There is no time like the present to think about antimicrobial management in aged care homes.
With the recent release of the clinical pathways (To Dip Or Not To Dip) for older people in aged care homes with suspected urinary tract infections, it is timely that we are discussing antimicrobial stewardship this week.
So, what is Antimicrobial Stewardship?
Antimicrobial stewardship (AMS) is defined as an ongoing effort by a health service organisation to optimise antimicrobial use among consumers, improve outcomes, ensure cost-effective therapy and reduce adverse sequelae of antimicrobial use (including antimicrobial resistance).
What are Antimicrobials?
Antimicrobials are medications to treat or prevent infections. Including:
- antibiotics which are active against bacteria (for example Amoxicillin, Cefalexin)
- antivirals which are active against viruses (for example Acyclovir)
- antifungals which are active against fungi (for example topical Clotrimazole)
- anthelmintics which are active against parasites. (for example Mebendazole)
- antiretrovirals which are used in the management of HIV. (for example Atazanavir)
Antibiotics are among the most frequently prescribed medications in aged care, with up to 70% of residents receiving one or more courses of systemic antibiotics when followed over a year.
Studies have shown that 40 – 75% of antibiotics prescribed may be unnecessary or inappropriate. Harms from antibiotic overuse are significant for frail and older adults. These harms include risk of serious diarrheal infections from Clostridium Difficile, increased adverse drug events and drug interactions, and colonization and/or infection with antibiotic-resistant organisms.
All the above can be reviewed and discussed at Medication Advisory Committee (MAC) meetings, with prescribers and addressed through Resident Medication Management Reviews (RMMR). Utilising electronic medication management reports that have the capability of highlighting all the above.
References –Australian Commission on Safety and Quality in Health Care relates to the commentary at the top, Aged Care Quality and Safety Commission: Antimicrobial Stewardship.