Determining Appropriateness of Antibiotic Therapy in Nursing Home Residents: A Review

Upwards of 70% of nursing home residents receive at least one course of antibiotics yearly but as many as 75% of these courses have been considered inappropriate. In response to this potential overprescribing of antibiotic nursing homes are now required to have an antimicrobial stewardship program to monitor and improve prescribing. However, determining appropriateness of antibiotic therapy in the nursing home setting has been a major challenge. The objectives of this review were to identify and review studies of appropriateness of antibiotic therapy in nursing homes with special focus on the criteria utilized for determining appropriateness. Of the 30 studies identified in the literature review, 50% utilized infection surveillance definitions that were not designed to assess appropriateness of antibiotic therapy in individual residents. There was also variation in the size of study populations, study design, and criteria for identifying the study population. These limitations not only make comparisons among studies problematic but also raise concerns about the validity of the findings regarding the level of appropriateness of antibiotic prescribing in nursing homes. Suggestions are provided for the design of future studies of antibiotic appropriateness in nursing homes that focus on standardizing the methodology to minimize the variation observed in the studies in this review.