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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 25, Issue 2, Pages 95-98
http://dx.doi.org/10.1155/2014/703898
Original Articles

Variation in Outpatient Oral Antimicrobial Use Patterns among Canadian Provinces, 2000 to 2010

Shiona K Glass-Kaastra,1 Rita Finley,1 Jim Hutchinson,2 David M Patrick,3,4 Karl Weiss,5 and John Conly6,7,8

1Public Health Agency of Canada, Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Guelph, Ontario, Canada
2Division of Medical Microbiology, Island Medical Program, University of British Columbia, Canada
3British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
4University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada
5University of Montreal, Department of Infectious Diseases and Microbiology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
6Department of Medicine, University of Calgary, Calgary, Alberta, Canada
7Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
8Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada

Copyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: The volume and patterns of antimicrobial drug use are key variables to consider when developing guidelines for prescribing, and programs to address stewardship and combat the increasing prevalence of antimicrobial resistant pathogens. Because drug programs are regulated at the provincial level, there is an expectation that antibiotic use may vary among provinces.

OBJECTIVE: To assess these potential differences according to province and time.

METHODS: Provincial antimicrobial prescribing data at the individual drug level were acquired from the Canadian Integrated Program for Antimicrobial Resistance Surveillance for 2000 to 2010. Data were used to calculate two yearly metrics: prescriptions per 1000 inhabitant-days and the average defined daily doses per prescription. The proportion of liquid oral prescriptions of total prescriptions was also calculated as a proxy measure for the proportion of prescriptions given to children versus adults. To assess the significance of provincial antimicrobial use, linear mixed models were developed for each metric, accounting for repeated measurements over time.

RESULTS: Significant differences among provinces were found, as well as significant changes in use over time. Newfoundland and Labrador was found to have significantly higher prescribing rates than all other provinces (P<0.001) in 2010, as well as the mean of all other provinces (P<0.001). In contrast, Quebec exhibited significantly lower prescribing than all other provinces (P<0.001 for all provinces except British Columbia, where P=0.024) and the mean of all other provinces (P<0.001).

DISCUSSION/CONCLUSION: Reports of reductions in antimicrobial use at the Canadian level are promising, especially prescribing to children; however, care must be taken to avoid the pitfall of the ecological fallacy. Reductions are not consistent among the provinces or among the classes of antimicrobial drugs dispensed in Canada.