Length of antibiotic treatment depends more on the prescriber than the patient: ICES study

Prescribers are the drivers behind antibiotic treatment duration according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES). Antibiotics are among the most frequently prescribed medications in long-term care facilities, with 6 to 10 per cent of residents receiving these medications at any given time, and 60 to 70 per cent receiving at least one prescription over the course of a year.

Most common bacterial infections can be treated with antibiotic courses of seven or fewer days, and so reducing antibiotic treatment durations may be an avenue to curtail antibiotic overuse in healthcare facilities.

“High rates of institutional antibiotic use are driving increased rates of antibiotic resistance, Clostridium difficile infection, antibiotic-related adverse events and healthcare costs; yet up to half of antibiotic use in acute and long-term care institutions is unnecessary or inappropriate,” says lead author Dr. Nick Daneman, an adjunct scientist at ICES.

The retrospective study of all older adults who received an incident treatment course with a systemic antibiotic while residing in an Ontario long-term care facility in 2010 found:

• Seventy-five per cent of Ontario long-term care residents received a new antibiotic treatment course
• Forty-five percent of these treatment courses were prolonged beyond seven days
• Among high volume antibiotic prescribers, there was much more variability in the use of prolonged treatment courses than would be expected by random chance or differences in the characteristics of treated patients
• If long duration and average duration prescribers adopted the prescribing habits of short duration prescribers, overall antibiotic days in long-term care would drop by 19 per cent

“Future trials should evaluate antibiotic stewardship interventions targeting prescriber preferences to systematically reduce average treatment durations, and thereby reduce the complications, cost and resistance associated with antibiotic overuse,” says Daneman.

The study “Prolonged antibiotic treatment in long-term care: role of the prescriber,” was published today in JAMA Internal Medicine.

Authors: Daneman N., Gruneir A., Bronskill SE., Newman A., Fischer HD., Rochon PA., Anderson GM., Bell CM.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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