Antibiotic Misuse in Hospital, Outpatient, and Long-Term Care Settings

Abstract

Antibiotic misuse is common in the United States, but the causes of antibiotic misuse may differ from one health care setting to another. In this commentary, we describe the factors associated with inappropriate antibiotic prescriptions in hospital, outpatient, and long-term care settings, along with specific measures that can help prevent antibiotic misuse. T he Centers for Disease Control and Prevention (CDC)estimates that up to 50% of all antibiotics prescribed for people are either not needed or are inappropriate [1]. Antibiotic misuse is a major factor in the emergence of multidrug resistant pathogens [2] and is associated with adverse drug reactions, Clostridium difficile infections, and increased health care costs [2].When prescribing an antibiotic, a provider must determine whether the drug is truly indicated in a particular clinical scenario. If so, the provider must consider several factors. The prescribed antibiotic has to be the correct choice for that indication. The dosage, frequency, route of administration, and duration must all be optimal for the prescription to qualify as appropriate. Lastly, the provider must consider drug-drug interactions for the antibiotic prescription to be truly effective and appropriate.In order to improve antibiotic use in a particular setting, efforts have to be directed to the most relevant factors applicable to that setting. The following are descriptions of challenges related to antibiotic misuse and recommendations for prevention in hospital, outpatient, and long-term care settings.

Interventions to Decrease Inappropriate Antibiotic Use for Non-acute Respiratory Illness in Long-Term Care Settings

“…A chief contributing factor to antibiotic resistance with the long-term care setting has been the overuse, misuse, or inappropriate use of antibiotics (Ashraf & Cook 2016;CDC, 2017;Crnich et al, 2015;Dar et al, 2016). More than half of nursing home residents are prescribed at least one systemic antibiotic to treat an illness every year (CDC, 2017;Fleming et al, 2015).…”

“…To prevent further negative healthcare outcomes in the long-term care setting, it is imperative to appreciate the complications of misuse, overuse, and inappropriate use of antibiotics (Ashraf & Cook, 2016;CDC, 2017;Crnich et al, 2015;Dar et al, 2016). Understanding that dire consequences can occur when antibiotics are inappropriately utilized in the long-term care setting is an essential component when initiating a change in current prescribing practices (CDC, 2017;Doron, Nadkami, Lyn, Lawarance, Dvidson, Evans & Snydman, 2013;Fleming et al, 2015).…”

“…Antibiotic resistance is reported to be a grave global health concern (Ashraf & Cook, 2016;CDC, 2017;Doron et al, 2013;Dar et al, 2016). In the United States alone, the CDC (2017) reports that antibiotic resistance accounts for approximately two million infections and 23,000 deaths per year (Lim, Stuart, & Kong, 2015;Sanchez, Fleming-Dutra, Roberts, & Hicks, 2016).…”

“…The current antibiotic prescribing practices (CDC, 2017;Fleming et al, 2015) and the unnecessary use of antibiotic treatment in long-term care facilities is contributing to the increase in global antibiotic-resistant microbes (CDC, 2017;Fleming et al, 2015). Research has demonstrated that antibiotic use, misuse, and overuse in the long-term care industry can negatively affect healthcare outcomes for residents within the facilities (Ashraf & Cook, 2016;CDC, 2017;Crnich, et al, 2015;Dar et al, 2016).…”

What Is New in Infectious Diseases?

“…More than 70% of patients with a diagnosis of acute bronchitis receive antibiotics in this country, despite guidelines recommending that antibiotics not be used for this condition [22]. In our commentary in this issue, Muhammad Ashraf and I describe the use of antibiotics in various settings [23], and we discuss the importance of reducing antimicrobial use in each setting. Point-of-care testing and use of biomarkers such as procalcitonin may help clinicians feel more comfortable in withholding antibiotics when patients have a low risk of bacterial infection [24].…”