Background: Antimicrobial 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 examine variability in antibiotic prescribing across physicians.
Methods: We conducted a cross-sectional study of antibiotics dispensed from community pharmacies in Ontario, Canada between 1 March 2016 and 28 February 2017. Ontario has a population of 13.9 million people and over 30,000 physicians. We analyzed data from the XponentTM database by QuintilesIMS. XponentTM 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.
Results: There were 6,995,416 antibiotics dispensed or 501/1000 population. The highest prescribing rate was for patients aged 65 and older at 702 antibiotic scripts/1000 population, children 0-17 years received 477 antibiotic scripts/1000 population and adults 18-64 years 446 antibiotics/1000 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.
Conclusion: This 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.
K. Brown, None
G. Garber, None
J. Johnstone, None
B. Langford, None
V. Leung, None
N. Daneman, None
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