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Nursing Homes Are Latest Target of Fight Against Antibiotic Overuse

Up to 75% of nursing home antibiotic prescriptions are incorrect

Antibiotics are among the most prescribed medicines in nursing homes, with up to 70% of residents receiving one or more courses each year for suspected illnesses including cellulitis, pneumonia, and urinary tract infections (UTIs). The Centers for Disease Control and Prevention (CDC) has found that up to 75% of these prescriptions are given either unnecessarily or the prescription is written for the wrong dose, duration, or drug entirely.

The Wall Street Journal reported that health officials and health care executives, concerned by a rise in dangerous drug-resistant infections, are turning more attention to nursing homes. They have concentrated for several years on curbing misuse of antibiotics in hospitals.

One of the biggest culprits, researchers say, is misdiagnosed UTIs. Only a quarter to a third of people in nursing homes who are diagnosed have actual symptoms, according to several studies. Most have only vague symptoms, such as confusion or bacteria in their urine that aren’t actually causing an infection, says David Nace, director of long-term care and flu programs at the University of Pittsburgh. UTIs are “the poster child of inappropriate antibiotic use,” he says.

Such practices spawn the spread of drug-resistant bacteria that can be particularly harmful to the elderly and are very difficult if not impossible to treat, researchers say. They can also lead to drug interaction problems or diarrhea from Clostridium difficile — a common complication in long-term care facilities that can be deadly for people more than 65 years of age, says Ghinwa Dumyati, an infectious disease physician in the Center for Community Health at the University of Rochester Medical Center.

Curbing antibiotic overuse is a particularly tall order for nursing homes. Doctors can be reluctant to hold off on prescribing medications because patients are frail, and they sometimes have milder fevers or other symptoms that differ from those in younger adults. Many patients also suffer from dementia or other forms of cognitive impairment and can’t tell nurses or doctors what their exact symptoms are. In addition, turnover among nursing home staff members is high, and antibiotics are often prescribed by providers who haven’t seen the patients.

The government and professional groups are taking action. Calling nursing homes the “next frontier” for antibiotic resistance, the Centers for Medicare and Medicaid Services recently proposed new requirements for facilities to track and curb unnecessary use of antibiotics. In September, the CDC issued guidelines to help nursing homes implement such practices.

Source: The Wall Street Journal; October 12, 2015.

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