Antibiotic use for respiratory tract infections among the older adults living in long term care facilities: a systematic review and meta-analysis

Background: Antibiotics are commonly prescribed for respiratory tract infections (RTIs) among older adults in long term care facilities (LTCFs), which contribute to the emergence of antimicrobial resistance. The objective of this study was to determine the antibiotic prescribing rate for RTIs among LTCF residents and analyze the antibiotic consumption patterns with World Health Organization's (WHO) developed monitoring tool called AwaRe. Methods: Articles were searched from MEDLINE, EMBASE and CINAHL from inception to March 2022. Eligible studies were extracted from original articles reporting antibiotic use for RTIs in LTCFs. Study quality was assessed using Joanna Briggs Institute’s Critical Appraisal Checklist for Prevalence Data. Random-effects meta-analysis was employed to calculate the pooled estimates. Subgroup analysis was conducted by types of RTI, country and study start year. Results: A total of 47 articles consisting of 50 studies were included. The antibiotic prescribing rate ranged from 21.5% to 100% (pooled estimates: 69.8%; 95% CI: 55.2%, 82.6%). The rate for lower respiratory tract infections (LRTIs) was higher than viral or general RTIs. Compared with Italy, France and the United States, the Netherlands had lower antibiotic use for LRTTs. A proportion of viral RTIs were treated with antibiotics and all the antibiotics were from the Watch group. The Access antibiotic use in the Netherlands, Norway, Switzerland and Slovenia was higher than the United States and Australia. Conclusion: The antibiotic prescribing rate for RTIs in LTCF was high, and the AWaRe antibiotic use patterns varied among types and countries. Improving the antibiotic use may require coordination efforts