OBJECTIVES: To describe patterns of antimicrobial use for respiratory tract infections (RTIs) in older residents of long-term care facilities (LTCFs). DESIGN: Data from a prospective, randomized, controlled study of the effect of vitamin E supplementation on RTIs conducted from April 1998 through August 2001 were analyzed. SETTING: Thirty-three LTCFs in the greater Boston area. PARTICIPANTS: Six hundred seventeen subjects aged 65 and older residing in LTCFs. MEASUREMENTS: RTIs, categorized as acute bronchitis, pneumonia, common cold, influenza-like illness, pharyngitis, and sinusitis, were studied for appropriateness of antimicrobial use, type of antibiotics used, and factors associated with their use. For cases in which drug treatment was administered, antibiotic use was rated as appropriate (when an effective drug was used), inappropriate (when a more-effective drug was indicated), or unjustified (when use of any antimicrobial was not indicated). RESULTS: Of 752 documented episodes of RTI, overall treatment was appropriate in 79% of episodes, inappropriate in 2%, and unjustified in 19%. For acute bronchitis, treatment was appropriate in 35% and unjustified in 65% of cases. For pneumonia, treatment was appropriate in 87% of episodes. Of the most commonly used antimicrobials, macrolide use was unjustified in 43% of cases. No statistically significant differences in the patterns of antibiotic use were observed when stratified according to age, sex, race, or comorbid conditions, including diabetes mellitus, dementia, and chronic kidney disease. CONCLUSION: Antimicrobials were unjustifiably used for one-fifth of RTIs and more than two-thirds of cases of acute bronchitis, suggesting a need for programs to improve antibiotic prescribing at LTCFs.
OBJECTIVES: To describe patterns of antimicrobial use for respiratory tract infections (RTIs) in older residents of long-term care facilities (LTCFs). DESIGN: Data from a prospective, randomized, controlled study of the effect of vitamin E supplementation on RTIs conducted from April 1998 through August 2001 were analyzed. SETTING: Thirty-three LTCFs in the greater Boston area. PARTICIPANTS: Six hundred seventeen subjects aged 65 and older residing in LTCFs. MEASUREMENTS: RTIs, categorized as acute bronchitis, pneumonia, common cold, influenza-like illness, pharyngitis, and sinusitis, were studied for appropriateness of antimicrobial use, type of antibiotics used, and factors associated with their use. For cases in which drug treatment was administered, antibiotic use was rated as appropriate (when an effective drug was used), inappropriate (when a more-effective drug was indicated), or unjustified (when use of any antimicrobial was not indicated). RESULTS: Of 752 documented episodes of RTI, overall treatment was appropriate in 79% of episodes, inappropriate in 2%, and unjustified in 19%. For acute bronchitis, treatment was appropriate in 35% and unjustified in 65% of cases. For pneumonia, treatment was appropriate in 87% of episodes. Of the most commonly used antimicrobials, macrolide use was unjustified in 43% of cases. No statistically significant differences in the patterns of antibiotic use were observed when stratified according to age, sex, race, or comorbid conditions, including diabetes mellitus, dementia, and chronic kidney disease. CONCLUSION: Antimicrobials were unjustifiably used for one-fifth of RTIs and more than two-thirds of cases of acute bronchitis, suggesting a need for programs to improve antibiotic prescribing at LTCFs.
Authors: M S Niederman; L A Mandell; A Anzueto; J B Bass; W A Broughton; G D Campbell; N Dean; T File; M J Fine; P A Gross; F Martinez; T J Marrie; J F Plouffe; J Ramirez; G A Sarosi; A Torres; R Wilson; V L Yu Journal: Am J Respir Crit Care Med Date: 2001-06 Impact factor: 21.405
Authors: R Gonzales; J G Bartlett; R E Besser; R J Cooper; J M Hickner; J R Hoffman; M A Sande Journal: Ann Intern Med Date: 2001-03-20 Impact factor: 25.391
Authors: R Gonzales; J G Bartlett; R E Besser; R J Cooper; J M Hickner; J R Hoffman; M A Sande Journal: Ann Intern Med Date: 2001-03-20 Impact factor: 25.391
Authors: R J Cooper; J R Hoffman; J G Bartlett; R E Besser; R Gonzales; J M Hickner; M A Sande Journal: Ann Emerg Med Date: 2001-06 Impact factor: 5.721
Authors: Ralph Gonzales; Angela Sauaia; Kitty K Corbett; Judith H Maselli; Kathleen Erbacher; Bonnie A Leeman-Castillo; Carol A Darr; Peter M Houck Journal: J Am Geriatr Soc Date: 2004-01 Impact factor: 5.562
Authors: Angela C Eke-Usim; Mary A M Rogers; Kristen E Gibson; Christopher Crnich; Lona Mody Journal: J Am Geriatr Soc Date: 2016-09-22 Impact factor: 5.562
Authors: Inger van Heijl; Valentijn A Schweitzer; Lufang Zhang; Paul D van der Linden; Cornelis H van Werkhoven; Douwe F Postma Journal: Drugs Aging Date: 2018-05 Impact factor: 3.923
Authors: Ana Eugenia Arango; Sergio Jaramillo; Juan Perez; Julia S Ampuero; David Espinal; Jorge Donado; Vidal Felices; Josefina Garcia; Alberto Laguna-Torres Journal: Influenza Other Respir Viruses Date: 2014-08-06 Impact factor: 4.380