This article is more than 5 years old. Information may no longer be current.
Prescriber, not patient characteristics influenced antibiotic duration
Click Here to Manage Email Alerts
In long-term care facilities, patients are often prescribed a long duration of antibiotics based on the prescriber’s preference, not patient characteristics, researchers from the Institute for Clinical Evaluative Sciences in Canada reported.
“Evidence has been piling up that shorter duration antibiotic treatment —1 week or less — is sufficient for most common bacterial infections, so reducing treatment durations may be one way to reduce the complications associated with antibiotic overuse, such as allergy, side effect, Clostridium difficile infection and antibiotic resistance,” Nick Daneman, MD, of Sunnybrook Research Institute in Toronto, told Infectious Disease News. “If we can devise antimicrobial stewardship interventions to change prescribing behavior, we could reduce the antibiotic days of treatment in long-term care facilities by about 20%.”
Nick Daneman
Daneman and colleagues conducted a retrospective analysis across a cohort of older residents in long-term care facilities in Ontario. Antibiotic prescription information, including the duration of treatment, was obtained from the Ontario Drug Benefit Program database. They also collected data on resident-level factors and prescriber-level characteristics that could influence antibiotic needs and prescriptions.
During the 2010 study year, 77.8% of long-term care residents received an antibiotic treatment course and were included in the study. The most common antibiotic prescriptions were second-generation fluoroquinolones, penicillins, third-generation fluoroquinolones, first-generation cephalosporins and sulfonamides. Seven days was the most common treatment duration, comprising 41% of the prescriptions, but 44.9% of the prescriptions were for more than 7 days.
There were 2,601 different prescribers, but 561 were responsible for 79.6% of the antibiotic prescriptions. There were 699 physicians who prescribed 20 or more antibiotic treatment courses, and among these, the median proportion of treatment courses more than 7 days was 43.5%. The characteristics of the patients were similar, suggesting that patient variables were not affecting prescribing patterns. The prescriber was significantly associated with the receipt of longer treatment duration.
“Future steps in our research program will involve testing interventions to shift prescribing habits in a small number of nursing homes and then rolling out effective interventions at a population level,” Daneman said. “Hopefully, in this manner, we can shift the paradigm of antibiotic treatment duration, optimizing the benefits of the medications but limiting antibiotic overuse and minimizing potential harms.”
Disclosure: Daneman reports no relevant financial disclosures.
Perspective
Back to Top
Robert A. Bonomo, MD
The impact of antimicrobial therapy, including the duration of therapy and the type of antibiotic used, have a significant effect on the emergence of antimicrobial resistance in long-term care facilities. These facilities are regarded as “reservoirs” of resistance. When elderly patients receive inappropriate antibiotics, this practice could increase the risk of colonization and/or infections with resistant pathogens. In addition, the transfer of patients between long-term care facilities and hospitals facilitates the spread of resistance. This has been shown for methicillin-resistant Staphylococcus aureus, and future studies need to show the impact that prolonged antibiotic treatment has on the development of multidrug-resistant gram negative pathogens.
This study shows that although antibiotic courses of 7 days were the most common, up to 40% of treatment courses were 7 days or more. This needs to be further evaluated because most infections can be treated with 7 days or less of antimicrobial therapy. Antibiotic treatment durations can be excessively prolonged in long-term care facilities. Clearly, we need to do more targeted studies to help mitigate the emergence of resistance in long-term care.
Click Here to Manage Email Alerts