<P> High pill burden decreases compliance with drug therapy, resulting from the need to take a large quantity of pills or other forms of medication on a regular basis . It also increases the possibility of adverse medication reactions (side effects) and drug - drug interactions . High pill burden has also been associated with an increased risk of hospitalization, medication errors, and increased costs for both the pharmaceuticals themselves and for the treatment of adverse events . Finally, pill burden is a source of dissatisfaction for many patients . </P> <P> High pill burden was once commonly associated with antiretroviral drug regimens to control HIV, but now is more often seen in other patient populations . For instance, adults with multiple common chronic conditions such as diabetes, hypertension, lymphedema, hypercholesterolemia, osteoporosis, constipation, and clinical depression can often be prescribed more than a dozen different medications daily . The adverse reactions of these combinations of drugs are not reliably predictable . Obesity is implicated in many of the aforementioned conditions, and it is not uncommon for a clinically obese patient to receive pharmacologic treatment for all of these . Because chronic conditions tend to accumulate in the elderly, pill burden is a particular issue in geriatrics . </P> <P> Reducing pill burden is recognized as a way to improve medication compliance . This is done through "deprescribing", where the risks and benefits are weighed when considering whether to continue a medication . This includes drugs such as bisphosphonates (for osteoporosis) where it is often used indefinitely although there is only evidence to use it for five to ten years . </P> <P> The selection of long - acting active ingredients over short - acting ones may also reduce pill burden . For instance, ACE inhibitors are used in the management of hypertension . Both captopril and lisinopril are examples of ACE inhibitors . However, lisinopril is dosed once a day, whereas captopril may be dosed 2 - 3 times a day . Assuming that there are no contraindications or potential for drug interactions, using lisinopril instead of captopril may be an appropriate way to limit pill burden . </P>

Which of the following best explains a long term disadvantage of antibiotic use in patient care