Study protocol

Optimizing antibiotics in residents of nursing homes: protocol of a randomized trial

Mark Loeb^1,2,3 , Kevin Brazil² , Lynne Lohfeld² , Allison McGeer⁴ , Andrew Simor⁵ , Kurt Stevenson⁶ , Stephen Walter² and Dick Zoutman⁷

¹Department of Pathology and Molecular Medicine, McMaster University

²Department of Clinical Epidemiology and Biostatistics, McMaster University

³Hamilton Regional Laboratory Program, Hamilton, ON, Canada

⁴Department of Microbiology, Toronto Medical Laboratories and Mount Sinai Hospital and the University of Toronto, Toronto, ON, Canada

⁵Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre and the University of Toronto, Toronto, ON, Canada

⁶Qualis Health, Boise, Idaho, USA

⁷Department of Pathology, Queen's University, Kingston, ON, Canada

author email corresponding author email

BMC Health Services Research 2002, 2:17doi:10.1186/1472-6963-2-17

Published:	3 September 2002

Abstract

Background

Antibiotics are frequently prescribed for older adults who reside in long-term care facilities. A substantial proportion of antibiotic use in this setting is inappropriate. Antibiotics are often prescribed for asymptomatic bacteriuria, a condition for which randomized trials of antibiotic therapy indicate no benefit and in fact harm. This proposal describes a randomized trial of diagnostic and therapeutic algorithms to reduce the use of antibiotics in residents of long-term care facilities.

Methods

In this on-going study, 22 nursing homes have been randomized to either use of algorithms (11 nursing homes) or to usual practise (11 nursing homes). The algorithms describe signs and symptoms for which it would be appropriate to send urine cultures or to prescribe antibiotics. The algorithms are introduced by inservicing nursing staff and by conducting one-on-one sessions for physicians using case-scenarios. The primary outcome of the study is courses of antibiotics per 1000 resident days. Secondary outcomes include urine cultures sent and antibiotic courses for urinary indications. Focus groups and semi-structured interviews with key informants will be used to assess the process of implementation and to identify key factors for sustainability.