A first of its kind Australian study has found substantial increases in both the prevalence of use and total consumption of antibiotics in residential aged care over 10 years.

The project highlights the need for enhanced efforts to optimise antibiotic use in aged care homes, the researchers from the Registry of Senior Australians (ROSA) at South Australian Health and Medical Research Institute found.

Lead author Dr Janet Sluggett said the national study was a first in Australia and filled a gap in knowledge about aged care residents’ antibiotic use.

Dr Janet Sluggett

“This is one of the largest studies of its kind globally that has been published,” Dr Sluggett told Australian Ageing Agenda.

The analyses showed increases in both the percentage of residents who received an antibiotic and the total number of antibiotic doses supplied, said Dr Sluggett, a pharmacist and Senior Research Fellow with the University of South Australia.

The research examined antibiotic dispensing among more than 500,000 aged care residents aged 65 or over from more than 3,200 facilities across Australia between July 2005 and June 2016.

Antibiotics were dispensed more than 5.6 million times during the study period, of which 88 per cent were for oral use and Cefalexin, amoxicillin-clavulanic acid and trimethoprim the most common.

“We found at the start of the study period that 64 per cent of all residents across all facilities in Australia received an antibiotic at least once that year, but by the end of the study period that had increased to 70 per cent of residents,” Dr Sluggett said.

Residents often received antibiotics more than once during the year. The median was three times a year, the study found.

The researchers also looked at the number of standard doses of each antibiotic dispensed each year and found a relative increase of 39 per cent in the total consumption of systemic antibiotics, which means oral or injectable varieties.

“It went from 68 per standard doses per 1,000 resident days to 94 by the end of the study period,” Dr Sluggett said.

The 94 standard doses per 1,000 resident days can be interpreted as enough antibiotics dispensed each day to treat almost 10 per cent of all residents everyday, she said.

Dr Slugget said the percentage of residents who got at least one antibiotic stabilised from around 2013 but the overall consumption continued to increase consistently throughout the study.

Overexposure to antibiotics is a problem because it can cause the bacteria to become resistant to treatments.

Antibiotics are maybe used unnecessarily or longer than they need to be, Dr Sluggett said.

“We suspect that some of the increase we are seeing in our study represents unnecessary use or opportunities to improve use.”

Tips for improving aged care antibiotic practice

Improving the use of antibiotics requires a team approach between aged care providers and their staff, pharmacists and general practitioners, Dr Sluggett said.

She suggested members of the residential aged care team could routinely question the need for antibiotics.

“Always raise the question about how long an antibiotic should be taken for when it is prescribed and ask is it still needed when it is written on the chart.”

Dr Sluggett said facilities also needed to provide evidence of antimicrobial stewardship policies and practices under the sector’s quality standards.

“It could be good to ensure that antimicrobial stewardship or antibiotic use is raised for discussion at infection control meetings and medication advisory committee meetings because they are sometimes multidisciplinary where a GP or pharmacist might be in attendance.

“The other strategy that could be good is talking to the pharmacist who provides the quality use of medicines services to the facility,” she said.

Providers could work with the pharmacist and ask them to audit the antibiotic use or provide tailored education or other agreed strategies to together understand current practices and how to target any issues, Dr Sluggett said.

The findings are published in the Journal Clinical Infectious Diseases.

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