Nursing homes should improve antibiotic use

Antibiotics frequently misused in long-term care

Citing increasing use of antibiotics in long-term-care facilities and noting that much of the medication is administered inappropriately, a national epidemiology organization recently issued guidelines that may be of assistance to infection control consultants.1

According to the Society for Healthcare Epidemiology of America (SHEA) in Woodbury, NJ, antimicrobials are among the most frequently prescribed pharmaceutical agents in long-term care facilities (LTCFs) -- accounting for approximately 40% of all systemic drugs prescribed. A substantial proportion of the antimicrobial use in LTCFs is considered inappropriate. Recent reports indicate that 25% to 75% of systemic antimicrobials and up to 60% of topical antimicrobials are prescribed inappropriately. Yet attempts to improve antimicrobial use in LTCFs are complicated by characteristics of the patient population, limited availability of diagnostic tests, and virtual absence of relevant clinical trials. Despite such limitations, SHEA advised facilities to consider at a minimum the following general measures:

* Infection control programs in LTCFs should be encouraged to include a component of antimicrobial utilization review. The purpose of this activity should be to promote the rational use of antimicrobial agents and, potentially, to limit the extent of antibiotic-resistant pathogens in the LTCF. The process of antimicrobial utilization review falls most appropriately into the domain of the infection control program because inappropriate antibiotic prescribing practices have an impact on the success or failure of infection control efforts.

* The antimicrobial review program should monitor antibiotics that are prescribed in the LTCF. Surveillance data should be reviewed on a regular basis -- monthly, quarterly, or semiannually -- depending on the size of the institution and quantity of antibiotics prescribed. The program should list the specific types of antibiotics used in the LTCF and should record the number of doses or days of treatment, as well as costs. Whenever possible, these data should be linked with surveillance data of infections caused by resistant pathogens. This information should be reviewed by the infection control committee and forwarded to prescribing physicians.

* The antimicrobial review program should develop and promote programs to optimize judicious antibiotic use. This would include ensuring that information regarding the use of antibiotics for symptomatic infections is included in the patient's medical records as part of the treatment plan. Whenever possible, the use of antibiotics, particularly broad-spectrum antibiotics, should be minimized.


1. Nicolle LE, Bentley D, Garibaldi R, et al. SHEA position paper: Antimicrobial use in long-term-care-facilities. Infect Control Hosp Epidemiol 1996; 17:119-128. *