By Richard Ueberfluss
Antibiotics have played a critical role in treating a variety of diseases. But new research has found that overuse of antibiotics is creating a rise in drug-resistant infections, especially in nursing homes where urinary tract infections (UTI) are an ongoing problem.
The issue is that overuse of antibiotics has led to the rise in dangerous drug-resistant infections. A bacterium is resistant to a drug when it has changed in some way that either protects it from the action of the drug or neutralizes the drug. Any bacterium that survives an antibiotic treatment can then multiply and pass on its resistant properties.
Also, some bacteria can transfer their drug-resistant properties to other bacteria, helping them thrive. The fact that bacteria develop resistance to a drug is normal and expected. However, the way that drugs are used affects how quickly and to what extent drug resistance occurs.
Up to 70% of nursing home residents receive one or more courses of antibiotics every year for urinary tract infections, pneumonia, cellulitis and other suspected conditions, according to researchers. Yet according to a Wall Street Journal story, up to 75% of those prescriptions are given incorrectly—either unnecessarily or the prescription is for
the wrong drug, dose or duration, the Centers for Disease Control and Prevention says.
One of the biggest culprits, researchers say is misdiagnosed urinary tract infections. Only a quarter to a third of people in nursing homes who are diagnosed have actual symptoms, according to several studies. Most have only vague symptoms like confusion or bacteria in their urine that aren’t actually causing an infection. There is increasing evidence that such practices can lead to the spread of drug-resistant bacteria.
This is particularly harmful to the elderly and are very difficult if not impossible to treat, researchers say. They can also lead to drug interaction problems or diarrhea from Clostridium difficile—a common complication in long-term care facilities that can be deadly for people over age 65, Nursing homes can contribute to this since doctors can be reluctant to hold off on prescribing, and on top of that, turnover in nursing home staff is high. So antibiotics can be prescribed without the proper monitoring.
Geriatricians are attacking the issue by trying to dispel a myth that confusion alone or even a fall signals a possible urinary tract infection. Instead, patients should be checked for actual UTI symptoms such as fever, pelvic pain, incontinence or urgency to urinate, and urine tests should be done only on those with UTI symptoms, according to guidelines and campaigns issued in recent years by several professional societies.
Common viral infections that do not benefit from antibiotic treatment include:
- Cold
- Flu (influenza)
- Bronchitis
- Most coughs
- Most sore throats
- Some ear infections
- Some sinus infections
- Stomach flu (viral gastroenteritis)
In spite of a growing awareness of antibiotic resistance in recent years, overuse still occurs for a number of reasons:
- Doctors may prescribe antibiotics before receiving test results that identify the actual cause of infection.
- People who want quick relief from symptoms, regardless of the cause of illness, may pressure doctors for antibiotic prescriptions.
- People may take antibiotics purchased abroad or via the Internet for self-diagnosed illnesses.
- People may take antibiotics that are leftovers from a previous prescription.
One of the benefits of at-home care is that home health aides closely monitor patients so they can help detect UTIs early or if another cause is indicating a UTI symptom.. And if a patient is on antibiotics, home health aides can determine how long a patient is on the antibiotics and discuss this with a physician. This can help minimize discomfort and potential drug interactions.
