Updated definition of fever could improve antibiotic prescribing practices in nursing homes, researchers say

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Standard definitions of fever do not fit the nursing home population well and could be creating a picture of antibiotic prescribing practices in these settings that is too negative, according to recently published research.

Researchers funded by the Agency for Healthcare Research and Quality recommend that each resident should have a documented “mean normal temperature” when he or she is not ill. A temperature more than 1ºF above that mean would qualify as a fever.

Their reasoning is based on data from more than 1,000 residents of 12 nursing homes in North Carolina. These residents all received an antibiotic to treat a presumed infection during the three-month study period. The researchers noted the highest temperature recorded for the resident on the day he or she began receiving the antibiotic, as well as three temperatures from when the resident was not ill.

“In agreement with past studies, the current study found that the normal non-illness temperature in the study population was lower than the often-quoted 98.6ºF, suggesting that the definition of fever should be lower as well,” the researchers wrote.

A change in the definition also would better align with the number of residents currently receiving antibiotics, which may appear too high when judged by the current definition, raising potentially unwarranted concerns about overprescribing, the researchers stated. Clinicians often must rely on fever as an indicator of bacterial infection, because residents with dementia cannot report whether they are experiencing other telltale symptoms.

Findings appear in the Journal of the American Geriatrics Society.

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