Study Finds Reduction in Nursing Home Antibiotic Use, But Duration Remains Problematic

New rules that require nursing homes to track antibiotic prescriptions appear to be leading to more cautious prescribing habits, CDC researchers suggest.

Nursing homes are finally pulling back from heavy prescribing of antibiotics, after years of global concerns about overuse of the drugs, which increases the risk of the subsequent development of antibiotic-resistant “superbugs.”

Doctors often prescribe antibiotics to nursing home residents to treat infections that are common in long-term care facilities, such as urinary tract infections, respiratory infections like pneumonia, and skin infections, like bedsores. However, they have also been widely prescribed in recent years for a variety of conditions that can’t be treated by antibiotics.

Health officials estimate that 40% to 75% of antibiotics used in nursing homes are either prescribed for inappropriate uses or excessive durations. Using unnecessary antibiotics can cause a number of serious adverse side effects, especially among older adults, including diarrhea, nausea, vomiting, headaches, rashes and other skin reactions, as well as interactions with other medications.

Studies also indicate that overuse of antibiotics can lead to the development of antibiotic-resistant superbugs, which are difficult to treat and can be deadly. In fact, researchers from the University of Washington’s Institute for Health Metrics and Evaluation indicate these superbugs could kill nearly 40 million people by 2050 unless drastic measures are taken to curb the overuse of antibiotics globally.

Antibiotic Use Declined in Nursing Homes

According to findings that were published last month in the medical journal Antimicrobial Stewardship & Healthcare Epidemiology, nursing home prescriptions for several classes of antibiotics dropped significantly from 2013 to 2021, but there is still room for improvement.

For the new study, U.S. Centers for Disease Control and Prevention (CDC) researchers used data on antibiotic prescriptions from pharmacy dispensing records for 1,900 long-term care facilities in the United States from 2013 to 2021.

According to the team, led by Dr. Katryna A. Gouin, the number of antibiotic prescriptions given to nursing home residents dropped from 51% to 44% during that time period. The greatest drop in antibiotic use was seen from 2019 to 2021, which researchers said is likely because of changes in antibiotic prescribing due to the COVID-19 pandemic.

Researchers suggested the decrease in antibiotic prescribing may also be linked to a new rule implemented by the U.S. Centers for Medicare & Medicaid Services (CMS) in 2017, which requires nursing homes to have a system for tracking antibiotic use. This may have encouraged nursing homes not to use antibiotics for preventive measures or conditions that the drugs are ineffective at treating, they speculated.

The findings indicate the rate for total courses of antibiotics fell by 8% in nursing homes since 2013. Prescribing for fluoroquinolones like Levaquin and Cipro dropped by 49% and prescribing for macrolides, like Zithromax, fell by 30%. However, prescribing rates for tetracyclines increased by 56% and for cephalosporins like Ancef by 22%.

The study noted that there was no improvement in reducing the duration of antibiotic treatments, however.

The CDC researchers concluded that their findings make a strong argument for more intensive tracking of antibiotic use in nursing homes.

“Tracking antimicrobial use in LTC (long-term care) settings can be used to describe baseline prescribing rates, track changes over time, and identify where further evaluation is needed,” they concluded. “LTC pharmacy dispensing data can be used to calculate antibiotic use measures at a facility- and national-level and support stewardship implementation in LTC settings.”