Abstract
Background: Little is known about the impacts at an individual level of long-term antibiotic consumption. We explored health outcomes of long-term antibiotic therapy prescribed to a cohort of patients to suppress infections deemed incurable. Methods: We conducted a 5-year longitudinal study of patients on long-term antibiotics at Monash Health, a metropolitan tertiary-level hospital network in Australia. Adults prescribed antibiotics for >12 months to suppress chronic infection or prevent recurrent infection were included. A retrospective review of medical records and a descriptive analysis was conducted. Results: Twenty-seven patients were followed up during the study period, from 29 patients originally identified in Monash Health in 2014. Seven of the 27 patients (26%) died from causes unrelated to the suppressed infection, six (22%) ceased long-term antibiotic therapy and two (7%) required treatment modification. Fifteen (56%) were colonised with multiresistant microorganisms, including vancomycin resistant Enterococci, methicillin resistant Staphylococcus aureus, and carbapenem resistant Enterobacteriaciae. Conclusions: This work highlights the potential pitfalls of long-term antibiotic therapy, and the frailty of this cohort, who are often ineligible for definitive curative therapy.
Highlights
Antibiotics were originally developed and used as short-term therapy for bacterial infections [1]
We previously reviewed antibiotic prescribing practices at Monash Health, a large tertiary-level, university-affiliated health service in Melbourne, Australia, and found that long-term antibiotic therapy made up only a small proportion (202/66,127, 0.3%) of total prescriptions, with great heterogeneity in indication for use [5]
We looked more closely at this cohort of 29 patients and found one in five patients screened to be colonised with multiresistant microorganisms (MROs) including vancomycin resistant Enterococci (VRE) and methicillin resistant Staphylococcus aureus (MRSA) [3]
Summary
Antibiotics were originally developed and used as short-term therapy for bacterial infections [1]. Subsequent evidence supports specific long-term effective use of certain antibiotics for prophylaxis against infection following transplantation, splenectomy and for recurrent urinary tract infections (UTI) [2], though less evidence supports their use in other settings, such as for infected prosthetic material not amenable to removal and for nonantibacterial effects such as immunomodulation [2]. In this context, the evidence is limited, as is the measurement of the adverse consequences of long-term therapy [3]. Conclusions: This work highlights the potential pitfalls of long-term antibiotic therapy, and the frailty of this cohort, who are often ineligible for definitive curative therapy
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