Antibiotic Prescribing In Dutch Nursing Homes: How Appropriate Is It?

Abstract Objective To investigate the appropriateness of decisions to prescribe or withhold antibiotics for nursing home (NH) residents with infections of the urinary tract (UTI), respiratory tract (RTI), and skin (SI). Design Prospective study. Setting Ten NHs in the central-west region of the Netherlands. Participants Physicians providing medical care to NH residents. Measurements Physicians completed a registration form for any suspected infection over an 8-month period, including patient characteristics, signs and symptoms, and treatment decisions. An algorithm, developed by an expert panel and based on national and international guidelines, was used to evaluate treatment decisions for appropriateness of initiating or withholding antibiotics. Results Appropriateness of 598 treatment decisions was assessed. Overall, 76% were appropriate, with cases that were prescribed antibiotics judged less frequently “appropriate” (74%) compared with cases in which antibiotics were withheld (90%) ( P = .003). Decisions around UTI were least often appropriate (68%, compared with 87% for RTI and 94% for SI [ P