Submitted to: Journal of the American Geriatrics Society
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/1/2010
Publication Date: 6/1/2011
Citation: Vergidis, P., Hamer, D.H., Meydani, S.N., Dallal, G.E., Barlam, T.F. 2011. Patterns of antimicrobial use for respiratory tract infections in older residents of long-term care facilities. Journal of the American Geriatrics Society. 59(6):1093-1098. Interpretive Summary: Few studies have been published describing how antibiotics are used in nursing homes. We analyzed data from a previous study that included 617 individuals, aged 65 years or older, residing in 33 facilities in the greater Boston area. We rated the use of antibiotics as appropriate (when an effective drug was used), inappropriate (when a more effective drug was indicated), or unjustified (when use of any antimicrobial was not indicated). Of 752 episodes of respiratory infection (such as common cold, bronchitis, pneumonia) treatment was appropriate in 79% of the cases, inappropriate in 2%, and unjustified in 19%. We did not find significant differences in the way the antibiotics were used based on age, gender, race or among residents with different underlying diseases, such as diabetes, dementia or kidney disease. Our study shows that there is a need for programs to improve antibiotic prescribing for the elderly living in nursing homes.
Technical Abstract: OBJECTIVE: To describe patterns of antimicrobial use for respiratory tract infections (RTIs) among elderly residents of long-term care facilities (LTCFs). DESIGN: Data from a prospective, randomized, controlled study conducted from April 1998 through August 2001 to investigate the effect of vitamin E supplementation on RTIs were analyzed. SETTING: Thirty-three LTCFs in the greater Boston area. PARTICIPANTS: 617 residents aged greater or equal to 65 years of participating LTCFs. MEASUREMENTS: RTIs, categorized as common cold, influenza-like illness, pharyngitis, sinusitis, acute bronchitis, and pneumonia, were studied for appropriateness of antimicrobial use, type of antibiotics used, and factors associated with their use. For cases where drug treatment was administered, we rated antibiotic use as appropriate (when an effective drug was used), inappropriate (when a more effective drug was indicated), or unjustified (when use of any antimicrobial was not indicated). RESULTS: Of 752 documented episodes of RTI, overall treatment was appropriate in 79% of episodes, inappropriate in 2%, and unjustified in 19%. For acute bronchitis, treatment was appropriate in 34% and unjustified in 65 per cent of cases. For pneumonia, treatment was appropriate in 87% of episodes. Among the most commonly used antimicrobials, macrolide use was unjustified in 43 per cent of cases; macrolides were the most frequently used drug class for treatment of the common cold. No statistical significant differences in the patterns of antibiotic use were observed when stratified by age, gender, race or co-morbid conditions including diabetes mellitus, dementia and chronic kidney disease. CONCLUSION: Antimicrobials are unjustifiably used for one-fifth of RTIs and over two-thirds of cases of acute bronchitis, thus suggesting a need for programs to improve antibiotic prescribing at LTCFs.