[Prudent use of antibiotics and suggestions for improvement in long-term-care facilities]

Antibiotics are among the most prescribed drugs in long-term-care facilities, accounting for nearly 40% of all prescribed drugs. It is estimated that the likelihood that a resident patient will receive at least one course of antibiotics per year is 70%. Prevalence is 4%-10%, and incidence between 3 and 4 treatments per 1,000 stays, though there is great variability between apparently similar centres in terms of consumption. On the other hand, a high percentage of antibiotic treatments are considered inappropriate because most are empirical, often prescribed to treat bacterial colonisation and too many broad-spectrum antibiotics are used for too long. The main consequences of inappropriate use are the increase of microbial resistance and side effects in this frail, elderly population. The challenges of improving the use of antibiotics lie in the basic characteristics of these centres, with limited resources to carry out organised activities to control infections and antibiotic policies. Some possibilities for improvement include organising local programmes focused on the most basic aspects of appropriate use of antibiotics, from the diagnosis of infection and the development of empirical and targeted treatment protocols, to the implementation of minimal activities of analysis and surveillance. Centers with more resources and greater experience should lead the implementation and evaluation of educational interventions and research projects.