Antimicrobial Resistance and Responsible Antibiotic Use in Care Homes

Antibiotics are prescribed more heavily in care homes than almost anywhere else in the community, and much of that prescribing is for infections, particularly urinary tract infections, that would often resolve without antibiotics or could be managed with a narrower, more targeted course. Antimicrobial resistance is not an abstract future threat for care settings — drug-resistant infections already cause an estimated 8,000 deaths in the UK every year, and care home residents, with their higher rates of infection, more frequent antibiotic courses, and often more vulnerable immune systems, are among those most exposed to the consequences.

How Much Antibiotic Use Happens in Care Homes

A survey by Boots UK covering nearly 18,000 residents across more than 600 care facilities found that over two-thirds of care homes visited — 66.8% — had at least one resident on antibiotics at the time of the survey. Urinary tract infections are a particularly significant driver of this prescribing, partly because older adults, and residents with dementia in particular, can present with vague or non-specific symptoms that make a UTI easy to suspect even where standard diagnostic criteria are not clearly met, leading to antibiotics being started as a precaution. This pattern of elevated prescribing increases residents' exposure to the risk of resistant infections developing, including serious complications such as E. coli bloodstream infections, which are more dangerous and harder to treat once resistance develops.

The UK's Current Approach to Tackling AMR

The UK's current national action plan on antimicrobial resistance, running from 2024 to 2029, sits within a broader 20-year vision to contain and control AMR by 2040. The plan is built around four strategic themes: preventing infections in the first place through better infection control and vaccination, so antibiotics are needed less often; optimising antimicrobial use so drugs are only used when medically necessary; driving innovation in new vaccines, diagnostics, and alternative treatments; and international leadership in supporting the global response. For care settings, the first two themes — prevention and optimisation — are where day-to-day staff practice has the most direct impact.

What Antimicrobial Stewardship Looks Like in Practice

Good stewardship at the care home level starts before any antibiotic is prescribed. Clear, complete observation and documentation when a resident is suspected of having an infection — accurate temperature, any change in behaviour or confusion, the specific nature of any urinary symptoms rather than a vague description — gives the prescriber, whether a GP or a pharmacist working under a shared care arrangement, the information needed to make an accurate decision rather than prescribing speculatively because the picture is unclear. Simple, non-antibiotic measures such as ensuring adequate hydration, which is itself a preventative measure against UTIs, should be part of the everyday care routine rather than only considered once an infection is already suspected.

Once a course of antibiotics is prescribed, supporting the resident to complete it exactly as directed, at the right times and for the full course length, is one of the most important things care staff can do — stopping early once symptoms improve, or missing doses, both contribute directly to resistance developing. Boots UK's chief pharmacist has specifically highlighted the value of practical, ongoing training for care staff on supporting residents with antibiotic timing and dose form, recognising that pharmacy teams and care staff working closely together closes a genuine knowledge gap that exists in many homes.

Connecting Stewardship to Wider Infection Prevention

Reducing how often antibiotics are needed at all is ultimately more powerful than optimising their use once prescribed, and this connects directly to the infection prevention and control practices covered in outbreak management and infection control, since good hand hygiene, prompt isolation of infectious residents, and thorough environmental cleaning all reduce the infections that lead to antibiotics being prescribed in the first place. Staying current with vaccination programmes, including the guidance covered in RSV vaccination for older adults, also reduces the respiratory infections that frequently lead to antibiotic prescribing, particularly where a secondary bacterial infection follows an initial viral illness.

Why Older Adults and Care Home Residents Are at Greater Risk

Age-related changes to the immune system mean older adults are both more prone to developing infections and less able to clear them without treatment, which partly explains the higher rate of antibiotic prescribing in care settings compared with the wider population. This same vulnerability means that when a resistant infection does take hold, older care home residents are less able to fight it off without effective antibiotics, making the stakes of preserving antibiotic effectiveness for this group particularly high. Residents who have had multiple courses of antibiotics over time, whether for recurrent UTIs or other infections, are also more likely to carry resistant bacteria, which can complicate treatment choices if they develop a serious infection later.

This is part of why a cautious, well-documented approach to suspected infection — rather than a reflexive one — genuinely protects residents' future treatment options, not just the wider public health goal of slowing resistance. A resident who avoids an unnecessary antibiotic course today keeps more treatment options available if they develop a genuinely serious infection in future.

Frequently Asked Questions

How common is antibiotic use in UK care homes?
A Boots UK survey of nearly 18,000 residents across over 600 care facilities found that 66.8% of homes visited had at least one resident on antibiotics at the time of the survey.

What is the UK doing to tackle antimicrobial resistance?
A national action plan running from 2024 to 2029, part of a 20-year vision to contain AMR by 2040, focused on preventing infections, optimising antimicrobial use, driving innovation, and international leadership.

What can care staff do to support antimicrobial stewardship day to day?
Provide clear, accurate observations when an infection is suspected, support good hydration as a preventative measure, and help residents complete prescribed antibiotic courses exactly as directed rather than stopping early.