Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

Magdalena Raban*, Claudia Gasparini, Ling Li, Melissa Baysari, Johanna Westbrook

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

32 Citations (Scopus)
34 Downloads (Pure)


Objectives: There are high levels of inappropriate antibiotic use in long-term care facilities (LTCFs). Our objective was to examine evidence of the effectiveness of interventions designed to reduce antibiotic use and/or inappropriate use in LTCFs.

Design: Systematic review and meta-analysis.

Data sources: MEDLINE, Embase and CINAHL from 1997 until November 2018.

Eligibility criteria: Controlled and uncontrolled studies in LTCFs measuring intervention effects on rates of overall antibiotic use and/or appropriateness of use were included. Secondary outcomes were intervention implementation barriers from process evaluations.

Data extraction and synthesis: Two reviewers independently applied the Cochrane Effective Practice and Organisation of Care group’s resources to classify interventions and assess risk of bias. Meta-analyses used random effects models to pool results.

Results: Of include studies (n=19), 10 had a control group and 17 had a high risk of bias. All interventions had multiple components. Eight studies (with high risk of bias) showed positive impacts on outcomes and included one of the following interventions: audit and feedback, introduction of care pathways or an infectious disease team. Meta-analyses on change in the percentage of residents on antibiotics (pooled relative risk (RR) (three studies, 6862 residents): 0.85, 95% CI: 0.61 to 1.18), appropriateness of decision to treat with antibiotics (pooled RR (three studies, 993 antibiotic orders): 1.10, 95% CI: 0.64 to 1.91) and appropriateness of antibiotic selection for respiratory tract infections (pooled RR (three studies, 292 orders): 1.15, 95% CI: 0.95 to 1.40), showed no significant intervention effects. However, meta-analyses only included results from intervention groups since most studies lacked a control group. Insufficient data prevented meta-analysis on other outcomes. Process evaluations (n=7) noted poor intervention adoption, low physician engagement and high staff turnover as barriers.

Conclusions: There is insufficient evidence that interventions employed to date are effective at improving antibiotic use in LTCFs. Future studies should use rigorous study designs and tailor intervention implementation to the setting.
Original languageEnglish
Article numbere028494
Pages (from-to)1-13
Number of pages13
JournalBMJ Open
Issue number1
Publication statusPublished - 9 Jan 2020

Bibliographical note

Copyright the Author(s) 2020. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


  • anti-bacterial agents
  • antimicrobial stewardship
  • meta-analysis
  • nursing homes
  • quality in health care
  • residential facilities


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