A new front is emerging in the war on the overuse of antibiotics: the nursing home.

Health officials and health-care executives, concerned by a rise in dangerous drug-resistant infections, are turning more attention to nursing homes, where antibiotics are some of the most frequently prescribed medications. They have concentrated over the past several years on curbing misuse of antibiotics in hospitals.

Up to 70 percent of nursing home residents receive one or more courses of antibiotics every year for urinary tract infections, pneumonia, cellulitis and other suspected conditions, according to researchers. Yet up to 75 percent of those prescriptions are given incorrectly—either unnecessarily or the prescription is for the wrong drug, dose or duration, the Centers for Disease Control and Prevention says.

One of the biggest culprits, researchers say: misdiagnosed urinary tract infections. Only a quarter to a third of people in nursing homes who are diagnosed have actual symptoms, according to several studies. Most have only vague symptoms like confusion or bacteria in their urine that aren’t actually causing an infection, says David Nace, director of long-term care and flu programs at the University of Pittsburgh. UTIs are “the poster child of inappropriate antibiotic use,” he says.

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