Research paper| Volume 24, ISSUE 4, P179-186, November 2019

Download started.


Surveillance of life-long antibiotics—A cross-sectional cohort study assessing patient attitudes and understanding of long-term antibiotic consumption


      • Little is known of the possible pitfalls of long-term antibiotic use.
      • Patients on long-term antibiotics had a good understanding of their indication for prolonged therapy.
      • Despite >40% experiencing side effects attributed to prolonged antibiotic therapy, adherence was high.
      • Patients on long term antibiotics may be carriers of multi-resistant organisms.



      Some patients receive long-term or life-long antibiotics for suppression of infections deemed otherwise incurable. Little is known about the consequences of this strategy. We aimed to explore patients' attitudes towards and knowledge concerning prolonged antibiotic therapy.


      A cross-sectional cohort pilot study of outpatients on long-term antibiotics was performed. Surveys were conducted at our healthcare network in Victoria, Australia between April and December 2015. Microbiological screening for multi-resistant organisms (MRO) was also performed.


      Heterogeneity was noted in the prescribed antibiotics and documented indications, with rifampicin and fusidic acid for suppression of prosthetic joint infection the most common regimen and indication. 41% (12/29) of participants reported side-effects attributed to their antibiotics, but 72% (21/29) still declared complete adherence to their prescribed regimen. 76% (22/29) of participants stated that they would cease their long-term antibiotics based on medical advice. 19/29 (66%) participants consented to microbiological screening and 4 were found to be colonised with MROs. They had spent more days as an inpatient in the preceding 12 months than the screened participants who were not colonised.


