Optimizing antibiotics in residents of nursing homes: protocol of a randomized trial.
BACKGROUND
Antibiotics are frequently prescribed for older adults who reside in long-term care facilities. A substantial proportion of antibiotic use in this setting is inappropriate. Antibiotics are often prescribed for asymptomatic bacteriuria, a condition for which randomized trials of antibiotic therapy indicate no benefit and in fact harm. This proposal describes a randomized trial of diagnostic and therapeutic algorithms to reduce the use of antibiotics in residents of long-term care facilities.


METHODS
In this on-going study, 22 nursing homes have been randomized to either use of algorithms (11 nursing homes) or to usual practise (11 nursing homes). The algorithms describe signs and symptoms for which it would be appropriate to send urine cultures or to prescribe antibiotics. The algorithms are introduced by inservicing nursing staff and by conducting one-on-one sessions for physicians using case-scenarios. The primary outcome of the study is courses of antibiotics per 1000 resident days. Secondary outcomes include urine cultures sent and antibiotic courses for urinary indications. Focus groups and semi-structured interviews with key informants will be used to assess the process of implementation and to identify key factors for sustainability.
Department of Pathology and Molecular Medicine, McMaster University Hamilton, ON, Canada. loebm@mcmaster.ca
Mark
M
Loeb
Kevin
K
Brazil
Lynne
L
Lohfeld
Allison
A
McGeer
Andrew
A
Simor
Kurt
K
Stevenson
Stephen
S
Walter
Dick
D
Zoutman
D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001437:Bacteriuria / Q000188:drug therapy* / Q000652:urine*; D002985:Clinical Protocols; D004352:Drug Resistance, Microbial; D004363:Drug Utilization / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008503:Medical Staff / Q000193:education / Q000592:standards; D008875:Middle Aged; D009735:Nursing Homes / Q000592:standards*; D009740:Nursing Staff / Q000193:education / Q000592:standards; D009864:Ontario; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents