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A study of Veterans Health Administration data found that antibiotic prescribing was prevalent among a national cohort of persons living with dementia (PLWD), and inappropriate use appeared high, researchers reported late last week in Open Forum Infectious Diseases.

For the study, the researchers identified patients who received home-based personal care (HBPC) through the Veterans Affairs healthcare system from 2014 through 2018, focusing on patients aged 65 and older who received two or more in-person home visits by a physician and had a diagnosis of dementia. Antibiotics prescribed within 3 days of an HBPC visit were assessed from the initial HBPC visit through death or the end of the study period, and prescription fills and days of therapy (DOT) per 1,000 days of home care (DOHC) were calculated.

Among 39,861 PLWD (median age 85, 97% male, 15% Black), 16,956 (42.5%) received 45,122 antibiotic prescription fills, 67% of which were associated with diagnoses for conditions for which antibiotics are not indicated—mainly non-infectious noninformative diagnoses, such as chronic or other conditions. The antibiotic use rate was 20.7 DOT per 1,000 DOHC.

The most common antibiotic classes filled were quinolones (24.3%), aminopenicillins (16.6%), and sulfonamides/related agents (12.3%). The median length of antibiotic therapy was 7 days. Nearly one third (30.9%) of antibiotic fills were associated with HBPC telephone visits, and 42% were associated with advanced practice providers.

The study authors note that the findings suggest that the rate of antibiotic prescribing in HBPC is similar to that in nursing homes. Particularly concerning is the use of quinolones, which are classified as potentially inappropriate medications for older adults.

"Collectively, these findings underscore the need for further investigation regarding the scope, appropriateness, and harms of antibiotic use in home care settings," the study authors wrote. "It is necessary to better understand the clinical reasoning and documentation practices among HBPC providers." Sep 3 Open Forum Infect Dis abstract

A prospective study in Toronto, Canada, found that children who received antibiotics for upper respiratory tract infections (URTIs) early in childhood were more likely to receive them for URTIs later in childhood, researchers reported yesterday in the Journal of the Pediatric Infectious Diseases Society.

To evaluate the relationship between antibiotic prescriptions for URTI prior to age 2 and antibiotic prescriptions for URTI after age 2, the investigators followed children ages 0 through 5 from nine primary care practices in Toronto over an 8-year period (December 2008 through March 2016). Children were included in the study if they had at least one sick visit with their primary care physician prior to 2 years of age and one sick visit after. Diagnoses of pharyngitis, unspecified viral infection, cold, acute otitis media (AOM, or ear infection), and influenza were considered URTIs.

A total of 2,380 children were included in the final analysis, and the average duration of follow-up from the first visit was 4.6 years. Of 12,695 visits before age 2, 1,968 (15.5%) resulted in an antibiotic prescription (50.9% for AOM, 15.2 % for non-AOM URTI, and 33.9% for other conditions). Of 13,295 sick visits after age 2, 10,719 (24%) resulted in an antibiotic prescription (41.3% for AOM, 27.9% for non-AOM URTI, and 30.8% for other conditions).

In an adjusted analysis, antibiotic prescription for URTI prior to age 2 was associated with a 39% increased likelihood of an antibiotic prescription for a URTI after age 2 (adjusted odds ratio [aOR], 1.39; 95% confidence interval [CI], 1.19 to 1.63). A secondary analysis found that children prescribed an antibiotic for AOM prior to age 2 were more likely to receive antibiotics for URTI after age 2 (aOR, 1.44; 95% CI, 1.00 to 2.05).

The study authors speculate that antibiotic prescriptions early in life may reinforce parental expectations for antibiotics for URTIs, making withholding antibiotics for URTIs later in life more difficult.

"Results from the present study suggest that antibiotic prescription for URTI in early life may establish a pattern for antibiotic prescription for URTI in later childhood," the study authors wrote. "Reducing early life antibiotic prescription for URTI may result in reduction in antibiotic prescription for URTI in later life." Sep 6 J Pediatric Infect Dis Soc abstract

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