England

Urgent action needed to stop care home residents receiving unnecessary antibiotics

Residents in nursing homes in England receive twice as many antibiotics as those of the same age living in their own homes, potentially harming their health and contributing to the growing problem of drug-resistant superbugs

Residents in nursing homes in England receive twice as many antibiotics as those of the same age living in their own homes, potentially harming their health and contributing to the growing problem of drug-resistant superbugs, says The Royal Pharmaceutical Society.

Routine testing of residents in nursing homes is leading to large scale over-diagnosis and unnecessary treatment of urinary tract infections (UTIs). UTI is the most common reason antibiotics are provided in nursing homes.

Research shows that residents aged 75 and over in nursing homes receive twice as many antibiotics as those of the same age living in their own homes. Prescriptions for antibiotics are often provided after a routine dipstick test, when a strip is dipped into a resident’s urine to detect bacteria which could cause an infection.

However, the presence of bacteria is a common finding in the elderly and on its own does not mean the resident has a UTI or needs antibiotics. NICE guidance  warns about the accuracy of dipstick testing and says those over 65 should have a full clinical assessment before a diagnosis of urinary tract infection is made, but reliance on dipstick testing alone remains widespread.

When pharmacists were employed to train nursing home staff in Bath to reduce their reliance on dipstick testing and take residents’ symptoms into account when diagnosing a UTI they reduced inappropriate antibiotic prescribing in over 50% of residents and cut unplanned admissions to hospital.

The RPS would like to see the roll out of this successful project in Bath across the country so residents can benefit from the scheme whatever part of the country they live in. 

RPS England Board Chair Sandra Gidley said:

“Far too many nursing home residents are getting antibiotics they don’t need. We must talk to residents about their symptoms rather than give them antibiotics based on a test result alone.

“Inappropriate use of antibiotics is fuelling the rise of antibiotic resistance, when bacteria become resistant to the antibiotics used to treat them. The rate at which resistant bacteria develop can be slowed by reducing the number of unnecessary antibiotics used, ultimately helping protect frail elderly residents from hard-to-treat superbugs.

“We need to prevent unnecessary harm to our frail elderly population. Antibiotics can cause distressing side-effects in older people such as nausea, diarrhoea, vomiting and skin rashes, as well as affect other medicines they may be taking.

“If pharmacists had responsibility for how all medicines are used in nursing homes they could improve the care of residents, reduce the use of antibiotics and help prevent antibiotic resistance.” 

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