One in three antimicrobials in aged care for topical use

Topical treatments such as creams, ointments and drops account for a third of all prescribed antimicrobials in aged care.

A third of antimicrobials prescribed in residential aged care are for topical treatments such as creams and drops and most commonly for tinea and conjunctivitis, a University of Melbourne study has found.

The study published in the American Journal of Infection Control aimed to identify the prescribing patterns of topical antimicrobials in aged care facilities and areas for improvement.

The study analysed data from the National Antimicrobial Prescribing Survey from 2018 and 2019 on 52,431 residents at 629 facilities.

Of the almost 5,000 prescribed microbials identified in the survey, a third were topical treatments such as creams, ointments and ear or eye drops, and 3 per cent of participating residents were prescribed at least one.

The majority of topical antimicrobials were anti-fungals (66 per cent) and antibacterials (28 per cent) and topical antimicrobials were most commonly prescribed to treat tinea (38 per cent) and conjunctivitis (24 per cent).

Lead researcher Associate Professor Noleen Bennett said the findings shows a large percentage of antimicrobials used in aged care homes are topical applications.

“It is important because topical antimicrobials have some advantages over other types of antimicrobials, but they also had some disadvantages,” Associate Professor Bennett told Australian Ageing Agenda.

Noleen Bennett

Adverse consequences of antimicrobials include antimicrobial resistance, hypersensitivity reactions, toxicity, drug interactions and unnecessary healthcare costs, said Dr Bennett, a professor in the Department of Nursing at University of Melbourne.

The study found that topical antimicrobials were sometimes prescribed on an as-needed basis (39 per cent), for greater than six months (11 per cent) and without a stop date of the prescription documented (39 per cent).

Dr Bennett said the findings highlight areas where aged care providers can look to develop antimicrobial stewardship strategies to reduce the possibility of adverse consequences of topical antimicrobials.

“They weren’t surprising… but that breakdown and drilling down of where we can make improvement was informative and insightful so that we know now where to start improving the use of topical agents in our aged care homes,” said Dr Bennett, who is also a senior infection control consultant at the Victorian Healthcare-Associated Infection Surveillance System.

“Starting out, it can be overwhelming for these providers [to think about] where to start. I think this study like ours and others is really helpful to be able to pinpoint where we should be targeting initially any antimicrobial strategies,” Dr Bennett said.

It is critically for aged care providers to develop antimicrobial strategies in their facilities in conjunction with infection control and prevention, she said.

“The two go hand in hand …. and are critical because it’s very clear the adverse events are associated if appropriate strategies are not put in place,” she said.

Access the study here.

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Tags: American Journal of Infection Control, antimicrobial, antimicrobial resistance, noleen bennett, topical antimicrobials, university of melbourne,

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