Outpatient antibiotic use in British Columbia, Canada: reviewing major trends since 2000

Abstract

Background With 90% of all antibiotics in Canada being used in the community setting, tracking outpatient prescribing is integral to mitigate the issue of antimicrobial resistance. In 2005, a provincial programme was launched in British Columbia (BC) to disseminate information regarding the judicious use of antibiotics. These efforts include educational campaigns, updated practitioner guidelines and academic detailing. The impact of provincial stewardship on community prescribing requires ongoing evaluation. Objectives This study examines outpatient prescribing to quantify rates of antibiotic use, evaluate major trends over time and identify new targets for stewardship. Methods A retrospective cohort design using population-level data. Results This study included over 3.5 million unique individuals with a total of 51 367 938 oral antibiotic prescriptions dispensed over a 19 year period (2000–18). Overall antibiotic utilization decreased by 23% over the course of the study period. This trend in the reduction of antibiotic prescription was observed across all major antibiotic classes, apart from the class of other antibacterials, which was mostly related to use of nitrofurantoin. The largest magnitudes of decreased prescribing were observed in the paediatric population. Prescribing across two distinct eras of provincial stewardship reaffirmed preliminary findings of programme efficacy, when compared with pre-stewardship levels of antibiotic use. Conclusions Outpatient prescribing in BC is decreasing overall, and this study confirms an association between provincial stewardship interventions and improvements in antibiotic use. Pronounced declines in paediatric populations are promising, and further research is underway to examine prescribing quality.

Retrospective Cohort Analysis of Outpatient Antibiotic Use for Clostridioides difficile-Indicated Agents in British Columbia, from 2000 to 2018

“…Although stagnant in use when compared to the other medications, metronidazole was dispensed at rates far and above vancomycin and/or fdaxomicin across all study years. Tese results are corroborated by previous provincial analyses, which report a 97% total increase in prescribing for the J01X ATC class of "other antimicrobials"; comprised of metronidazole, vancomycin, and more [16].…”

“…Future research eforts should continue to monitor these CDI-indicated drugs in order to monitor guideline adherence. As previous antibiotic use remains a leading risk factor for CDI, particularly fuoroquinolone exposure, it is notable that provincial quinolone use declined by 22%, over the same study period [6,16]. However, provincial rates of CDI continue to trend upward, particularly within the community [3][4][5].…”

Quantifying the Gap between Expected and Actual Rates of Antibiotic Prescribing in British Columbia, Canada

“…High caliber stewardship efforts aim to ensure that antibiotics are available when medically necessary and reserved otherwise to protect against rising resistance. A recent study confirmed that the overall antibiotic prescribing rates are declining in BC [ 38 ]. As further reductions remain a target for provincial stewardship, this study offers the first concrete quantifications for the potential reduction in unnecessary antibiotic use within BC for 18 distinct indications across two healthcare settings.…”

A Time Series Analysis Evaluating Antibiotic Prescription Rates in Long-Term Care during the COVID-19 Pandemic in Alberta and Ontario, Canada

“…It is much more accurate and informative than comparing average prescription rates between pandemic versus pre-pandemic periods, as it counts for a variety of pre-existing trends. This is crucial for antibiotics, where stewardship programs have been in place for years, aiming to reduce prescribing [ 20 , 21 , 22 , 23 ]. Next to that, it takes seasonality into account, which is an important factor, especially for respiratory diseases and their associated antibiotic prescriptions.…”