Some seniors getting antibiotics for too long

Many seniors living in long-term care facilities could and probably should be put on shorter courses of antibiotics when they have bacterial infections, a new study suggests.

Many seniors living in long-term care facilities could and probably should be put on shorter courses of antibiotics when they have bacterial infections, a new study suggests.

It found that nearly half of antibiotic prescriptions written for Ontario seniors in long-term care in 2010 were for treatment courses longer than seven days, which in most cases would be unnecessarily lengthy.

The prescribing habits of doctors rather than the needs of the patients appeared to be what was behind the longer-than-needed use of the drugs, the study also found.

“We’re all creatures of habit in life, and more likely to do something the same way as we did previously,” said Dr. Nick Daneman, first author of the paper, published Monday in the journal JAMA Internal Medicine.

“So if we get used to prescribing 14 days, we’re more likely to be writing 14 days on most of our antibiotic prescriptions. If we get used to writing five days, we’re more likely to write that on future prescriptions as well.”

Daneman is an adjunct scientist at Toronto’s Institute for Clinical Evaluative Sciences; his co-authors are also affiliated with the institute. Daneman is an infectious diseases specialist at Sunnybrook Health Sciences Centre in Toronto as well.

Antibiotic use is common among seniors, whose waning immune systems leave them susceptible to infections. In long-term care, antibiotics are most commonly used to treat urinary tract or respiratory tracts infections, or infections of the skin and soft tissue. Most of these infections can generally be treated successfully with seven or fewer days on antibiotics.

In this study, the researchers looked at records for Ontario seniors living in long-term care in 2010. They found nearly 78 per cent of residents of these facilities had at least one prescription for an antibiotic during the study period. And while seven days was the most common length of treatment course, 45 per cent of prescriptions were for longer than that.

“You don’t need to treat for more than seven days for most of these infections. And yet what they found was even if you assume that all of the courses of antibiotics were appropriately decided upon, the duration was still inappropriately prolonged,” said Dr. Andrew Simor, an infectious diseases expert who was not involved in the study.

Simor said some doctors may be trying to play it safe. “They often will say: ’We’ll treat until they get better and then maybe a couple of extra days just to be sure.”’

But in fact, using antibiotics for longer than is needed isn’t playing it safe. These drugs have side-effects. There’s a greater risk of developing C. difficile diarrhea or of contracting an infection caused by an antibiotic resistant bacterium the longer a senior takes antibiotics.

Likewise, excessive use of these drugs in long-term care facilities contributes to the overall pressure antibiotic use places on bacteria, fuelling the development of so-called superbugs. Antibiotics typically kill susceptible bacterial strains, giving those that are naturally resistant to the drugs a chance to thrive and multiple.

“So there’s no question that this is an issue that profoundly affects not only the community at large, but the individual who is being prescribed an inappropriately long course of antibiotics as well,” said Simor, who is head of microbiology at Sunnybrook Health Sciences Centre.

Daneman and his co-authors tried to determine whether differences in the patients could account for the longer prescriptions. Maybe the patients who received antibiotics for 10 or 14 days were sicker or sick with different conditions? But they found that couldn’t explain the differences.

They concluded it was an issue of individual prescribing patterns, with individual doctors generally prone to ordering short, average or long duration courses of antibiotics.

Interestingly, when doctors who wrote long antibiotic prescriptions were compared to those who wrote short and average-length ones, there were no clear demographic differences among the three groups. One couldn’t predict, say, that male doctors would prescribe one way and females another. Nor did they break down by age, years in practice, or whether the doctor was trained in Canada or abroad.

The study suggests that if all doctors adopted the habits of those who treat with short courses of antibiotics, the overall number of days seniors in long-term care end up on antibiotics could drop by as much as 19 per cent.

Daneman said he thinks this is an exciting opportunity, an way to reduce the overall use of antibiotics that is within reach.

“It’s easy to talk about and difficult to do, antibiotic stewardship,” he said, referring to the term used to describe efforts to use the drugs wisely to protect their efficacy. Rates of resistance are rising at alarming rates in some bacterial diseases, raising the spectre of a return to a time when some infections might be untreatable.

“Shortening that tail end of treatment, at which point antibiotics are putting people at potential risk without any potential benefit, seems to be a real feasible way to reduce antibiotic overuse,” Daneman said.

But Simor suggested changing this behaviour may not be easy.

Dementia is common among seniors in long-term care. So doctors may be trying to treat patients who cannot describe their symptoms, which complicates their care. As well, long-term care facilities don’t typically have testing laboratories and pharmacists, which offer key support to hospitals struggling to reduce inappropriate use of antibiotics.

Said Simor: “All of this contributes to enormous diagnostic uncertainty that may drive inappropriate antibiotic use. And it’s a real challenge.”

