To examine antibiotic prescribing in nursing homes and determine to what degree the prescribing was in accordance with the national guidelines for antibiotic prescribing.
Retrospective examination of patients' records who were prescribed antibiotics in the period 1 March 2007 to 28 February 2008.
Patients residing in the nursing homes of Arendal, Norway.
Choice of antibiotic in respect of the recommendations in the national guidelines for antibiotic prescribing.
A total of 714 antibiotic courses were prescribed to 327 patients yielding a prevalence of 6.6%. Compliant prescribing was 77% for urinary tract infections (UTI), 79% for respiratory tract infections (RTI), and 76% for skin and soft tissue infections (SSTI). Ciprofloxacin was responsible for 63% of non-compliant prescribing. On the respite wards there was a higher rate of total prescribing, non-compliant prescribing, and prescribing by physicians employed at the local hospital.
Guidelines for antibiotic use must be implemented actively and efforts to improve antibiotic prescribing in nursing homes must be aimed at both nursing home and hospital physicians.
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Antibiotic resistance is a problem in nursing homes. Presumed urinary tract infections (UTI) are the most common infection. This study examines urine culture results from elderly patients to see if specific guidelines based on gender or whether the patient resides in a nursing home (NH) are warranted.
This is a cross sectional observation study comparing urine cultures from NH patients with urine cultures from patients in the same age group living in the community.
There were 232 positive urine cultures in the NH group and 3554 in the community group. Escherichia coli was isolated in 145 urines in the NH group (64%) and 2275 (64%) in the community group. There were no clinically significant differences in resistance. Combined, there were 3016 positive urine cultures from females and 770 from males. Escherichia coli was significantly more common in females 2120 (70%) than in males 303 (39%) (p?
Cites: Intern Med J. 2012 Jul;42(7):e157-6421241444
According to Norwegian guidelines for antibiotic use in primary care, ciprofloxacin is reserved for complicated urinary tract infections (UTI). Despite these recommendations, ciprofloxacin use has increased in Norway in recent years. We aimed to reduce inappropriate ciprofloxacin prescribing in the emergency department.
An intervention study was performed by removing ciprofloxacin from the local antibiotic formulary and including a suggestion list for antibiotic use with all point of care urine dipstick testing in an emergency department. An emergency department in the neighbouring county served as the control. Prescriptions for UTI were registered 1 y prior to and 1 y after the intervention.
In the targeted emergency department, there was a significant (p
Although medical students gain experience in performing procedures during their clinical clerkships, which skills they should acquire remains unclear. The authors sought opinions from internal medicine clerkship directors regarding procedural and interpretive skills students should and do learn during clerkships.
In 2002, the 123 members of the Clerkship Directors in Internal Medicine (CDIM) were confidentially surveyed using a 79-item questionnaire about the appropriateness of 20 procedural skills, demographics, clerkship characteristics, and curricula in procedural skills. Participants had the choice of completing a mailed paper questionnaire or an electronic version on the CDIM's Web site. After univariate analysis, adjusted comparisons among participants were made using linear regression.
Surveys were completed by 89 clerkship directors (72%). Most thought that students should be taught 17 of 20 procedural skills. However, the majority thought students do not learn five of these skills. Over 80% of respondents thought students should learn: chest x-ray interpretation, electrocardiogram interpretation, phlebotomy, throat culture, blood culture, urinalysis, Pap smear, central line placement, peripheral blood smear. However, the majority thought students do not learn five of these skills. The mean of skills that should be taught and are learned were 15 (standard deviation [SD] = 3) and 12 (SD = 4), respectively. About half used formal teaching in procedures (44%), used logs (51%) and tested competency (45%).
CDIM members thought medical students should be taught a variety of procedural skills but thought students fail to learn many. These findings may help prioritize which procedures to teach. It may be helpful to develop standardized curricular materials on teaching procedures.
In Norway, a substantial increase in the use of fluoroquinolones (in the last years) has occurred in parallel with a disconcertering increase in ciprofloxacin resistant E. Coli bacteria. Elderly patients (over 70 years) use most antibiotics. The purpose of this study is to investigate prescribing of fluoroquinolone in nursing homes within a Norwegian municipality.
Clinical information was recorded for nursing home patients treated with fluoroquinolone in Arendal municipality in the period 01.12.06-31.11.07.
94 courses of ciprofloxacin were prescribed for 78 patients. No patients were treated with ofloxacine. Urinary tract infection was the most common indication for patients both in long- term (78%) and short term (40%) wards. In short-term wards, respiratory tract infection was also a common indication for prescribing ciprofloxacin (37%), but not in long- term wards (4%). 44 infections (47%) were verified by microbiology culture. 12 infections were caused by a bacterium susceptible only to ciprofloxacin.
Ciprofloxacin was used in a large proportion of the patients in cases when another antibiotic should have been the first choice according to Norwegian national guidelines. Results of microbiology culture showed that most pathogens were susceptible to antibiotics with a narrower spectrum than ciprofloxacin.