Pharmacists Key to Curbing Antibiotic Overuse in Nursing Homes

Arbitrary antibiotic use is running rampant in nursing homes, but pharmacists can be valuable players in supporting stewardship efforts.

In a session at the 2015 American Society of Consultant Pharmacists (ASCP) Annual Meeting and Exhibition in Las Vegas, Nevada, Nimalie Stone, MD, MS, a medical epidemiologist for the US Centers for Disease Control and Prevention (CDC), explained that the agency has issued a “call to action” to address antibiotic overuse and resistance in health care—and especially in nursing homes.

Elderly patients often take a variety of medications, and because current health care practice focuses on diagnosing and prescribing, the need to taper, reduce, or discontinue inappropriate medication therapy receives relatively little attention.

“Over the course of a year, 50% to 70% of residents will receive 1 or more courses of antibiotics, and 25% to 75% of antimicrobial use in nursing homes may be inappropriate,” Dr. Stone said. “This liberal use of antibiotics can cause harm to residents, including a higher risk of side effects and adverse events, and it is a major factor for C. difficile infection.”

Elias Cachine, PharmD, BCPS (AQ-10), spoke exclusively with Pharmacy Times about how pharmacists are in an optimal position to help curb antibiotic overuse.

He advised pharmacists working in nursing homes to confirm the presence of the infection. Double-checking is important because older patients may present with atypical signs and symptoms of infection, he noted.

For instance, “elderly patients presenting with [urinary tract infections] may not present with dysuria frequency, [but] they may present with alteration of mental status,” Dr. Cachine said.

Dr. Stone noted in her presentation that 43% of nursing home-initiated antibiotic courses lack documentation of infection in the patient’s medical record, and 67% of antibiotic prescriptions initiated over the phone are based on an assessment made by a surrogate.

If an older patient is in fact found to have an infection, then Dr. Cachine cautioned that pharmacists should consider both the “host factor” and the “drug factor” before selecting an antibiotic regimen in order to reduce the risk of drug-drug interaction.

In a previous interview, J. Russell May, PharmD, FASHP, told Pharmacy Times that the advantage of having pharmacists on the antimicrobial stewardship team stems from the fact that they look at “the entire picture, not just the antibiotics.”

Dr. Cachine concluded that educating health care providers and patients about the need for antimicrobial stewardship is very important.

“We don’t have a whole lot of antimicrobials, so the more we use them appropriately and judiciously, the more we can prolong their life and use them in the best interests of the patients.”

The CDC estimates that antibiotic resistance causes 23,000 deaths per year.