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Published on: August 30, 2018
Antibiotic use and associated factors in patients with dementia: a systematic review
Tessa van der Maaden1, Simone A Hendriks, Henrica C W de Vet
1EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands, t.vandermaaden@vumc.nl.
Background:
Infections frequently occur in patients with dementia and antibiotics are often prescribed, but may also be withheld.
Objectives:
The aim of this systematic review is to provide a systematic overview of the prevalence of antibiotic use, and factors associated with prescribing antibiotics in patients with dementia.
Data Sources:
A systematic search of MEDLINE, EMBASE, PSYCINFO, CINAHL, and the Cochrane library databases until February 13, 2014 was performed, using both controlled terms and free-text terms.
Results:
Thirty-seven articles were included. The point prevalence of antibiotic use in patients with dementia ranged from 3.3 to 16.6%. The period prevalence ranged from 4.4 to 88% overall, and from 23.5 to 94% in variable time frames before death; the median use was 52% (median period 14 days) and 48% (median period 22 days), respectively. Most patients with lower respiratory tract infections or urinary tract infections (77-91%) received antibiotic treatment. Factors associated with antibiotic use related to patients, families, physicians, and the healthcare context. More severe dementia and a poor prognosis were associated with less antibiotic use in various countries. Associations with aspiration and illness severity differed by country.
Conclusions And Implications:
Antibiotic use in patients with dementia is substantial, and probably highly associated with the particular healthcare context. Future studies may report antibiotic use by infection type and stage of dementia, and compare cross-nationally.
Insights
Antibiotic use is common in dementia patients, especially for infections like pneumonia and UTIs. Prescribing patterns vary significantly based on patient, family, physician, and healthcare factors.
Area of Science:
- Geriatric Medicine
- Infectious Diseases
- Pharmacology
Background:
- Infections are common in patients with dementia.
- Antibiotic prescribing is frequent but variable in this population.
Purpose of the Study:
- To systematically review antibiotic use prevalence in dementia patients.
- To identify factors associated with antibiotic prescribing decisions.
Main Methods:
- Systematic search of multiple databases (MEDLINE, EMBASE, PSYCINFO, CINAHL, Cochrane Library) until February 2014.
- Inclusion of 37 articles reporting on antibiotic use in dementia.
Main Results:
- Point prevalence of antibiotic use ranged from 3.3% to 16.6%.
- Period prevalence varied widely (4.4%–88% overall, up to 94% near death).
- High treatment rates (77-91%) for lower respiratory and urinary tract infections; prescribing influenced by patient, family, physician, and healthcare context.
Conclusions:
- Antibiotic use in dementia patients is substantial.
- Healthcare context appears to be a major driver of prescribing patterns.
- Future research should explore use by infection type and dementia stage.
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