title: Patterns of antimicrobial use for respiratory tract infections in older residents of long-term care facilities.
abstract: OBJECTIVE
  To describe patterns of antimicrobial use for respiratory tract infections (RTIs) in older residents of long-term care facilities (LTCFs).
  
  
  METHODS
  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.
  
  
  METHODS
  Thirty-three LTCFs in the greater Boston area.
  
  
  METHODS
  Six hundred seventeen subjects aged 65 and older residing in LTCFs.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Section of Infectious Diseases, Department of Medicine, School of Medicine, Center for Global Health and Development, Boston University, Boston, Massachusetts 02118, USA.
authors.forename: Paschalis
authors.initials: P
authors.lastname: Vergidis
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
authors.forename: Simin N
authors.initials: SN
authors.lastname: Meydani
authors.forename: Gerard E
authors.initials: GE
authors.lastname: Dallal
authors.forename: Tamar F
authors.initials: TF
authors.lastname: Barlam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001900:Boston; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000453:epidemiology; D014810:Vitamin E / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014810:Vitamin E