Highlights
- •Topical antimicrobials are frequently prescribed in Australian aged care homes.
- •First line topical antimicrobial therapy is not always prescribed.
- •Antimicrobial stewardship teams should regularly review topical antimicrobial use.
Background
Australian residential aged care facilities (RACFs) are encouraged to participate
in an annual Aged Care National Antimicrobial Prescribing Survey. This data source
was analysed to describe patterns of topical antimicrobial prescribing and thereby
provide insight into antimicrobial stewardship (AMS) changes that might be required.
Methods
2018 and 2019 survey data was analysed.
Results
The overall prevalence of the 52,431 audited residents (629 facilities) who were prescribed
1 or more topical antimicrobials was 2.9%. Of all prescribed antimicrobials (n=4899),
33.0% were for topical application. Most frequently prescribed topical antifungals
were clotrimazole (85.3%) and miconazole (9.1%), and antibacterials chloramphenicol
(64.1%) and mupirocin (21.8%). Tinea (38.3%) and conjunctivitis (23.8%) were the 2
most common indications. Topical antimicrobials were sometimes prescribed for pro
re nata administration (38.8%) and greater than 6 months (11.3%). The review or stop
date was not always documented (38.7%).
Conclusions
To reduce the possibility of adverse consequences associated with antimicrobial use,
antimicrobial stewardship programs in Australian residential aged care facilities
should at least ensure mupirocin is appropriately used, first line antimicrobial therapy
is prescribed for tinea, chloramphenicol is prescribed for conjunctivitis only if
necessary, pro re nata orders for prescriptions are discouraged and to avoid prolonged
duration of prescriptions, review or stop dates are always documented.
Key Words
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References
- Recent advances on topical antimicrobials for skin and soft tissue infections and their safety concerns.Crit Rev Microbiol. 2018; 44: 40-78
- Current and emerging topical antibacterials and antiseptics: agents, action, and resistance patterns.Clin Microbiol Rev. 2017; 30: 827-860
- A bug in the ointment: topical antimicrobial usage and resistance in New Zealand.N Z Med J. 2015; 128: 103-109
- Australian Commission on Safety and Quality in Health Care.Antimicrobial Stewardship in Australian Health Care Sydney ACSQHC, 2018
- Australian Government Aged Care Quality and Safety Commission.Guidance and Resources for Providers to support the Aged Care Quality Standards, 2018
- Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis.Lancet Infect Dis. 2016; 16: 847-856
- Therapeutic Guidelines: Antibiotic. Version 16.Melbourne Therapeutic Guidelines Limited, Melbourne2019
- The Core Elements of Antibiotic Stewardship for Nursing Homes Atlanta, GA: US Department of Health and Human Services, CDC.2015 (Available at: http://www.cdc.gov/longtermcare/index.html. Accessed May 3, 2021)
European Centre for Disease Prevention and Control. Healthcare associated infections in long term care facilities in Europe: the HALT project. Available at: https://www.ecdc.europa.eu/en/all-topics-z/healthcare-associated-infections-long-term-care-facilities/surveillance-and-disease-13. Accessed May 3, 2021.
- Healthcare-associated infections in long-term care facilities (HALT) in Frankfurt am Main, Germany, January to March 2011.Euro Surveill. 2012; 17
- Antimicrobial prescribing in residential homes.J Antimicrob Chemother. 2012; 67: 1781-1790
- A point prevalence study of antimicrobial use and practice among nursing homes in Singapore.Drugs Aging. 2019; 36: 559-570
- Topical antibacterial and antiviral agents: prescribing and resistance.Prescriber. 2016; 27: 29-36
- Dumb and dumber–the potential waste of a useful antistaphylococcal agent: emerging fusidic acid resistance in Staphylococcus aureus.Clin Infect Dis. 2006; 42: 394-400
- Therapeutic Guidelines: Dermatology. Version 3.Therapeutic Guidelines Limited, Australia2015
- Australian Medicines Handbook Pty Ltd.Adelaide, South Australia2021
- Comparison of terbinafine and clotrimazole in treating tinea pedis.BMJ. 1993; 307: 645-647
- Topical antifungal-corticosteroid combination therapy for the treatment of superficial mycoses: conclusions of an expert panel meeting.Mycoses. 2016; 59: 365-373
- Therapeutic Guidelines: Dermatology. Version 4..Melbourne Therapeutic Guidelines Limited, Melbourne2015
- Australian Medicines Handbook: Aged Care Companion.Australian Medicines Handbook Pty Ltd, Adelaide2019
- Australian Commission on Safety and Quality in Health Care.Antimicrobial Stewardship Clinical Care Standard Sydney ACSQHC, 2014
- RACGP aged care clinical guide (Silver Book) Part B.Collaboration and multidisciplinary team-based care, 2019
- Managing responsible antimicrobial use: perspectives across the healthcare system.Clin Microbiol Infect. 2017; 23: 441-447
- Australian Guidelines for the Prevention and Control of Infection in Healthcare Australia Co, editor.Canberra NHMRC, 2019
- Skin infections and ageing.Ageing Res Rev. 2004; 3: 69-89
Article Info
Publication History
Published online: March 31, 2021
Footnotes
Conflicts of interest: All authors have no conflicts of interest to declare.
Identification
Copyright
Crown Copyright © 2021 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.
