Cut use of antibiotics in nursing homes, pharmacists say

The Royal Pharmaceutical Society (RPS) is calling for action to cut overuse of antibiotics in nursing homes, saying they are potentially harming health and contributing to the problem of drug-resistant bacteria.

Routine testing of residents is leading to large-scale over-diagnosis and unnecessary treatment of urinary tract infections (UTIs), one of the most common reasons antibiotics are prescribed in nursing homes, according to the Society.

The RPS cited research from BMC Geriatrics showing residents in nursing homes in England receive twice as many antibiotics as those of the same age living in their own homes.

The research was published in 2015, but the RPS presented a case study where pharmacists were able to vastly reduce the amount of antibiotics prescribed.

An evaluation of a pilot scheme in nursing homes in Bath and North East Somerset showed pharmacists were able to reduce by 56% the proportion of residents who had an antibiotic for a UTI.

There was a 67% reduction in the number of antibiotic prescriptions and an 82% reduction in the number of residents prescribed antibiotic prophylaxis.

The scheme also reduce unplanned admissions to hospital, according to the RPS.

Part of the problem is an over-reliance on dipstick testing, despite warnings from NICE about these tests’ accuracy in national guidance.

NICE says those over 65 should have a full clinical assessment before a diagnosis of a UTI, not dipstick testing alone.

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.

Sandra Gidley

RPS England board chair Sandra Gidley said: “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.

“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.”