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

BMC Health Serv Res. 2002 Sep 3;2(1):17. doi: 10.1186/1472-6963-2-17.


Background: 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.

Methods: 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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Algorithms*
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Bacteriuria / drug therapy*
  • Bacteriuria / urine*
  • Clinical Protocols*
  • Drug Resistance, Microbial
  • Drug Utilization / standards*
  • Drug Utilization / statistics & numerical data
  • Female
  • Humans
  • Male
  • Medical Staff / education
  • Medical Staff / standards
  • Middle Aged
  • Nursing Homes / standards*
  • Nursing Staff / education
  • Nursing Staff / standards
  • Ontario
  • Randomized Controlled Trials as Topic / methods*
  • Treatment Outcome


  • Anti-Bacterial Agents