Open Access Study protocol

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

Mark Loeb123*, Kevin Brazil2, Lynne Lohfeld2, Allison McGeer4, Andrew Simor5, Kurt Stevenson6, Stephen Walter2 and Dick Zoutman7

Author Affiliations

1 Department of Pathology and Molecular Medicine, McMaster University

2 Department of Clinical Epidemiology and Biostatistics, McMaster University

3 Hamilton Regional Laboratory Program, Hamilton, ON, Canada

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

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

6 Qualis Health, Boise, Idaho, USA

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

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

Published: 3 September 2002



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.


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.