At least one resident per care home on antibiotics, finds Boots UK study

Caregiver care home older person

A month-long survey looking at the antibiotic use of nearly 18,000 patients has revealed that at least one resident in each of 644 long-term care facilities in the UK was taking an antibiotic.

The research, commissioned by Boots UK and published in the Journal of Antimicrobial Chemotherapy
 on 16 April 2019, surveyed the antibiotic use of 17,909 residents in long-term care facilities between 13 November 2017 and 12 December 2017, aged 65 years and older. 

The researchers found that at least one resident was on antibiotics at each facility at the time of the survey. According to the latest statistics from Public Health England, published in 2015, one in three individuals in England take at least one course of antibiotics each year.

Some 38.7% of the antibiotics prescribed were for urinary tract infections (UTIs), while the other 61.3% were prescribed to treat respiratory, eye, skin or other infections.

Of the antibiotics prescribed for UTIs, 47.1% were given for prophylactic reasons, while 52.5% were prescribed for a confirmed UTI.

The findings come after the National Institute for Health and Care Excellence said in October 2017 that antibiotic resistance was “now common” for UTIs, and advised prescribers to only use antibiotics to treat such infections “when they are really needed”.

Meanwhile, in 2017 the government set the ambition to reduce inappropriate antimicrobial prescribing by 50% by 2021.

According to the researchers, 9.9% of staff in nursing homes and 6.5% in residential homes were trained in “good antimicrobial practice”.

The study notes that long-term care facilities “for [older] people are often described as nursing or residential homes, the difference being that a nursing home always has a qualified nurse on site”. Overall, the study found that the “proportion of residents on antibiotics was higher in nursing homes (7.7%) compared with residential homes (6.7%)”.

But the authors added that high staff turnover in both types of facilities can “result in problems with maintaining staff knowledge and awareness”.

They added: “Training programmes should support long-term care facility staff in understanding preventative measures, recognising warning symptoms with minor infections and use of antibiotics.”

The researchers acknowledged that community pharmacists have an important role to play during the medicine dispensing process in “identifying inappropriate prescribing” and to ensure that the prescribing decisions matched national guidelines.

“Working collaboratively with the community pharmacy team would enable carers to identify early signs of infection with residents and treatment using homely remedies, supporting self-care,” they wrote.

Marc Donovan, chief pharmacist at Boots UK, said the research reinforced the need for community pharmacy involvement in promoting antimicrobial stewardship. “This should include ongoing training and support for carers on self-care for residents, such as practical advice on how to support residents in taking antibiotics such as timings and dose form.”

The study comes after an earlier Boot UK-led study published on 31 January 2019 revealed that 52% of 341,536 surveyed care home residents were prescribed at least one antibiotic between November 2016 and October 2017.

Last updated
Citation
The Pharmaceutical Journal, April 2019;Online:DOI:10.1211/PJ.2019.20206458