Ensuring appropriate and safe antibiotic prescribing for elderly patients: that’s the goal of an Amsterdam UMC led study.
The guidelines for diagnosing a urinary tract infection (UTI) include a urine culture but for elderly nursing home residents, bacteria are often present in urine without causing infection and symptoms. Since symptoms of UTI are often vague and non-specific in the elderly, which means distinguishing the innocent presence of bacteria from a true UTI is challenging. This challenge results in unnecessary prescribing of antibiotics, which in turn may lead to increased antibiotic resistance.
The PROGRESS study team seeks to identify a point-of-care test that can accurately diagnose UTIs, and ultimately, avoid inappropriate antibiotic use among people living in nursing homes. It’s the first study of its kind in the country.
“Antibiotic resistance is becoming a global threat due to misuse and over prescribing of antibiotics. This has resulted in the emergence and spread of bacteria that are resistant to the drugs that are typically used to treat them,” said Amsterdam UMC Prof. Menno de Jong, principal investigator of the study.
“We need to ensure accurate diagnostic tools are available to all patients, especially including the growing population of elderly people and nursing home residents, to avoid misuse and over prescribing.”
The project consists of two consecutive studies. The first study will determine which of two point-of-care tests works best to help diagnose urinary tract infections (UTI), while the second study will evaluate if the use of the selected test reduces unnecessary antibiotic use.
The avoidance of unnecessary medication is particularly important for this vulnerable population.
“Due to the likelihood of the elderly being on other age-related medications for conditions such as hypertension, stroke, and diabetes, there is a higher chance of drug interaction between the antibiotics and their existing treatment regimes,” noted Amsterdam Institute for Global Health and Development Assoc. Prof. Frank van Leth, who is leading AIGHD’s role in the study.
“They’re also more prone to longer and more severe side effects due to their age so ensuring they’re prescribed the right medication – or none at all, if it’s deemed safe – is critical.”
Currently 11 nursing homes in the Amsterdam and Utrecht areas are participating in the project, with plans to expand to others. The work is expected to be completed by the end of 2020. In parallel to the studies, the team is working with local health care providers to determine how to best integrate the testing approach in routine care if it is proven successful.
World Antibiotic Awareness Week takes place this week and encourages best practices of antibiotic use and prescription to limit further development of resistance around the world. Along with a number of international organizations, including the World Health Organization, AIGHD is raising awareness of antibiotic resistance. The PROGRESS Study is one of many research projects in which AIGHD’s team is involved to better understand and address this emerging global threat.