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Skin Infection Patients Fail to Follow Drug Regimen After Hospital Discharge

LOS ANGELES – When a skin and soft tissue infection patient leaves the hospital with antibiotic prescription in hand, chances are fairly good you’ll see them again.

Why? A new study reports that low medication adherence by patients with S. aureus infections resulted in nearly half of them getting a new infection or needing additional treatment for the existing skin infection.

The research, published recently in Antimicrobial Agents and Chemotherapy, reports that those patients took only slightly more than half — 57% — of the antibiotic doses prescribed to them as they left the hospital.

For the study, led by researchers from the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed), antibiotic dosing was measured at enrollment, 14 days, and 30 days by using medication containers fitted with electronic caps that kept track when the patient opened the pill container.

That way, study authors were able to spot a large discrepancy between patient reports and the electronic measurement: While patients reported taking, on average, 96% of their medication, the electronic caps suggested the percentage was a little more than half as much.

"We have seen similar differences and similar failures to take all the prescribed medications in many other conditions, including hypertension, diabetes, and HIV," lead researcher Loren G. Miller, MD, MPH, explained. "But these failures have never been studied in skin infections or linked with clinical outcomes. 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."

Overall, of the 87 patients who had complete records after hospitalization for S. aureus associated skin and soft tissue infections, 40 required additional treatment within 30 days of leaving the hospital because:

  • a new skin infection developed,
  • their infections needed incision and drainage, or
  • the infection hadn’t cleared and new antibiotics were necessary.

Higher rates of non-adherence to antibiotic regimens were identified among patients who were prescribed more than one antibiotic after leaving the hospital, didn't see the same healthcare provider for follow-up visits, or reported they didn't have a regular healthcare provider, according to the results.

“In conclusion, we found patient adherence to oral antibiotic therapy for SSTI after hospital discharge was low (57%) and associated with poor clinical outcome,” the study authors wrote. “Patients commonly overstate their medication adherence, which may make identifying patients at risk for non-adherence and poor outcomes challenging. Further studies are needed to improve post-discharge antibiotic adherence after SSTIs.”

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