Being Selective: Why Antibiotic Selection Criteria Is Important to Post-acute Care Pharmacy

Antibiotics are one of the most widely prescribed classes of medications in the United States. They’re also one of the most overly and inappropriately prescribed medications, particularly among the senior population. Constant or inappropriate use of antibiotics can worsen a resident’s health, potentially affecting his or her gastrointestinal, renal, and/or hepatic functions. Furthermore, some antibiotics can cause neurologic and psychiatric disorders. For these reasons, it’s vitally important for post-acute care providers, including post-acute care pharmacy services, to stay informed about antibiotic best practices. Read on for a look at key factors that should be taken into consideration when selecting antibiotics for Skilled Nursing Facility residents. [Tweet “#Antibiotics are one of the most overly and inappropriately prescribed medications among seniors.”]

Post-acute Care Pharmacy Update: Understanding the Basics of Antibiotic Selection Criteria

When choosing the most appropriate antibiotics for SNF residents, several factors must be taken into consideration. Here are four key factors that should be assessed before prescribing an antibiotic.

1. The type and severity of the infection

First things first: Determining what kind of infection the resident has. For example, is the infection pneumonia, or is it a urinary tract infection?
Once the infection type and severity have been determined, it’s important to look for the bacteria and pathogens that likely caused the infection. Often, a culture is taken to accurately identify the bacteria.

2. The existence of known drug resistance in the local community

Some facilities and healthcare settings have an antibiogram, which shows known bacterial resistance rates to medications in the local area.

3. The presence of any limiting factors or contraindications

It’s not uncommon for SNF residents to have certain medical conditions, such as decreased kidney or liver function, or take chronic medications that can potentially be affected by specific antibiotics.

4. The cost of available options

Cost can be an important factor, as some medications may offer decreased monitoring or be slightly more effective but are only available in an expensive, name-brand form.
Because residents are often on a limited income, it’s important for post-acute care pharmacy providers to discuss the various options available with residents and their families.

Post-acute Care Pharmacy Update: Therapies for SNF Residents Battling Infections

Once a diagnosis has been made and the likely pathogens have been determined, antibiotic therapy should be started.
The first wave of antibiotics is usually referred to as “empiric” therapy, which aims to start fighting the infection and reduce the risk of further complications. Empiric therapy usually consists of broad-spectrum antibiotics, such as ciprofloxacin (Cipro®) and doxycycline (Vibramycin®, Adoxa®), that can fight against many different strains of bacteria.
Once culture results are in and the causative bacteria is found, the resident should be switched to a narrow-spectrum antibiotic—such as gentamicin (Garamycin®) or vancomycin (Vancocin®)—that will target only specific types of bacteria. The chief benefit of this type of antibiotic is that it attacks bacteria more effectively, while also reducing the risk of increasing drug resistance in other bacteria.
If a culture comes back negative for any bacterial infection, however, empiric antibiotic therapy should be discontinued and the resident’s condition should be reassessed.

Antibiotic Usage in SNF Residents: Final Considerations

After an antibiotic has been selected, a care plan, detailing the length of therapy and date of termination, should be determined.
Finally, it is important to ensure the resident takes every prescribed dose of antibiotic until finished to ensure proper bacterial eradication and reduce bacterial drug resistance.

Regardless of which antibiotic is ultimately chosen, it is important to follow proper procedures and only use these medications when clinically appropriate. By selecting the best antibiotic and duration of therapy for each resident’s needs, we can effectively treat infections while also reducing the risks associated with overprescribing or inappropriately prescribing these medications.
The Grane Rx team stays up-to-date on the latest information related to long-term care pharmacy—and passes that knowledge along to your team. Call (866) 824-MEDS (6337) or fill out this quick form to find out how your SNF could benefit.]]>

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