      Participants in this study had a good understanding of their infection and the indications for their long-term antibiotic therapy, and were adherent to this therapy despite many experiencing side-effects attributed to their antibiotics. Patients who are prescribed life-long antibiotics can be carriers of multi-resistant organisms, but both the drivers of this resistance, and the broader impact of colonisation with MRO in this population is unclear.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Infection, Disease & Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Waksman S.A.
        • Woodruff H.B.
        Actinomyces antibioticus, a new soil organism antagonistic to pathogenic and non-pathogenic bacteria.
        J Bacteriol. 1941; 42: 231-249
        • Chain E.
        • Florey H.W.
        • Gardner A.D.
        • Heatley N.G.
        • Jennings M.A.
        • Orr-Ewing J.
        • et al.
        1940. Penicillin as a chemotherapeutic agent.
        Lancet. 1940; 24: 226-231
        • Ladd W.E.
        • Bill Jr., A.H.
        Actinomycosis of the chest with spread to the abdomen.
        N Engl J Med. 1943; 229: 748-750
        • Enzler M.J.
        • Berbari E.
        • Osmon D.R.
        Antimicrobial prophylaxis in adults.
        Mayo Clin Proc. 2010; 86: 686-701
        • Goto N.
        • Oka S.
        Pneumocystis jirovecii pneumonia in kidney transplantation.
        Transpl Infect Dis. 2011; 13: 551-558
        • Trampuz A.
        • Zimmerli W.
        Prosthetic joint infections: update in diagnosis and treatment.
        Swiss Med Wkly. 2005; 135: 243-251
        • Spelman D.
        • Buttery J.
        • Daley A.
        • Isaacs D.
        • Jennens I.
        • Kakakios A.
        • et al.
        Guidelines for the prevention of sepsis in asplenic and hyposplenic patients.
        Intern Med J. 2008; 38: 349-356
        • Dason S.
        • Dason J.T.
        • Kapoor A.
        Guidelines for the diagnosis and management of recurrent urinary tract infection in women.
        Can Urol Assoc J. 2011; 5: 316-322
        • Lau J.S.Y.
        • Korman T.M.
        • Woolley I.
        Life-long antimicrobial therapy: where is the evidence?.
        J Antimicrob Chemother. 2018; 73: 2601-2612
        • Mogayzel P.J.
        • Naureckas E.T.
        • Robinson K.A.
        • Mueller G.
        • Hadjiliadis D.
        • Hoag J.B.
        • et al.
        Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health.
        Am J Respir Crit Care Med. 2013; 187: 680-689
        • Webster G.
        • Del Rosso J.Q.
        Anti-inflammatory activity of tetracyclines.
        Dermatol Clinics. 2007; 25: 133-135
        • Lau J.S.Y.
        • Kiss C.
        • Roberts E.
        • Horne K.
        • Korman T.M.
        • Woolley I.
        Surveillance of life-long antibiotics: a review of antibiotic prescribing practices in an Australian Healthcare Network.
        Ann Clin Microbiol Antimicrob. 2017; 16: 3
        • European Centre for Disease Prevention and Control
        The bacterial challenge.
        The Publications Office of the European Union, Stockholm2009
        • Ferri M.
        • Ranucci E.
        • Romagnoli P.
        • Giaccone V.
        Antimicrobial resistance: a global emerging threat to public health systems.
        Crit Rev Food Sci Nutr. 2015; 57: 2857-2876
        • Ramchurren K.
        • Balakrishna Y.
        • Mahomed S.
        Patients' knowledge, attitudes and practices regarding antibiotic use at a regional hospital in KwaZulu-Natal, South Africa 2017.
        S Afr J Infect Dis. 2018; : 1-6
        • Sutthiruk N.
        • Considine J.
        • Hutchinson A.
        • Driscoll A.
        • Malathum K.
        • Botti M.
        A survey of reported behaviours, attitudes and knowledge related to antibiotic use of hospitalised patients in Thailand.
        Infect Dis Health. 2018; 23: 203-210
        • Davis M.E.
        • Liu T.L.
        • Taylor Y.J.
        • Davidson L.
        • Schmid M.
        • Yates T.
        • et al.
        Exploring patient awareness and perceptions of the appropriate use of antibiotics: a mixed-methods study.
        Antibiotics (Basel). 2017; 6
        • McNulty C.A.M.
        • Boyle P.
        • Nichols T.
        • Clappison P.
        • Davey P.
        The public's attitudes to and compliance with antibiotics.
        J Antimicrob Chemother. 2007; 60: i63-i68
        • Grabsch E.A.
        • Ghaly-Derias S.
        • Gao W.
        • Howden B.P.
        Comparative study of selective chromogenic (chromID VRE) and bile esculin agars for isolation and identification of vanB-containing vancomycin-resistant enterococci from feces and rectal swabs.
        J Clin Microbiol. 2008; 46: 4034-4036
        • Lee L.-Y.
        • Korman T.M.
        • Graham M.
        Rapid time to results and high sensitivity of the CarbaNP test on early cultures.
        J Clin Microbiol. 2014; 52: 4023-4026
        • Peel T.N.
        • Cheng A.C.
        • Buising K.L.
        • Choong P.F.M.
        Microbiological aetiology, epidemiology, and clinical profile of prosthetic joint infections: are current antibiotic prophylaxis guidelines effective?.
        Antimicrob Agents Chemother. 2012; 56: 2386-2391
      1. A randomized study evaluating oral fusidic acid (CEM-102) in combination with oral rifampin compared with standard-of-care antibiotics for treatment of prosthetic joint infections: a newly identified drug-drug interaction.
        . 2016 15; 63: 1599-1604
        • Aboltins C.
        • Daffy J.
        • Choong P.
        • Stanley P.
        Current concepts in the management of prosthetic joint infection.
        Intern Med J. 2014; 44: 834-840
        • Currie A.
        • Davis L.
        • Odrobina E.
        • Waldman S.
        • White D.
        • Tomassi J.
        • et al.
        Sensitivities of nasal and rectal swabs for detection of methicillin-resistant Staphylococcus aureus colonization in an active surveillance program.
        J Clin Microbiol. 2008; 46: 3101-3103
        • Karki A.
        • Houston L.
        • Land G.
        • Bass P.
        • Kehoe R.
        • Borrell S.
        • et al.
        Prevalence and risk factors for VRE colonisation in a tertiary hospital in Melbourne, Australia: a cross sectional study.
        Antimicrob Resist Infect Control. 2012; 1: 31