Responsible Antibiotic Stewardship in Senior Care
Antibiotics are among the most frequently prescribed medications in nursing homes, with up to 70% of residents in a nursing home receiving one or more courses of systemic antibiotics when followed over a year, according to the Center for Disease Control and Prevention. Studies have shown that somewhere between 40-75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate.
As antibiotic resistance becomes an increasing global threat, antibiotic use in long-term care facilities is an issue that most experts agree needs to be addressed as part of the nationwide effort to slow the emergence of antibiotic-resistant bacteria.
Antibiotics can destroy or slow the growth of bad bacteria that cause infection, dramatically reducing mortality rates of once-fatal diseases such as pneumonia. While antibiotics are incredibly useful, throughout the years they have been used too frequently and in too large of doses. This exploitation of antibiotics has led to a new problem: antibiotic resistance.
When bacteria are exposed to antimicrobials (antibiotics), they can then develop a resistance to such treatments, according to The Society for Healthcare Epidemiology of America. This resistance has made it so certain types of bacteria have adapted and become more difficult to treat, causing panic in the scientific community. Antibiotic stewardship refers to the attempt to limit the use of antibiotics in order to reduce antibiotic resistance, toxicity, and unnecessary costs. It is not only an effort to decrease antibiotic use, but to use antibiotics more effectively and in the appropriate doses for the correct duration of time.
Although antibiotic stewardship isn’t a new philosophy, it has become more formalized through recommendations by the CDC, and a relatively new rule by the Centers for Medicare and Medicaid Services (CMS) that requires nursing homes to have an antibiotics stewardship program. The rule is part of a broader initiative aimed at improving the care and safety of the nearly 1.5 million residents in the 15,000 US long-term care facilities that participate in the Medicare and Medicaid programs.
The CDC has outlined the core elements of antibiotic stewardship for nursing homes into practical ways to initiate or expand antibiotic stewardship activities in nursing homes as the following:
While the effects of antibacterial resistance are widespread, they are seen to be the most problematic in elderly people, who make up the largest portion of antibiotic-users. Dr. Lindsay Nicolle from the University of Manitoba argues that “intense antimicrobial treatment in long-term care facilities promotes the emergence and persistence of antimicrobial-resistant organisms and leads to adverse effects”.
This issue of antibiotic (or antimicrobial) stewardship in geriatric medicine is not new, according to Peter Bernstein and Carole Lambert’s article, Developing and Implementing Antibiotic Stewardship in Long-Term Care. The issue was addressed nearly 30 years ago by an article in the Journal of the American Geriatrics Society, and again 20 years ago by The Society for Healthcare Epidemiology of America (SHEA). Unfortunately, this is not an issue with an easy fix. Medical treatment for people in nursing homes is dependent on not just one doctor, but a variety of nurses, physicians, and oftentimes family members as well.
Many possible courses for the implementation of antibiotic stewardship programs in nursing homes have been proposed, with limited success. While the solution to antibiotic resistance is still unknown, it is an issue that is being explored by experts in all different fields of medicine.
For more information on antibiotic stewardship and its importance in geriatric medicine, check out Today’s Geriatric Medicine.