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Invited Commentary
August 2015

Effects of Excessive Antibiotic Use in Nursing Homes

Author Affiliations
  • 1Division of Geriatric and Palliative Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
  • 2Geriatric Research Education and Clinical Center, Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
  • 3Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
  • 4William S. Middleton Veterans Affairs Hospital, Madison, Wisconsin
JAMA Intern Med. 2015;175(8):1339-1341. doi:10.1001/jamainternmed.2015.2774

In the United States, on any given day, approximately 1.4 million people reside in more than 15 000 nursing homes (NHs).1 As a testament to the burgeoning post–acute care population, approximately 3.3 million Medicare recipients are admitted to NHs for short stays each year, making NHs a crucial segment of the overall health care provision system within the United States.2 Antibiotics are one of the most frequently prescribed medications in NHs where 6% to 10% of residents are taking antibiotics at any given time and more than half receive at least one antibiotic prescription in a single year.3 Much of this use is inappropriate. An estimated 25% to 75% of antibiotic prescriptions do not meet clinical guidelines for appropriate prescribing.3 The most common infection leading to inappropriate antibiotic therapy is suspected urinary tract infection, which accounts for 30% to 56% of antibiotics prescribed, with up to a third of these prescribed for NH residents with asymptomatic bacteriuria.4