RT Journal Article
SR Electronic
T1 Unnecessary antibiotic prescribing in a Canadian primary care setting: a descriptive analysis using routinely collected electronic medical record data
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E360
OP E369
DO 10.9778/cmajo.20190175
VO 8
IS 2
A1 Kevin L. Schwartz
A1 Bradley J. Langford
A1 Nick Daneman
A1 Branson Chen
A1 Kevin A. Brown
A1 Warren McIsaac
A1 Karen Tu
A1 Elisa Candido
A1 Jennie Johnstone
A1 Valerie Leung
A1 Jeremiah Hwee
A1 Michael Silverman
A1 Julie H.C. Wu
A1 Gary Garber
YR 2020
UL http://www.cmajopen.ca/content/8/2/E360.abstract
AB Background: Unnecessary antibiotic use in the community in Canada is not well defined. Our objective was to quantify unnecessary antibiotic prescribing in a Canadian primary care setting.Methods: We performed a descriptive analysis in Ontario from April 2011 to March 2016 using the Electronic Medical Records Primary Care database linked to other health administrative data sets at ICES. We determined antibiotic prescribing rates (per 100 patient–physician encounters) for 23 common conditions and estimated rates of unnecessary prescribing using predefined expected prescribing rates, both stratified by condition and patient age group.Results: The study included 341 physicians, 204 313 patients and 499 570 encounters. The rate of unnecessary antibiotic prescribing for included conditions was 15.4% overall and was 17.6% for those less than 2 years of age, 18.6% for those aged 2–18, 14.5% for those aged 19–64 and 13.0% for those aged 65 or more. The highest unnecessary prescribing rates were observed for acute bronchitis (52.6%), acute sinusitis (48.4%) and acute otitis media (39.3%). The common cold, acute bronchitis, acute sinusitis and miscellaneous nonbacterial infections were responsible for 80% of the unnecessary antibiotic prescriptions. Of all antibiotics prescribed, 12.0% were for conditions for which they are never indicated, and 12.3% for conditions for which they are rarely indicated. In children, 25% of antibiotics were for conditions for which they are never indicated (e.g., common cold).Interpretation: Antibiotics were prescribed unnecessarily for 15.4% of included encounters in a Canadian primary care setting. Almost one-quarter of antibiotics were prescribed for conditions for which they are rarely or never indicated. These findings should guide safe reductions in the use of antibiotics for the common cold, bronchitis and sinusitis.