Just Posted

The Red Deer Public Library downtown branch will be reopening after a year on Monday, after work is completed on its HVAC system replacement. (File photo by ADVOCATE staff)
Red Deer Public Library opens with limited in-person services Monday

All three Red Deer Public Library branches will be open for in-person… Continue reading

The City of Red Deer sits at 249 active cases of the virus, after hitting a peak of 565 active cases on Feb. 22. (Black Press file image)
Red Deer down to 119 active COVID-19 cases

Province identifies 179 new cases Saturday

Red Deer Emergency Services responded to an explosion at a duplex on Rupert Crescent Saturday morning. (Photo by Sean McIntosh/Advocate staff)
Firefighters respond to explosion in Red Deer early Saturday morning

There was an explosion at a Red Deer duplex early Saturday morning.… Continue reading

Terry Betts, of Kananaskis, looks at the vehicle he was hoping to sell during the Quick Times Red Deer Swap Meet in the Westerner Park parking lot Saturday. (Photo by Sean McIntosh/Advocate staff)
Quick Times Red Deer Swap Meet held outdoors

A big automotive swap meet was held outdoors this year in Red… Continue reading

The Alberta Sports Hall of Fame and Museum is set to re-open on July 2. (File Photo)
Alberta Sports Hall of Fame and Museum to reopen Monday

The Alberta Sports Hall of Fame and Museum will reopen for visitors… Continue reading

Huzaifa (left), Saif (middle) and Zoya (right) were among the 60 or so Red Deerians who participated in a vigil for the victims of a recent terrorist attack that killed four people in London Ont. (Photo by BYRON HACKETT/Advocate Staff)
Red Deer vigil honours victims of London, Ont. terrorist attack

About 60 people gathered at the corner of 49 Ave. and 50… Continue reading

The Great Ogopogo Bathtub Race has been held in Summerland as a fundraising event. Do you know which Canadian city introduced this sport? (Black Press file photo)
QUIZ: A summer’s day at the water

How much do you know about boats, lakes and water?

A man wears a face mask as he walks by a sign for a COVID-19 vaccination site in Montreal, Sunday, May 16, 2021, as the COVID-19 pandemic continues in Canada and around the world. THE CANADIAN PRESS/Graham Hughes
Canada paid a premium to get doses from Pfizer earlier than planned

OTTAWA — Canada paid a premium to get more than 250,000 doses… Continue reading

The Kamloops Indian Residential School in Kamloops, B.C., is shown in this 1930 handout photo. HO — Deschatelets-NDC Archives
Calls grow for Ottawa to review settlement decisions for residential school survivors

Lawyer Teri Lynn Bougie still cries when she talks about the final… Continue reading

Syringes are readied at a COVID-19 mobile vaccination clinic for members of First Nations and their partners, Friday, April 30, 2021 in Montreal. Most of the federal contracts for COVID-19 vaccines allow for Canada to donate some of its doses to other countries or international aid organizations and in at least three cases, for the doses to be resold.THE CANADIAN PRESS/Ryan Remiorz
Canada’s vaccine contracts allow for doses to be donated, in some cases resold

OTTAWA — Most of the federal contracts for COVID-19 vaccines allow for… Continue reading

Grand Chief Stewart Phillip, President of the Union of British Columbia Indian Chiefs, responds to the report on the National Inquiry into Missing and Murdered Indigenous Women and Girls, in Vancouver, on Monday June 3, 2019. As stories of the horrors of residential schools circulate after the Tk'emlups te Secwepemc First Nation announced it had located what are believed to be the remains of 215 children, Grand Chief Stewart Phillip of the Union of B.C. Indian Chiefs said he feels a connection with the former students. THE CANADIAN PRESS/Darryl Dyck
Two sides of the same coin: Ex-foster kids identify with residential school survivors

VANCOUVER — As stories of the horrors of residential schools circulate after… Continue reading

A woman sits and weeps at the scene of Sunday's hate-motivated vehicle attack in London, Ont. on Tuesday, June 8, 2021. Four members of a family in London, Ont., are set to be buried today. The public has been invited to help celebrate the lives of Talat Afzaal, 74, her son Salman Afzaal, 46, his wife Madiha Salman, 44, and their 15-year-old daughter Yumna Salman.THE CANADIAN PRESS/ Geoff Robins
Funeral to be held today for London family killed in attack

LONDON, Ont. — Four members of a Muslim family killed in what… Continue reading

Canadian Prime Minister Justin Trudeau and United States President Joe Biden listen to United Kingdom Prime Minister Boris Johnson deliver opening remarks at a plenary session at the G7 Summit in Carbis Bay, United Kingdom Friday June 11, 2021. THE CANADIAN PRESS/Adrian Wyld
Trudeau to discuss foreign policy with G7 leaders at second day of summit meeting

CARBIS BAY, CORNWALL, ENGLAND — Foreign policy is on the agenda for… Continue reading

Multivitamins are shown on the packaging line at the Pfizer plant in Montreal, Thursday, July 12, 2012. THE CANADIAN PRESS/Graham Hughes
Canadian drug companies want new pricing regs delayed again until after pandemic

OTTAWA — Almost three dozen Canadian pharmaceutical companies made a direct appeal… Continue reading

Most Read