Antimicrobial use in Residential Care Facilities and Nursing Homes

People living in residential care facilities are at greater risk of physical frailty due to their age, functional impairment, and co-morbidities. Polypharmacy, dysphagia, renal impairment and infection/colonisation with antibiotic resistant organisms can be common among this cohort. These factors are important considerations in selecting the optimal antibiotic agent and dosing regimen as they may influence efficacy, side-effects, drug interactions or other potential harm of prescribed antibiotics.

The resources below have been developed to support optimal antimicrobial use in residential care facilities.

Antibiotic treatment guidelines

Antibiotic guidance for the most common infections treated in residential care facilities are listed below. Further guidance on antimicrobial use for other indications is available under ‘Conditions & Treatments’ on the website homepage.

Urinary Tract Infections
Respiratory Tract Infections
Skin and Soft Tissue Infections

Skip the Dip for UTI in over 65s campaign


SKIP THE DIP for UTI in over 65s is a quality improvement initiative in HSE older persons residential care facilities (RCFs) led by HSE Community Antimicrobial Pharmacists and the HSE Quality and Patient Safety Office, in collaboration with the national AMRIC team. Commencing in September 2023, this new initiative aims to reduce the levels of inappropriate prescribing for urinary tract infections (UTIs) in people aged 65 years and older.

UTIs are the most common reason for antibiotic prescribing in older persons RCFs. The diagnosis and management of UTI can be challenging in older persons. Asymptomatic bacteriuria (ASB) is the presence of bacteria in the urine without symptoms of a UTI. It can be present at any age but is particularly common in those aged over 65 years and is very common in those persons with an indwelling urinary catheter. Urine dipstick tests are not a useful marker to assess for evidence of UTI in older people as they do not distinguish between ASB and UTI. ASB can lead to positive results for markers of UTI in urine dipstick tests, even in those without a UTI.

Inappropriate use of urine dipstick tests can lead to unnecessary antibiotic prescribing.  This does not benefit the resident and may cause considerable harm including adverse effects, drug interactions and antimicrobial resistance.  The diagnosis of a UTI should be based on clinical signs and symptoms of UTI in those aged 65 and older, not a urine dipstick test result. Antibiotics should be prescribed in line with national guidance available at 

The following resources are available to support the SKIP THE DIP for UTI in over 65s quality improvement initiative:

Antimicrobial survey findings in residential care facilities in Ireland

Successive HALT studies in long-term care facilities (in 2010, 2012, 2013 & 2016) have shown that Irish Nursing home residents are prescribed far more antibiotics than their European counterparts. Antibiotics are most commonly prescribed for urinary tract infection (UTI), respiratory tract infection (RTI) and skin and soft tissue infection (SSTI).

These findings were echoed and expanded upon in an antibiotic point prevalence survey conducted by CHO-based antimicrobial pharmacists in HSE Older Persons residential care facilities between October and December 2020 (for CHO 1,3,4,5,8) which was expanded to CHO 2,6,7,9 between April-August 2021. This study found that:

A further study was conducted in a sample of HSE Mental Health residential care facilities by CHO-based antimicrobial pharmacists between November 2021 and January 2022 (CHO 1, 4, 5, 6, 7, 8, 9). This study found that:

Reviewed October 2023

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