Time Out! A Close Look at Antibiotic Use in Post-acute and Long-term Care

Neil Gaffin, MD

Disclosures

October 02, 2018

Press Pause, and Reassess

The recommendation was to discontinue the antibiotics owing to the lack of clinical evidence of pneumonia. Most antibiotic prescriptions in nursing facilities are initiated over the phone without a bedside evaluation by a clinician. The Centers for Disease Control and Prevention recommend an "antibiotic timeout" and critical reevaluation within 48-72 hours of starting therapy, which could help, as it did in this case, minimize unnecessary and potentially harmful therapy.[9]

Discussion

All of these cases were seen over a span of approximately 2 weeks. Several other similar cases were reviewed during that period but were not included. None of these patients had the infections for which the antibiotics were initially prescribed. It is highly unlikely that the initial diagnoses would have been challenged and the prescriptions stopped without an intervention.

Accurate diagnosis starts with a compelling clinical picture that dictates the need for testing; overreliance on lab tests and chest radiography reports, particularly in nursing facilities, often leads to unnecessary antibiotics.[13]

The cases presented herein represent the "low-hanging fruit" of nursing home antibiotic stewardship and underscore the desperate need for a sustainable and systematic approach to reduce unnecessary prescriptions in this vulnerable population.

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