Table 1.
Studies describing antibiotic prescribing patterns in RACF across different countries
| Authors (country, year of surveillance, study size) | Rates of antibiotic use; most common antibiotics | Issues of concern highlighted in the study |
|---|---|---|
| Point prevalence survey – prevalence: (residents receiving ≥1 antibiotic)/(all residents) | ||
| Zimmer et al79 (US, 1983, 42 RACFs) | Prevalence: 173/2,238 (8%); trimethoprim/sulfamethoxazole (43%) ampicillin or amoxicillin (19%), nitrofurantoin (8%) | Evidence to initiate the antibiotic was judged as adequate in 62% of cases based on an expert panel. Main concern is high proportion of empiric antibiotic therapy without prior investigation. |
| Pakyz and Dwyer9 (US, 2004, 1174 RACFs) | Prevalence: 161,599/1,330,608 (11%); nitrofurantoin (12%), levofloxacin (12%), and ciprofloxacin (7%) | No assessment on the appropriateness of antibiotic use. |
| Moro et al22 (Italy, 2007, 49 RACFs) | Prevalence: 234/1,926 (12%); most common antibiotics not specified | 27 of 122 patients (22%) receiving systemic antimicrobials with reason for antibiotic therapy not clear. |
| Latour et al80 (21 European countries, 2009, 323 RACFs) | Prevalence: 1,966/32,685 (6%); β-lactam penicillins (29%), quinolones (14%), other beta-lactam antibiotics (11%) | Empirical treatments were most common (54% of all antibiotic use), followed by prophylactic (29%) and microbiologically documented treatments (16%). |
| Daneman et al81 (Canada, 2009, 363 RACFs) | Prevalence: 2,190/37,371 (6%); nitrofurantoin (15%), trimethoprim/sulfamethoxazole (14%), and ciprofloxacin (13%) | Treatment courses were at least 10 days in duration (63%), and many exceeded 90 days (21%), suggesting chronic prophylaxis. |
| Rummukainen et al82 (Finland, 2009, nine RACFs) | Prevalence: 716/5,691 (13%); methenamine (41%), trimethoprim (14%), and pivmecillinam (11%) | The prophylaxis of UTIs was the most common indication for antibiotic use. |
| McClean et al83 (15 European countries, 2009, 85 RACFs) | Prevalence of two surveys: 6.5% in April/5.0% in November; methenamine (18%), trimethoprim (11%), and co-amoxiclav (11%) in April and co-amoxiclav (12%), nitrofurantoin (12%) and methenamine (12%) in November | No assessment on the appropriateness of antibiotic use. |
| Cotter et al16 (Ireland, 2010, 69 RACFs) | Prevalence: 426/4,170 (10%); most common antibiotics not specified | Up to 40% of total prescriptions were for prophylactic indications. Only 57% of residents prescribed antibiotics for UTI had a microbiological investigation. |
| Moro et al23 (Italy, 2010, 92 RACFs) | Prevalence: 438/9,285 (5%); quinolones (24%), penicillin plus beta-lactamase inhibitor (22%), and third-generation cephalosporins (21%) | Only 49% treatment given for McGeer modified confirmed infection, 30% nonconfirmed infection, and 21% no documented infection. |
| McClean et al84 (Ireland, 2010–2011, 30 RACFs) | Prevalence: 9% systemic antibiotic, 6% topical antibiotic; trimethoprim, cephalexin, and nitrofurantoin were most commonly prescribed | High use of topical antimicrobial for prolonged duration. Based on antibiotic guidelines, almost 25% of systemic antibiotics were prescribed at inappropriate doses. |
| Stuart et al85 (Australia, 2011, five RACFs) | Prevalence: 23/257 (9%); doxycycline (26%), cephalexin (17%) and flucloxacillin (13%), or trimethoprim (13%) | A total 26% of antibiotic use was given for prophylactic reasons. Up to 40% did not fulfill the McGeer criteria for bacterial infection. |
| Smith et al24 (Australia, 2011, 29 RACFs) | Prevalence: 63/757 (8%); cephalexin (33%), amoxicillin, trimethoprim, and nitrofurantoin (10% each) | Up to 39% of total prescriptions were for prophylactic indications. |
| Heudorf et al20 (German, 2011, 40 RACFs) | Prevalence: 90/3,732 (2%); quinolones (n=31), cephalosporins (n=19), penicillins (n=11), and co-trimethoprim/sulfamethoxazole (n=11) | Empiric prescribing without microbiological investigation for UTIs (92% of antibiotic treatment) |
| Longitudinal surveillance – incidence: (number of antibiotic courses)/(100 patient-days) | ||
| Mylotte75 (US, 1989, single RACF) | 111/156 (71%) received ≥1 incident course a year Incidence: 0.61 antibiotic course/100 patient-days; trimethoprim/sulfamethoxazole (29%), ciprofloxacin (26%), amoxycillin (12%) | Questionable high use of fluoroquinolones as empiric therapy. |
| Warren et al77 (US, 1991, 53 RACFs) | 2,105/3,899 (54%) received ≥1 incident course a year Incidence: 0.46 antibiotic course/100 patient-days; beta-lactam antibiotics (54%) most common | >50% of antibiotic courses started without documented investigation. Treatments were initiated for “viral” upper respiratory infections (13%) and asymptomatic bacteriuria (9%) |
| Loeb et al74 (Canada, 1996, 22 RACFs) | 2,408/3,656 (66%) received $1 incident course a year Incidence: 0.73 antibiotic course/100 patient-days; trimethoprim–sulphamethoxazole, (17%) ciprofloxacin (17%), amoxicillin (13%) | McGeer criteria were only met in 49% of patients prescribed antibiotics; 30% of antibiotic prescriptions for urinary indication were for asymptomatic bacteriuria. |
| Blix et al86 (Norway, 2003, 133 RACFs) | Incidence: range 4–44 DDD/100 patient-days; penicillins with extended spectrum, followed by trimethoprim and sulfonamides | High use of a urinary prophylactic agent, methenamine, represented nearly half (46%) of DDDs used. |
| Pettersson et al87 (Sweden, 2003, 58 RACFs) | Incidence: one treatment/resident/year; penicillins (38%), followed by quinolones (23%) and trimethoprim (18%) | Based on national guidelines, 50% of lower UTIs in women were not treated according to the recommendations (questionable length of treatment and overprescribing of quinolones). |
| Lim et al34 (Australia, 2010, four RACFs) | Incidence: 0.71 antibiotic course/100 patient-days; cephalexin (25%), trimethoprim (14%), amoxycillin–clavulanate (13%) | Up to 37% did not fulfill the McGeer criteria for bacterial infection. Antimicrobials were routinely prescribed for URTI and acute bronchitis (31%), also common for asymptomatic bacteriuria. |
| Daneman et al72 (Canada, 2010, 630 RACFs) | 50,061/66,901 (75%) received ≥1 incident course a year; second-generation fluoroquinolones (19%), penicillins (17%), third-generation fluoroquinolones (17%) | Prolonged treatment courses were common for all antibiotic subclasses, with 45% that exceeded a 7-day course. |
Abbreviations: RACFs, residential aged care facilities; UTI, urinary tract infection; n, number; DDD, defined daily dose; URTI, upper respiratory tract infection.