Antibiotic use and associated factors in patients with dementia: a systematic review.
BACKGROUND
Infections frequently occur in patients with dementia and antibiotics are often prescribed, but may also be withheld.


OBJECTIVE
The aim of this systematic review is to provide a systematic overview of the prevalence of antibiotic use, and factors associated with prescribing antibiotics in patients with dementia.


METHODS
A systematic search of MEDLINE, EMBASE, PSYCINFO, CINAHL, and the Cochrane library databases until February 13, 2014 was performed, using both controlled terms and free-text terms.


RESULTS
Thirty-seven articles were included. The point prevalence of antibiotic use in patients with dementia ranged from 3.3 to 16.6%. The period prevalence ranged from 4.4 to 88% overall, and from 23.5 to 94% in variable time frames before death; the median use was 52% (median period 14 days) and 48% (median period 22 days), respectively. Most patients with lower respiratory tract infections or urinary tract infections (77-91%) received antibiotic treatment. Factors associated with antibiotic use related to patients, families, physicians, and the healthcare context. More severe dementia and a poor prognosis were associated with less antibiotic use in various countries. Associations with aspiration and illness severity differed by country.


CONCLUSIONS
Antibiotic use in patients with dementia is substantial, and probably highly associated with the particular healthcare context. Future studies may report antibiotic use by infection type and stage of dementia, and compare cross-nationally.
EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands, t.vandermaaden@vumc.nl.
Tessa
T
van der Maaden
Simone A
SA
Hendriks
Henrica C W
HC
de Vet
Menno T
MT
Zomerhuis
Martin
M
Smalbrugge
Elise P
EP
Jansma
Raymond T C M
RT
Koopmans
Cees M P M
CM
Hertogh
Jenny T
JT
van der Steen
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003704:Dementia / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000188:drug therapy; D014552:Urinary Tract Infections / Q000188:drug therapy
D000900:Anti-Bacterial Agents