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Electronic bottle caps show patients overstate adherence to antibiotics for SSTIs

A study that used electronic bottle caps to record each time a pill bottle was opened showed that patients commonly overstated their adherence to antibiotic regimens for skin and soft tissue infections.

Such behavior has been documented in patients with other conditions, according to study author Loren G. Miller, MD, MPH, of the division of infectious diseases at Harbor–UCLA Medical Center, and colleagues whose findings were published in Antimicrobial Agents and Chemotherapy.

Loren G. Miller

“But these failures have never been studied in skin infections or linked with clinical outcomes,” Miller said in a news release. “These findings suggest that we need better methods to have patients receive antibiotics for skin infections, such as counseling them on the importance of adhering to the medication dosing or by using newer antibiotics that require only once-weekly dosing.”

Miller and colleagues enrolled adult patients (n = 188) with uncomplicated skin and soft tissue infections (SSTIs) caused by Staphylococcus aureus at Harbor–UCLA Medical Center from November 2009 to March 2012. All were discharged with oral antibiotics to complete therapy.

Recurrence rates of SSTIs after initial S. aureus infections can be high, but the reasons are poorly understood, Miller and colleagues wrote. Antibiotics for skin infections typically are taken often and can lead to adverse drug effects — factors associated with lower medication adherence, they wrote.

To determine outcomes, Miller and colleagues fitted each patient’s prescription pill bottle with a medication event monitoring system — an electronic bottle cap that can measure the date and time that a pill bottle is opened. They gave the patients a standardized questionnaire at enrollment, 14 days and 30 days, and reviewed each participant’s medical records to determine outcomes.

Among the 87 patients who completed the study, 46% had a poor clinical outcome at 30 days and required additional treatment within 30 days of discharge. Further, the investigators recorded a significant difference between the number of patients who reported adhering to their antibiotic therapy (96%) and the mean electronically measured adherence (57%) of the same patients.

“Patients commonly overstate their medication adherence, which may make identifying patients at risk for nonadherence and poor outcomes challenging,” Miller and colleagues wrote. “Further studies are needed to determine methods to improve antibiotic adherence and clinical outcomes after a hospitalization for skin infection.” – by Gerard Gallagher

Disclosure: Miller reports receiving grants from Pfizer and serving as a consultant for Durata Therapeutics, Melinta, Merck and Theravance.

Photo credit: Los Angeles Biomedical Research Institute