Two in three aged care residents prescribed antibiotics they don’t need

The latest annual Aged Care National Antimicrobial Prescribing Survey (AC NAPS) of infections and antimicrobial prescribing practices in Australian aged-care homes has been published, coinciding with World Antibiotic Awareness Week (18–24 November 2019).

The 2018 Survey reviewed the medication charts of over 20,000 aged care residents from 407 participating facilities across Australia and reports:

– On any given day, almost 10% of residents in aged-care homes are taking an antibiotic, despite only around 3% having any signs or symptoms of infection

– Nearly 65% of aged care residents had been recently prescribed antimicrobials, despite having no documented signs or symptoms of suspected infection in the week before they started treatment

– Over 25% of aged care residents had been taking antibiotics for more than six months

– Incomplete documentation was a prominent barrier to proper review of antimicrobial therapy, with the indication, review date or stop date not documented for many prescriptions.

According to Associate Professor Noleen Bennett from the National Centre for Antimicrobial Stewardship in Melbourne, who co-authored the study, although antibiotics are valuable in aged-care homes to treat infections and reduce the elevated risk of complications,

“many people are using antibiotics for much longer than is needed to treat an infection, or even using them to prevent infections”.

“This puts them at risk of developing infections that become resistant to antibiotics. As resistant bacteria can spread from person to person, this puts other residents at risk.”

“The survey, funded by the Australian Commission on Safety and Quality in Health Care, showed that in aged-care facilities, it is often not recorded why an antibiotic is being used, when it was started, when it should be reviewed and when it should be stopped. This information should be kept up-to-date and available to all relevant medical staff and carers,” she said.

Recommendations include using appropriate microbiological testing to guide prescribing, following national antimicrobial prescribing guidelines, documenting the indication for the antimicrobial, and its start, stop and review dates, and monitoring and re-evaluating long-term antimicrobial use.

Minimising the risk of antimicrobial resistance (AMR)

With the newly updated Aged Care Quality Standards, Australian aged-care homes now must show how they promote best-practice use of antibiotics.

Overuse and inappropriate use of antimicrobials can, directly and indirectly, harm aged care residents and lead to deterioration of their health and increased risk of mortality.

Of particular concern, overuse of antimicrobials in aged care homes can also result in these facilities becoming reservoirs and sites of transmission of drug-resistant microorganisms impacting the community as a whole.

NPS MedicineWise has issued an urgent message to all Australians: It’s time to take antibiotic resistance seriously, stating:

“Antibiotic resistance is a serious worldwide problem, and it’s happening in Australia. The World Health Organization has warned that antibiotic resistance is one of the greatest threats to human health today.”

With the newly updated Aged Care Quality Standards, Australian aged-care homes now must show how they promote best-practice use of antibiotics. Noleen Bennett comments that,

“By participating in and using the results and recommendations from the Aged Care National Antimicrobial Prescribing Survey, aged-care facilities can educate staff, and residents and their families about antibiotic use and make changes in how antibiotics are used. This should result in better outcomes for residents.”

Role of natural therapies

In the midst of this crisis are potential solutions – including the integration and/or parallel use of traditional and complementary medicine (T&CM) interventions that have a long history of use in combating infections and supported by a growing evidence base.

The UK National Health Service (NHS), for example, is recognising the potential of T&CM interventions as alternatives to antibiotics and funding research into some of these options.

A recent (2019) review has found that T&CM prevention and treatment strategies may contribute to reducing antibiotic use. In particular, the review found significant evidence to support the safety and effectiveness of a range of T&CM treatments for respiratory infections, based on many systematic reviews.

Sources:

The 2018 Aged Care National Antimicrobial Prescribing Survey: results show room for improvement. Australian Prescriber, 14.11.2019. https://www.nps.org.au/australian-prescriber/articles/the-2018-aged-care-national-antimicrobial-prescribing-survey-results-show-room-for-improvement

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