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Antibiotics and antimicrobial stewardship in aged care

GPs & clinicians Aged care staff Facility leadership 6 min read

By Dr Josh Hatch, FRACGP

Antimicrobial stewardship means using antibiotics, antifungals and antivirals when they are likely to help, and reviewing them so they stop when they are no longer needed. Under the strengthened Quality Standards, every provider must run an antimicrobial stewardship system 1. Choices of medicine and doses are matters for current prescribing guidelines and local advice, and are not covered here.

Numbers in the text link to the 7 sources listed at the foot of this page.

What the 2023 national survey found

The Aged Care National Antimicrobial Prescribing Survey (AC NAPS) is a point-prevalence survey. In 2023, 852 homes and 53,843 residents took part 5.

11.9%

of residents were prescribed at least one antimicrobial on the survey day, or 7.0% excluding topical products 5.

22.7%

of prescriptions were for prevention rather than treatment, most often of cystitis 5.

43.4%

of prescriptions had no documented review or stop date 5.

34.7%

of current antimicrobials had been started more than six months earlier 5.

Reading the survey

Only 3.6% of residents had signs or symptoms of a suspected infection on the survey day, and only 36.1% of those suspected infections met the McGeer surveillance definitions used in the survey 5. The indication was not documented for 17.0% of prescriptions 5. The report describes documentation of review or stop dates as well below its best-practice target of 95% 5.

A point-prevalence survey shows what was prescribed on one day in the homes that took part. It does not show whether each prescription was right for the person, and it is best used as a prompt to look at local data.

Points from the national aged care guidance

The Commission’s November 2024 guidance on applying the Antimicrobial Stewardship Clinical Care Standard in aged care includes these points 4.

  • Test when there are symptoms. Microbiology testing should generally be avoided unless there are symptoms and signs of infection 4.

  • Write the plan down. Antimicrobial treatment plans should be documented, with a stop date or review date supported by guidelines 4.

  • Look at results promptly. When microbiology results are available, they should ideally be reviewed by the doctor within 24 hours 4.

  • Avoid “as required” antibiotics. Antimicrobials charted PRN are not recommended 4.

  • Prevention is rarely the reason. There are limited reasons to prescribe antimicrobials to prevent infection, and preventive prescriptions should be reviewed for risk, benefit and reason. Antibiotics should not be given before inserting or removing an indwelling urinary catheter to prevent infection 4.

Stewardship programs: the evidence

Graded on randomised evidence for prescribing and resident outcomes in care homes.

Stewardship interventions in care homes (all types)

Uncertain / conflicting

Little effect on guideline adherence or how many residents were on antimicrobials; total use may fall.

The evidence

A 2019 systematic review found five randomised trials. The interventions had little impact on adherence to guidelines or prescribing prevalence, appeared to reduce total antimicrobial consumption, and were unlikely to have changed hospital admissions or deaths. The evidence was of low quality 19.

In practice

No harm to residents was apparent 19.

An algorithm for suspected urinary infection, with education

Promising, not yet proven

Fewer antibiotic courses for suspected urinary infection, with no rise in admissions or deaths.

The evidence

One cluster randomised trial in 24 nursing homes in Canada and the US 17.

Programs aimed at urinary infection

A 2022 meta-analysis of 16 studies in 216 nursing homes, most of them testing education for nurses and doctors, reported about 31% less antimicrobial prescribing and 36% fewer urine cultures (rate ratios 0.69 and 0.64) 20. The authors noted that the studies reported varied information and that effects on resistance take years to appear 20.

Related pages on this site

Sources cited on this page

  1. 1 Australian Government Department of Health, Disability and Ageing. Strengthened Aged Care Quality Standards (November 2025; implemented 1 November 2025). Outcome 3.2, Actions 3.2.4 and 3.2.5; Outcome 3.3, Action 3.3.3; Outcome 5.2, Actions 5.2.1 and 5.2.2; Outcome 5.4, Actions 5.4.2 and 5.4.5. View source
  2. 4 Australian Commission on Safety and Quality in Health Care. Guidance for implementation of the Antimicrobial Stewardship Clinical Care Standard in aged care. Sydney: ACSQHC; November 2024. View source
  3. 5 Australian Government Department of Health, Disability and Ageing. Infections and antimicrobial prescribing in Australian residential aged care homes: results of the 2023 Aged Care National Antimicrobial Prescribing Survey. Canberra; 2025. (Prepared by the Royal Melbourne Hospital and the National Centre for Antimicrobial Stewardship; 852 homes, 53,843 residents; point-prevalence survey.) View source
  4. 16 Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68:e83–110. (Checked at abstract level.) View source
  5. 17 Loeb M, Brazil K, Lohfeld L, et al. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial. BMJ. 2005;331:669. (24 nursing homes in Ontario and Idaho; 4,217 residents.) View source
  6. 19 Nguyen HQ, Tunney MM, Hughes CM. Interventions to improve antimicrobial stewardship for older people in care homes: a systematic review. Drugs Aging. 2019;36:355–69. (Five randomised trials; overall quality low.) View source
  7. 20 Tandan M, Thapa P, Maharjan P, Bhandari B. Impact of antimicrobial stewardship program on antimicrobial-resistance and prescribing in nursing homes: a systematic review and meta-analysis. J Glob Antimicrob Resist. 2022;29:74–87. (16 studies, 216 nursing homes; programs targeting urinary infection.) View source

See every source cited across the deteriorating resident section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at November 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment, and it does not set escalation rules for any facility. Antibiotic choices and doses follow current prescribing guidelines and local advice. Evidence, Australian regulatory requirements and local services change — always confirm current advice with the treating GP and the facility’s own procedures.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

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