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Antibiotic prescribing and associated diarrhoea: a prospective cohort study of care home residents

Antibiotic prescribing and associated diarrhoea: a prospective cohort study of care home residents
Antibiotic prescribing and associated diarrhoea: a prospective cohort study of care home residents

BACKGROUND: the risk factors for and frequency of antibiotic prescription and antibiotic-associated diarrhoea (AAD) among care home residents are unknown.

AIM: to prospectively study frequency and risks for antibiotic prescribing and AAD for care home residents.

DESIGN AND SETTING: a 12-month prospective cohort study in care homes across South Wales.

METHOD: antibiotic prescriptions and the development of AAD were recorded on case report forms. We defined AAD as three or more loose stools in a 24-h period occurring within 8 weeks of exposure to an antibiotic.

RESULTS: we recruited 279 residents from 10 care homes. The incidence of antibiotic prescriptions was 2.16 prescriptions per resident year (95% CI: 1.90-2.46). Antibiotics were less likely to be prescribed to residents from dual-registered homes (OR compared with nursing homes: 0.38, 95% CI: 0.18-0.79). For those who were prescribed antibiotics, the incidence of AAD was 0.57 episodes per resident year (95% CI: 0.41-0.81 episodes). AAD was more likely in residents who were prescribed co-amoxiclav (hazards ratio, HR = 2.08, 95% confidence interval, CI: 1.18-3.66) or routinely used incontinence pads (HR = 2.54, 95% CI: 1.26-5.13) and less likely in residents from residential homes (HR compared with nursing homes: 0.14, 95% CI: 0.06-0.32).

CONCLUSION: residents of care homes, particularly of nursing homes, are frequently prescribed antibiotics and often experience diarrhoea following such prescriptions. Co-amoxiclav is associated with greater risk of AAD.

Aged, Aged, 80 and over, Amoxicillin-Potassium Clavulanate Combination/adverse effects, Anti-Bacterial Agents/adverse effects, Diarrhea/chemically induced, Drug Prescriptions, Drug Utilization Review, Female, Gastrointestinal Microbiome/drug effects, Homes for the Aged, Humans, Logistic Models, Male, Multivariate Analysis, Nursing Homes, Odds Ratio, Practice Patterns, Physicians', Proportional Hazards Models, Prospective Studies, Risk Factors, Time Factors, Wales
0002-0729
853-60
Gillespie, David
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Hood, Kerenza
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Bayer, Antony
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Carter, Ben
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Duncan, Donna
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Espinasse, Aude
ee0917a1-b7d3-4ac4-aac7-497f9b84e428
Evans, Meirion
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Nuttall, Jacqueline
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Stanton, Helen
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Acharjya, Arun
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Allen, Stephen
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Cohen, David
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Groves, Sam
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Francis, Nick
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Howe, Robin
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Johansen, Antony
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Mantzourani, Efi
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Thomas-Jones, Emma
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Toghill, Alun
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Wood, Fiona
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Wigglesworth, Neil
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Wootton, Mandy
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Butler, Christopher C
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Gillespie, David
a796af31-39b7-47b9-840f-c893e43013dd
Hood, Kerenza
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Bayer, Antony
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Carter, Ben
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Duncan, Donna
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Espinasse, Aude
ee0917a1-b7d3-4ac4-aac7-497f9b84e428
Evans, Meirion
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Nuttall, Jacqueline
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Stanton, Helen
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Acharjya, Arun
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Allen, Stephen
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Cohen, David
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Groves, Sam
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Francis, Nick
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Howe, Robin
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Johansen, Antony
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Mantzourani, Efi
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Thomas-Jones, Emma
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Toghill, Alun
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Wood, Fiona
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Wigglesworth, Neil
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Wootton, Mandy
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Butler, Christopher C
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Gillespie, David, Hood, Kerenza, Bayer, Antony, Carter, Ben, Duncan, Donna, Espinasse, Aude, Evans, Meirion, Nuttall, Jacqueline, Stanton, Helen, Acharjya, Arun, Allen, Stephen, Cohen, David, Groves, Sam, Francis, Nick, Howe, Robin, Johansen, Antony, Mantzourani, Efi, Thomas-Jones, Emma, Toghill, Alun, Wood, Fiona, Wigglesworth, Neil, Wootton, Mandy and Butler, Christopher C (2015) Antibiotic prescribing and associated diarrhoea: a prospective cohort study of care home residents. Age and Ageing, 44 (5), 853-60. (doi:10.1093/ageing/afv072).

