title: Antibiotic prescribing in Dutch nursing homes: how appropriate is it?
abstract: OBJECTIVE
  To investigate the appropriateness of decisions to prescribe or withhold antibiotics for nursing home (NH) residents with infections of the urinary tract (UTI), respiratory tract (RTI), and skin (SI).
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Ten NHs in the central-west region of the Netherlands.
  
  
  METHODS
  Physicians providing medical care to NH residents.
  
  
  METHODS
  Physicians completed a registration form for any suspected infection over an 8-month period, including patient characteristics, signs and symptoms, and treatment decisions. An algorithm, developed by an expert panel and based on national and international guidelines, was used to evaluate treatment decisions for appropriateness of initiating or withholding antibiotics.
  
  
  RESULTS
  Appropriateness of 598 treatment decisions was assessed. Overall, 76% were appropriate, with cases that were prescribed antibiotics judged less frequently "appropriate" (74%) compared with cases in which antibiotics were withheld (90%) (P = .003). Decisions around UTI were least often appropriate (68%, compared with 87% for RTI and 94% for SI [P < .001]). The most common situations in which antibiotic prescribing was considered inappropriate were those indicative of asymptomatic bacteriuria or viral RTI.
  
  
  CONCLUSIONS
  Although the rate of appropriate antibiotic prescribing in Dutch NHs is relatively high compared with previous studies in other countries, our results suggest that antibiotic consumption can be reduced by improving appropriateness of treatment decisions, especially for UTI. Given the current antibiotic resistance developments in long-term care facilities, interventions reducing antibiotic use for asymptomatic bacteriuria and viral RTI are warranted.
authors.affiliation: EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Laura W
authors.initials: LW
authors.lastname: van Buul
authors.affiliation: EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Ruth B
authors.initials: RB
authors.lastname: Veenhuizen
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Wilco P
authors.initials: WP
authors.lastname: Achterberg
authors.affiliation: EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
authors.affiliation: Dutch Institute for Rational Use of Medicine (IVM), Utrecht, The Netherlands.
authors.forename: Rob T G M
authors.initials: RT
authors.lastname: Essink
authors.affiliation: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Sabine C
authors.initials: SC
authors.lastname: de Greeff
authors.affiliation: Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Natsch
authors.affiliation: EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: J.vandersteen@vumc.nl.
authors.forename: Jenny T
authors.initials: JT
authors.lastname: van der Steen
authors.affiliation: EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Cees M P M
authors.initials: CM
authors.lastname: Hertogh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D003657:Decision Making; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000188:drug therapy*; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Nursing homes; antibiotic prescribing; respiratory tract infection; urinary tract infection