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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
a796af31-39b7-47b9-840f-c893e43013dd
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Bayer, Antony
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Carter, Ben
f27540ee-2b8f-43b4-ac06-8bdcafb1ef5f
Duncan, Donna
f23b1ac8-25ff-48ae-9a28-80238a9c1ef8
Espinasse, Aude
ee0917a1-b7d3-4ac4-aac7-497f9b84e428
Evans, Meirion
86b2527d-967f-4108-ac98-e1123d236b49
Nuttall, Jacqueline
154aec0a-05f2-4379-918e-9c36767fdc4c
Stanton, Helen
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Acharjya, Arun
63aa3280-4f57-4d81-a6d0-f91b20e6f0c3
Allen, Stephen
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Cohen, David
8bd9a96d-519b-463a-a69f-8883fd3acbdb
Groves, Sam
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Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
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
b8a5fac2-a472-4013-8221-6bc5deae7285
Wood, Fiona
fc0b6a76-2928-4bda-aafc-2be3ac74446b
Wigglesworth, Neil
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Wootton, Mandy
4179ab83-aebf-4b01-9203-f067b2bd7d81
Butler, Christopher C
8bf4cace-c34a-4b65-838f-29c2be91e434
Gillespie, David
a796af31-39b7-47b9-840f-c893e43013dd
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Bayer, Antony
88870477-ad38-4f9b-b304-c2f20dee4987
Carter, Ben
f27540ee-2b8f-43b4-ac06-8bdcafb1ef5f
Duncan, Donna
f23b1ac8-25ff-48ae-9a28-80238a9c1ef8
Espinasse, Aude
ee0917a1-b7d3-4ac4-aac7-497f9b84e428
Evans, Meirion
86b2527d-967f-4108-ac98-e1123d236b49
Nuttall, Jacqueline
154aec0a-05f2-4379-918e-9c36767fdc4c
Stanton, Helen
05e8526c-706a-4615-add9-c942abf8d12a
Acharjya, Arun
63aa3280-4f57-4d81-a6d0-f91b20e6f0c3
Allen, Stephen
70bcdcd4-9637-43fe-a907-826a35dcf738
Cohen, David
8bd9a96d-519b-463a-a69f-8883fd3acbdb
Groves, Sam
590b3f11-e55d-475a-b509-ac0b7edd6a9b
Francis, Nick
9b610883-605c-4fee-871d-defaa86ccf8e
Howe, Robin
e02d3c72-421b-4396-bf99-392e8847247f
Johansen, Antony
fde1a484-07de-4937-9834-9288671d1143
Mantzourani, Efi
68471506-55d8-423d-ba21-a9e003032469
Thomas-Jones, Emma
ea15d5ac-8232-4823-ab40-17bec0968520
Toghill, Alun
b8a5fac2-a472-4013-8221-6bc5deae7285
Wood, Fiona
fc0b6a76-2928-4bda-aafc-2be3ac74446b
Wigglesworth, Neil
36d164ca-3374-446f-b6f4-d1c36707b1ee
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: 17 Mar 2024 03:58

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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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