Project APRES

Duration: 2009 - 2013
Appropriateness of PREScribing antibiotics in primary health care in Europe (with respect to antibiotic resistance)


Bacterial resistance against antibiotics is a worldwide concern for public health. If we want to ensure the effectiveness of antibiotics for the treatment of bacterial infections in the long term, restrictive and appropriate use is required. More than 90% of antibiotics in Europe are being prescribed to non-hospitalized patients. However, guidelines for prescribing antibiotics to community-dwelling patients are based on the antibiotic resistance pattern measured in hospitalized patients. Since the guidelines are based on insufficient data, there is a need for empirical research..



  • Full title: Appropriateness of PREScribing antibiotics in primary health care in Europe
  • Deliverables: see publications on the right
  • Funding: European Commission, Seventh Framework Programme
  • Project participants: 13 participants from 9 countries
  • Project Partners: University of Nottingham (England), University Hospital Maastricht (the Netherlands), Universiteit Antwerpen (Belgium)
  • Nivel involvement: lead partner
  • Nivel experts: John Paget PhD

Doel Aims

Providing information and recommendations on the appropriateness of prescribing antibiotics in primary care.

Producten en dienstenMethod

In nine European countries data will be collected on the antibiotic resistance patterns of bacteria circulating in the community. This will be correlated with antibiotic prescribing patterns retrieved from primary care practices. The relationship between the antibiotic resistance pattern for bacteria and the pattern of antibiotic prescription behaviour will give insights in the appropriateness of prescribing.

OrganisatieProject design

In order to contribute to knowledge about the appropriateness of prescribing antibiotics, the APRES project consists of several substudies of work packages, which results will be combined in the end. You can also find an overview of these work packages at the e APRES FP7 Poster

WP1 - Literature review (University of Nottingham)

A review study concerning the relationship between outpatient antibiotic prescribing patterns and antibiotic resistance patterns in the community has been done. Also, an inventory has been made of information sources and databases on these issues in nine European countries (click here to see our inventory).

WP2 - Antibiotic resistance patterns (Maastricht University)

To establish the patterns of antibiotic resistance in healthy community-dwelling persons, an empirical clinical study will be conducted. In each country, 20 GP practices will each be asked to collect 200 swabs containing samples of the bacterial flora in the nasal mucosa. The samples will be sent to one central laboratory in each country for culturing the bacterial flora, i.e. Staphylococcus aureus and Streptococcus pneumoniae. The isolated strains will be sent to the central laboratory in the Netherlands for standardized antibiotic resistance testing.

WP3 - Antibiotic prescribing patterns (University of Antwerp)

For this study, we will use prescribing data that will be made anonymous. They will be retrieved from the electronic medical records of all patients listed in the primary care practices participating in the study concerning resistance patterns. The prescribing data (ATC codes) include all antibiotics prescribed during the previous five years to all listed patients and the diagnoses for which these drugs were prescribed.

WP4 - The appropriateness of prescribing antibiotics (Nivel)

This study aims at establishing information and providing guidelines on the appropriateness of prescribing antibiotics by primary care physicians in nine European countries (with data collected as part the third study) in view of the antibiotic resistance patterns of S. aureus  and S. pneumoniae (as established in the second study). The accordance between the patterns of prescribed antibiotic types and specified resistance patterns will be measured for different antibiotic agents and for both bacteria per country. This will provide the necessary information to formulate country specific guidelines on prescribing antibiotics by primary care physicians, especially for the treatment of infections potentially caused by S. aureus or S. pneumoniae (pneumonia, skin infections).

SamenwerkingsverbandProject partners

The project is a collaboration between Nivel, the University of Nottingham (England), University Hospital Maastricht (Netherlands) and Universiteit Antwerpen (Belgium).


APRES is funded by the Seventh Framework Programme of the EU.

Meer wetenWant to know more?

For more information on (conducting research together with Nivel on) this topic, please contact (one of our) contact(s) on the right).
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Paget, J. Project APRES. From: [Last update 08-July-2021; consulted on 17-May-2022]. URL: