Avoiding Antibiotics In A Nursing Home: Why?

(We want every resident to receive the best possible care. The following information is based on guidelines from national medical organizations and represents the best appropriate care for your loved one.)


Nursing home residents frequently have infections. These are usually caused by viruses (such as a ‘cold’), rather than bacteria (such as ‘staph’). Elderly don’t always have symptoms of infection typically found in younger folks.  Often, the first indication of infection is a new or worse confusion, incontinence, loss of appetite, resisting care, falling, or refusing to get out of bed; and, only about half of them will have a fever.

What’s the best treatment if an infection is suspected?
Families often ask for an antibiotic. In general, most infections are viral and therefore do not require antibiotics.  In addition, many bacterial infections improve with only supportive care (such as breathing treatments, rest, extra fluids, cough medicine, Tylenol).  Therefore, antibiotics are prescribed only when someone clearly has a bacterial infection that is worsening or that will not heal unless those drugs are given.  All the references below strongly discourage the inappropriate use of antibiotics.

Why not use Antibiotics?
1.    The most important reason is that antibiotics cause bacteria to become resistant, which means the bacteria won’t respond as well to an antibiotic the next time it’s really needed.  These resistant bacteria then can spread to other residents.
2.    Seniors are more sensitive to drug side-effects – such as diarrhea, sore mouth, nausea – due to changes (from aging) in their kidney and liver.
3.    Antibiotics increase greatly the risk for a senior acquiring an abnormal bacteria called Clostridium difficile;  it causes diarrhea and increases their mortality.
4.    Antibiotics can be extremely expensive (particularly if they aren’t necessary).
5.    For those with a life-limiting disease [a disease you will eventually die from], and/or who no longer have a desirable quality of life and want to focus on being kept comfortable, antibiotics may interfere artificially in a more natural journey towards the ‘end’ and prolong suffering [Pneumonia was considered the “old person’s friend” before antibiotics].



References:


1. Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of LTC Facilities: 2008 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2009.
2. MD Consult: Nursing Home Care, American Family Physician.
3. Kamel, H. Managing UTIs: guide for Nursing Home Practitioners.  Annals of LTC 2005.
4. Common Infections in the LTC Setting.  CPG. American Medical Directors Association 2004.
5. Nicolle LE, et al.  Antimicrobial use in LTC Facilities. Society for Healthcare Epidemiology of America. 1996.

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