The Ontario Program To Improve AntiMIcrobial USE (OPTIMISE): A Descriptive Analysis of Dispensed Antibiotics

Abstract

BackgroundAntimicrobial resistant infections are an emerging global public health crisis. Antibiotic use is the largest modifiable risk factor for antimicrobial resistance. Greater than 90% of antibiotic use in Canada occurs outside of the hospital setting; however, there is a lack of data describing the patterns of community antibiotic use. Our objective was to describe outpatient antibiotic prescriptions for all of Ontario, Canada and to examine variability in antibiotic prescribing across physicians.MethodsWe conducted a cross-sectional study of antibiotics dispensed from community pharmacies in Ontario, Canada, between March 1, 2016 and February 28, 2017. Ontario has a population of 13.9 million people and over 30,000 physicians. We analyzed data from the Xponent™ database by QuintilesIMS. Xponent™ is based on data from 79% of retail pharmacies in Ontario. QuintilesIMS uses a geospatial extrapolation algorithm to project antibiotic utilization on 100% of the population. This analysis describes physician antibiotic prescribing patterns stratified by patient age and sex.ResultsThere were 6,995,416 antibiotics dispensed or 501/1,000 population. The highest prescribing rate was for patients aged 65 and older at 702 antibiotic scripts/1,000 population, children 0–17 years received 477 antibiotic scripts/1,000 population and adults 18–64 years 446 antibiotics/1,000 population. Females aged 65 years and older received the highest number of antibiotics. Narrow spectrum penicillins, macrolides, first-generation cephalosporins, and second-generation fluoroquinolones (ciprofloxacin and norfloxacin) were the most common classes of antibiotics overall; however, the urinary antibiotics including ciprofloxacin, norfloxacin, and nitrofurantoin were the most common in older females (Figure 1). There was significant prescriber variability with 25% of all antibiotics being prescribed by 2.2% of physicians. Family physicians comprised 91% of these high prescribers.ConclusionThis population-based study quantified community antibiotic utilization and demonstrated marked prescriber variability. Future antibiotic stewardship interventions should target the minority of family physicians that prescribe the majority of antibiotics.Disclosures All authors: No reported disclosures.