The best way to administer antibiotics to patients receiving intensive care is by using a mouth paste. This prevents infections, saves lives and is less costly than the alternatives. This is the conclusion of a JAMA publication by the University Medical Center (UMC) Utrecht, the findings of which have been used to prepare the new Dutch directive on the use of antibiotics in intensive care units.

Until now there was no consensus among doctors on the best way to administer antibiotics to patients in the intensive care unit (ICU). What has been clear for some time, however, is that preventive antibiotics prolong the life of ICU patients, while it does not lead to bacterial resistance. This has been demonstrated by Prof. Dr. Marc Bonten and his colleagues at the UMC Utrecht in previous large-scale studies in patients.

Study in ICU patients

To determine the best way of administering antibiotics, the Utrecht researchers compared the two most commonly used methods: using only a mouth paste or a mouth paste combined with a gastric tube (disinfecting the entire gastrointestinal tract). They analyzed the health of nearly 12,000 ICU patients who had been given preventive antibiotics in 16 Dutch hospitals between 2009 and 2013. These hospitals alternated the two methods for administering antibiotics from one year to the next, creating two groups of patients.

The health of the patients in the two groups did not appear to differ. A small percentage of all patients, however, still contracted a bacterial infection despite the antibiotics. Antibiotic-resistant bacteria were found on an equally small scale in both groups.

Mouth paste containing antibiotics the most cost-effective

The researchers therefore conclude that administering preventive antibiotics solely via the mouth is just as effective as via the mouth and a gastric tube. This means that the least expensive treatment is to be preferred: using only the mouth paste. The prices of antibiotics vary, but using only the mouth paste is ten times cheaper than the combination of mouth paste and gastric tube.

Prof. Dr. Marc Bonten says, “Together with colleagues elsewhere in the Netherlands, we have studied these treatments in almost 20,000 ICU patients over the last few years. Administering preventive antibiotics means that people live longer and contract infections less frequently. Moreover, it reduces the use of antibiotics, is cheaper than the standard treatment and does not lead to increased antibiotic resistance. We have now also demonstrated that mouth paste is the most cost-effective. This is now clear as day.”

The researchers at the UMC Utrecht describe their results in the October 1 issue of the scientific journal JAMA. A Dutch antibiotics working group has included the results in the new directive on the use of antibiotics in the ICU.

Reference
Oostdijk EAN, Kesecioglu J, Schultz MJ, et al. The effects of decontamination of the oropharynx and intestinal tract on antibiotic resistance in ICUs. JAMA, published online October 1, 2014