Antimicrobial Use in Patients with Dementia: Current Concerns and Future Recommendations

Area of Science:

• Geriatrics
• Infectious Diseases
• Pharmacology

Background:

• Infections are prevalent in individuals with dementia.
• Antibiotic use is widespread but highly variable globally in dementia care.
• Existing research on antibiotic appropriateness primarily targets advanced dementia.

Purpose of the Study:

• To highlight the need for careful consideration of antibiotic prescribing appropriateness in dementia care.
• To identify key factors influencing appropriate antimicrobial prescribing for dementia patients.
• To guide future research on antibiotic use across the dementia spectrum.

Main Methods:

• Literature review and expert opinion synthesis on antibiotic prescribing in dementia.
• Analysis of factors influencing clinical decision-making for infection treatment in dementia.
• Identification of research gaps in understanding antibiotic appropriateness.

Main Results:

• Current antibiotic prescribing for dementia patients, especially those with advanced dementia, may be potentially inappropriate.
• Appropriateness hinges on balancing infection risks/benefits, patient comfort, goals of care, and prognosis.
• Significant variability exists in antibiotic prescribing practices across settings and countries.

Conclusions:

• Clinicians must individualize antibiotic prescribing decisions for people with dementia.
• Integrating treatment preferences and goals of care is crucial for appropriate antibiotic use.
• Further research is needed to address antibiotic appropriateness across diverse dementia severities, infections, and care settings.