Antibiotics Overused in Nursing Homes

A new study reveals that antibiotic treatment courses in long-term care facilities appear to be driven more by prescriber preference than patient characteristics.

Researchers at the University of Toronto (Canada) conducted a retrospective analysis of 66,901 long-term care residents aged 66 years or older who received an incident treatment course with a systemic antibiotic while residing in one of 630 long-term care facilities in Ontario (Canada) during 2010. The main outcome measure was antibiotic treatment duration, examined across residents and prescribing physicians, to determine whether the variability was influenced by prescriber preference. The proportion of a physician's treatment courses that exceeded 7 days was used to classify short-, average-, and long-duration prescribers.

The results showed that 77.8% of the residents received an incident antibiotic treatment course during the study period. The most commonly selected antibiotic treatment course was 7 days (41%), but 44.9% exceeded 7 days. Among the 699 physicians responsible for 20 or more antibiotic treatment courses, the median proportion of treatment courses beyond 7 days was 43.5%. Analysis confirmed that prescribers were an important determinant of treatment duration, with 21% of prescribers responsible for prescriptions beyond the 7-day threshold. The study was published early online March 18, 2013, in JAMA Medicine.

“High rates of institutional antibiotic use are driving increased rates of antibiotic resistance, Clostridium difficile infection, antibiotic-related adverse events, and healthcare costs, yet up to half of antibiotic use in acute and long-term-care institutions is unnecessary or inappropriate,” concluded lead author Nick Daneman, MD, MSc, and colleagues. “If long-duration prescribers adopted the prescribing profile of average prescribers, their total antibiotic days prescribed would decrease by 22% and the overall antibiotic days in long-term care would decrease by 7%.”

The findings of the study concur with other research suggesting that physician preference appears to be the driving force in overuse of antibiotics, which may not reflect the actual individual needs of patients, particularly in circumstances such as long-term-care facilities where prescriptions are often written empirically. Possible interventions suggested to alter such behavior may include the implementation of standardized order sets, and the provision of feedback to clinicians.

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