4 June 2020

Antibiotic use in aged care is still escalating

Aged Care Research

A sustained increase in antibiotic prescribing in government aged care facilities over the last decade presents yet another risk for antimicrobial resistance, a study says.

An Australian population-based study, recently published in Clinical Infectious Diseases, found that in 2005, almost 64% of residents received an antibiotic at least once that year, and by 2015 that number had increased to more than 70%.

The study authors investigated national trends of antibiotic use in more than 3,000 residential aged-care facilities (RACFs) by examining the patient records of more than half a million long-term residents.

“The burden of use in this setting is high, with seven out of every 10 residents receiving at least one antibiotic in 2015-16, with a median of three antibiotic prescriptions dispensed that year,” the study authors said.

The most common antibiotics prescribed included cefalexin, amoxicillin-clavulanic acid and trimethoprim.

Perhaps surprisingly, there was an almost 40% increase in the consumption of broad-spectrum antibiotics, with their use increasing from about 68 to 94 standard daily doses, dispensed over a period of 1000 days.

The study did not look, however, at the relationship between which antibiotics were administered and the conditions they were prescribed to treat.

Joachim Sturmberg, Professor of General Practice at the University of Newcastle in NSW, commenting on the study, said he was concerned that the antibiotics being prescribed meant doctors were not adhering to the antimicrobial guidelines.

Anecdotally, Professor Sturmberg said that aged care homes had changed over the years to mirror a low-level hospital environment.

“We see more residents with more significant medical conditions that are now managed in the community, and while that is not a reason to prescribe more antibiotics, it means that the significantly ill patients do become much more susceptible to infection,” he said.

“Those circumstances are a necessary component to take into account when looking at patterns of prescribing of antibiotics.”

Dr Farhan Ulhaq, a GP working in aged care, said it would be valuable to know the difference in aged care homes between the prescribing patterns of the facility’s regular GP, compared with any after-hours GP services used.

“In my experience, most antibiotics prescribed to my patients in aged care seem to come from out-of-hours GP services which the facility has called,” he said.

“When the out-of-hours GP services are called, there’s sometimes a pressure they have to do something for the patient immediately and so they might prescribe an antibiotic for a suspected UTI, rather than sending urine away for testing, which is what the regular GP would often do, because they have time.”

Clinical Infectious Diseases 2020, 28 May



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