MedicalResearch.com Interview with:
Loren G. Miller, M.D., M.P.H.
Professor of Medicine,
David Geffen School of Medicine at UCLA
Division of Infectious Diseases
Los Angeles BioMedical Research Institute at Harbor-UCLA
Torrance CA 90502
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Miller: We know that medication adherence (compliance) by patients to all sort of treatments for a variety of diseases is suboptimal. Adherence to medication varies a lot by disease state (e.g. it is typically high in cancer and low in hypertension), but adherence to antibiotics for skin infection is unstudied. We wanted to find out what adherence is to antibiotics for patients with skin infections is and whether it was associated with important clinical outcomes.
We measured patients adherence to antibiotic dosing by using medication containers fitted with electronic caps that reported when the patient opened the antibiotic container.
We followed 87 patients who had been hospitalized and suffered S. aureus associated skin and soft tissue infections
We found that patients with S. aureus skin and soft tissue infections, on average, took just 57% of their prescribed antibiotic doses after leaving the hospital. Lower antibiotic adherence was associated with a higher chance of skin infection relapse or recurrence.
Interestingly, we also found a large discrepancy in patient reports and the electronic measurement. Patients reported taking, on average, 96% of their medication, or nearly twice the 57% reported by the electronic caps. This suggests that asking patients how well they took their medication is highly problematic as non-adherent patients will typically vastly overstate their medication adherence.
We also found higher rates of non-adherence to antibiotic regimens among patients who were prescribed more than one antibiotic after leaving the hospital, didn’t see the same healthcare provider for follow-up visits or felt they didn’t have a regular healthcare provider
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Miller: Clinicians should anticipate that some patients may not take their antibiotics as prescribed and counsel them about the importance of adherence and to seek care if they can’t take their medications as prescribed (such as they are having side effects, lose their medications, etc.).
Also, there are newer antibiotics approved for the treatment of skin infections that require only once-weekly dosing, specifically dalbavancin and oritavaincin, that perhaps could be considered for patients who are felt to be at high risk for medication non-adherence. These medications tend to be very costly, however.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Miller: Further studies are needed to determine methods to improve antibiotic adherence and clinical outcomes after a hospitalization for skin infection. These would include counseling by a clinician, such as a pharmacist. Also, there are many apps for smartphones that remind people to take their pills. However these innovations have not been utilized in the management of acute infections and improving clinical outcomes and require study to determine if they would be effective.
Newer longer acting antibiotics approved for treatment of skin infection may alleviate challenges associated with adherence.. However, their ability to improve outcomes over oral therapy is in either patients at risk for non-adherence or among a more general population remain unproven.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Miller: Medication non-adherence is incredibly common and infrequently appreciated by clinicians. We must always remain on our guard for non-adherence and its contribution to past or future untoward clinical events.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Samantha J. Eells, Megan Nguyen, Jina Jung, Raul Macias-Gil, Larissa May, Loren G. Miller. The Relationship Between Adherence to Oral Antibiotics and Post-Discharge Clinical Outcomes Among Patients Hospitalized with Staphylococcus aureus Skin Infections. Antimicrobial Agents and Chemotherapy, 2016; AAC.02626-15 DOI:10.1128/AAC.02626-15
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Dr. Loren Miller (2016). Patients Take Only Little More Than Half Prescribed Antibiotic After leaving Hospital For Skin Infections MedicalResearch.com