title: Antibiotic prescribing and associated diarrhoea: a prospective cohort study of care home residents.
abstract: BACKGROUND
  the risk factors for and frequency of antibiotic prescription and antibiotic-associated diarrhoea (AAD) among care home residents are unknown.
  
  
  OBJECTIVE
  to prospectively study frequency and risks for antibiotic prescribing and AAD for care home residents.
  
  
  METHODS
  a 12-month prospective cohort study in care homes across South Wales.
  
  
  METHODS
  antibiotic prescriptions and the development of AAD were recorded on case report forms. We defined AAD as three or more loose stools in a 24-h period occurring within 8 weeks of exposure to an antibiotic.
  
  
  RESULTS
  we recruited 279 residents from 10 care homes. The incidence of antibiotic prescriptions was 2.16 prescriptions per resident year (95% CI: 1.90-2.46). Antibiotics were less likely to be prescribed to residents from dual-registered homes (OR compared with nursing homes: 0.38, 95% CI: 0.18-0.79). For those who were prescribed antibiotics, the incidence of AAD was 0.57 episodes per resident year (95% CI: 0.41-0.81 episodes). AAD was more likely in residents who were prescribed co-amoxiclav (hazards ratio, HR = 2.08, 95% confidence interval, CI: 1.18-3.66) or routinely used incontinence pads (HR = 2.54, 95% CI: 1.26-5.13) and less likely in residents from residential homes (HR compared with nursing homes: 0.14, 95% CI: 0.06-0.32).
  
  
  CONCLUSIONS
  residents of care homes, particularly of nursing homes, are frequently prescribed antibiotics and often experience diarrhoea following such prescriptions. Co-amoxiclav is associated with greater risk of AAD.
authors.affiliation: South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: David
authors.initials: D
authors.lastname: Gillespie
authors.affiliation: South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.affiliation: School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Antony
authors.initials: A
authors.lastname: Bayer
authors.affiliation: Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Carter
authors.affiliation: Nutrition and Dietetics, Abertawe Bro Morgannwg Health Board, Port Talbot, UK.
authors.forename: Donna
authors.initials: D
authors.lastname: Duncan
authors.affiliation: South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Aude
authors.initials: A
authors.lastname: Espinasse
authors.affiliation: Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Meirion
authors.initials: M
authors.lastname: Evans
authors.affiliation: South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Nuttall
authors.affiliation: Cardiff University, Cardiff, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Stanton
authors.affiliation: Virus Reference Department, Public Health England, London, UK.
authors.forename: Arun
authors.initials: A
authors.lastname: Acharjya
authors.affiliation: College of Medicine, Swansea University, Swansea, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Allen
authors.affiliation: Health Economics and Policy Research Unit, University of South Wales, Pontypridd, UK.
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.affiliation: Health Economics and Policy Research Unit, University of South Wales, Pontypridd, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Groves
authors.affiliation: Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Francis
authors.affiliation: Microbiology Unit, Public Health Wales, Cardiff, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Howe
authors.affiliation: Cardiff and Vale University Health Board, Cardiff, UK.
authors.forename: Antony
authors.initials: A
authors.lastname: Johansen
authors.affiliation: School of Pharmacy, Cardiff University, Cardiff, UK.
authors.forename: Efi
authors.initials: E
authors.lastname: Mantzourani
authors.affiliation: South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Thomas-Jones
authors.affiliation: South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Alun
authors.initials: A
authors.lastname: Toghill
authors.affiliation: Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Wood
authors.affiliation: Welsh Healthcare Associated Infection Programme, Public Health Wales, Cardiff, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Wigglesworth
authors.affiliation: Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, Cardiff, UK.
authors.forename: Mandy
authors.initials: M
authors.lastname: Wootton
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D003967:Diarrhea / Q000139:chemically induced* / Q000175:diagnosis / Q000382:microbiology; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D000069196:Gastrointestinal Microbiome / Q000187:drug effects; D006707:Homes for the Aged; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes; D016017:Odds Ratio; D010818:Practice Patterns, Physicians'; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014852:Wales
chemical_list: D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination
keywords: Clostridium difficile; antibiotic prescribing; antibiotic-associated diarrhoea; care home residents; older people