies to antibiotics are among the most reported adverse reactions to medication. Accurate registration of these allergies is crucial to prevent rare but potentially lifethreatening reactions upon repeated exposure. In Dutch primary care practices, between 0.6% and 2.1% of patients have records of antibiotic allergies in the electronic patient records. However, approximately 80-90% of antibiotic allergy registrations in primary care practice turn out to be unjustified. As a result, antibiotic allergy registrations lead to an increase of physician encounters, higher healthcare costs and the more frequent prescription of second-choice antimicrobials. Second-choice antimicrobials are often broad-spectrum antimicrobials which have a greater risk of inducing the development of AMR. Removing an allergy registration that has been deemed "unjustified" can be particularly difficult: electronic health records (EHR) in hospitals, pharmacies and primary care practices containing registrations do not correct each other adequately. In chapter 5, we conducted a mixed-methods study using reviews of EHR and semistructured interviews with healthcare providers from different domains (pharmacy, nursing home, hospital and primary care practice). We investigated what information on the reaction is registered as an antibiotic allergy in an EHR, what causes incorrect antibiotic allergy registrations and how registrations can be improved. The study revealed that in 56.3% of cases, the recorded information was inadequate to confirm whether the reaction was allergic in nature. This emphasises the necessity for better recording of reactions following antimicrobial intake. The primary reasons for inadequate quality of registrations were lack of knowledge, lack of priority, limitations of registration functions in the electronic health record (EHR), and patients and doctors interpreting adverse reactions as allergies. The findings were unique in that the determinants were similar across all domains studied. This supports the need for developing cross-domain interventions. Improving quality of antimicrobial prescriptions in primary care practice Many determinants have already been identified in chapter 3, but this and previous research lacked socioeconomic determinants and information on primary care practices. It was unclear to what extent the quality of antimicrobial prescribing in primary care practice could be improved. A retrospective observational cohort study (chapter 6) was conducted to explore the feasibility of using and combining large health care registers for research on antimicrobial
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