Record type: Article

Abstract

BACKGROUND: the risk factors for and frequency of antibiotic prescription and antibiotic-associated diarrhoea (AAD) among care home residents are unknown.

AIM: to prospectively study frequency and risks for antibiotic prescribing and AAD for care home residents.

DESIGN AND SETTING: a 12-month prospective cohort study in care homes across South Wales.

METHOD: antibiotic prescriptions and the development of AAD were recorded on case report forms. We defined AAD as three or more loose stools in a 24-h period occurring within 8 weeks of exposure to an antibiotic.

RESULTS: we recruited 279 residents from 10 care homes. The incidence of antibiotic prescriptions was 2.16 prescriptions per resident year (95% CI: 1.90-2.46). Antibiotics were less likely to be prescribed to residents from dual-registered homes (OR compared with nursing homes: 0.38, 95% CI: 0.18-0.79). For those who were prescribed antibiotics, the incidence of AAD was 0.57 episodes per resident year (95% CI: 0.41-0.81 episodes). AAD was more likely in residents who were prescribed co-amoxiclav (hazards ratio, HR = 2.08, 95% confidence interval, CI: 1.18-3.66) or routinely used incontinence pads (HR = 2.54, 95% CI: 1.26-5.13) and less likely in residents from residential homes (HR compared with nursing homes: 0.14, 95% CI: 0.06-0.32).

CONCLUSION: residents of care homes, particularly of nursing homes, are frequently prescribed antibiotics and often experience diarrhoea following such prescriptions. Co-amoxiclav is associated with greater risk of AAD.

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More information

Accepted/In Press date: 5 March 2015
e-pub ahead of print date: 23 June 2015
Published date: September 2015
Keywords: Aged, Aged, 80 and over, Amoxicillin-Potassium Clavulanate Combination/adverse effects, Anti-Bacterial Agents/adverse effects, Diarrhea/chemically induced, Drug Prescriptions, Drug Utilization Review, Female, Gastrointestinal Microbiome/drug effects, Homes for the Aged, Humans, Logistic Models, Male, Multivariate Analysis, Nursing Homes, Odds Ratio, Practice Patterns, Physicians', Proportional Hazards Models, Prospective Studies, Risk Factors, Time Factors, Wales

Identifiers

Local EPrints ID: 436423
URI: http://eprints.soton.ac.uk/id/eprint/436423
ISSN: 0002-0729
PURE UUID: 628af14d-b9ef-4197-b486-a1d7491d09f7
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312

Catalogue record

Date deposited: 10 Dec 2019 17:30
Last modified: 09 Jan 2022 04:08

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Contributors

Author: David Gillespie
Author: Kerenza Hood
Author: Antony Bayer
Author: Ben Carter
Author: Donna Duncan
Author: Aude Espinasse
Author: Meirion Evans
Author: Jacqueline Nuttall
Author: Helen Stanton
Author: Arun Acharjya
Author: Stephen Allen
Author: David Cohen
Author: Sam Groves
Author: Nick Francis ORCID iD
Author: Robin Howe
Author: Antony Johansen
Author: Efi Mantzourani
Author: Emma Thomas-Jones
Author: Alun Toghill
Author: Fiona Wood
Author: Neil Wigglesworth
Author: Mandy Wootton
Author: Christopher C Butler

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