Abstract
Antimicrobials are among the most prescribed medications in Canada, with over 90% of antibiotics prescribed in outpatient settings. Seniors prescribed antimicrobials are particularly vulnerable to adverse drug events and antimicrobial resistance. The extent of inappropriate antibiotic prescribing in outpatient Canadian medical practice, and the potential long-term trends in this practice, are unknown. This study is the first in Canada to examine prescribing quality across two large-scale provincial healthcare systems to compare both quantity and quality of outpatient antibiotic use in seniors. Population-based analyses using administrative health databases were conducted in British Columbia (BC) and Ontario (ON), and all outpatient, oral antimicrobials dispensed to seniors (≥65 years) from 1 January 2000 to 31 December 2018 were identified. Antimicrobials were linked to an indication using a 3-tiered hierarchy. Tier 1 indications, which always require antibiotics, were given priority, followed by Tier 2 indications that sometimes require antibiotics, then Tier 3, which never require antibiotics. Prescription rates were calculated per 1000 population, and trends were examined overall, by drug class, and by patient demographics. Prescribing remained steady in both provinces, with 11,166,401 prescriptions dispensed overall in BC, and 27,656,014 overall in ON. BC prescribed at slightly elevated rates (range: 790 to 930 per 1000 residents), in comparison to ON (range: 745 to 785 per 1000 residents), throughout the study period. For both provinces, a Tier 3 diagnosis was the most common reason for antibiotic use, accounting for 50% of all indication-associated antibiotic prescribing. Although Tier 3 indications remained the most prescribed-for diagnoses throughout the study period, a declining trend over time is encouraging, with much room for improvement remaining. Elevated prescribing to seniors continues across Canadian outpatient settings, and prescribing quality is of high concern, with 50% of all antimicrobials prescribed inappropriately for common infections that do not require antimicrobials.
Highlights
The World Health Organization formally acknowledged the crisis of antimicrobial resistance (AMR) in 2014, and released a global action plan the year [1]
Evaluating appropriate antibiotic use is especially relevant for older Canadians (≥65 years), who are prescribed antimicrobials at elevated rates compared to other cohorts, for respiratory tract infections (RTI) and urinary tract infections (UTI), with incidence of hospitalizations and
An average of 736,750 unique patients in Ontario (ON), and 587,705 in British Columbia (BC), were prescribed an antibiotic in any study year, with roughly 39 million total antibiotic prescriptions dispensed over the 19-year period (Table 1)
Summary
The World Health Organization formally acknowledged the crisis of antimicrobial resistance (AMR) in 2014, and released a global action plan the year [1]. The United States, the United Kingdom (UK) and Australia have established jurisdiction-specific plans for the reduction of antibiotic use, but have gone one step further and pledged to decrease inappropriate antibiotic use [2,3,4,5]. Evaluating appropriate antibiotic use is especially relevant for older Canadians (≥65 years), who are prescribed antimicrobials at elevated rates compared to other cohorts, for respiratory tract infections (RTI) and urinary tract infections (UTI), with incidence of hospitalizations and “superbug” infections greater than in younger populations [9,10,11,12,13,14]. Despite moderate declines in incidence across Canada since 2009, C. difficile remains one of the most burdensome pathogens, in the elderly, causing more deaths than influenza each year [16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
