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Antibiotic doses escalate in aged care

Health & Medical

Warnings are being triggered over Australia-first research revealing a worrying trend in rising antibiotic use.

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The research from the Registry of Senior Australians at the South Australian Health and Medical Research Institute (SAHMRI) showed a sustained escalation in antibiotic prescribing for older people living in residential aged care facilities.

More than 5.6 million antibiotic prescriptions dispensed to residents between July 2005 and June 2016 were analysed.

Residents at the 3,218 Residential Aged Care Facilities across Australia were often dispensed antibiotics multiple times each year -a median of three times annually.

Lead author in the national study Dr Janet Sluggett said the dramatic rise in the quantity of antibiotics being prescribed among the study group of more than half a million people aged 65 years and over was surprising.

“This nationwide study showed substantial increases in both the percentage of people who received an antibiotic and the total number of antibiotic doses supplied,” Dr Sluggett said.

“In the first year of the study, almost 64 per cent of residents received an antibiotic at least once. By the final year that figure climbed to more than 70 per cent, at an annual rate of increase of 0.8 per cent.

“We suspected that antibiotic use had increased over time but I think overall we were surprised that it was at the levels it reached by the end of the study period.

“Antibiotic use is particularly prevalent among older people but when it comes to residential aged care facilities we simply didn’t have any national data about changes in antibiotic use until this study,” Dr Sluggett said.

The pharmacist and Senior Research Fellow with the University of South Australia says unless antibiotic use is closely monitored it could compound the infection risk from increasing rates of multidrug-resistant organisms.

“Overexposure to antibiotics can cause the bacteria we’re trying to eliminate to become resistant to our treatments,” Dr Sluggett said.

“Across the health system, we need to be really discerning about antibiotic use as much as possible to guard against antibiotic resistance, as well as unnecessary side-effects for individuals.”

Researchers also found the number of standard daily doses dispensed per 1000 resident-days jumped from 67.6 to 93.8 – a relative increase of 39 per cent in overall consumption.

Antibiotics were dispensed on 5,608,126 occasions during the study period, of which 88 per cent were for oral use. Cefalexin, amoxicillin-clavulanic acid and trimethoprim were the most commonly dispensed antibiotics.

“Older age, multiple health conditions and frequent contact with other residents and staff can place people living in residential aged care facilities at risk of infection,” Dr Sluggett said.

“Sometimes antibiotics are needed of course but our findings point to a need for greater efforts to support antibiotics to be used in the best possible way in this population.

“This showed at least 10 per cent of residents (across the nursing homes) were receiving an antibiotic on every day of the year.”

While hospitals had installed new models to track antibiotic use ensuring they were not used unnecessarily or for longer periods than required, the same systems were not in place at aged care facilities, Dr Sluggett said.

She believed more work was required to look at introducing similar systems as concern grows over bacteria becoming increasingly resistant to antibiotics.

“(Antibiotic resistant) organisms are an issue we should be concerned about in society, it’s not just happening in residential aged care facilities, we see them in hospitals and in the wider community.”

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