'A slower moving pandemic' that calls for urgent attention: antimicrobial resistance

Antibiotic use varies significantly across Canadian provinces, according to new research from the University of Toronto’s Leslie Dan Faculty of Pharmacy. The authors note these variance underline an urgent need for better safeguards and systems to reduce antimicrobial resistance from overuse. "While antimicrobial resistance is a slower-moving pandemic than COVID-19, it will have massive impact on complex medical procedures we now take for granted," senior author Mina Tadrous, an assistant professor at the pharmacy school, was quoted in Medscape News. "More urgency is needed in our efforts to bring new antibiotic options to Canada to slow the development of resistance, to save lives, and to reduce pressure on our healthcare system." Antimicrobial resistance is a serious global problem. In Canada, according to the study, antimicrobial resistance was directly responsible for 5,400 deaths and $1.4 billion in healthcare costs in 2019. Read: Future infectious diseases: Recent history shows we can never again be complacent about pathogens While Canada’s national antibiotic prescribing rate of 627 prescriptions per 1,000 in 2019 is lower compared to the United States—which has a prescribing rate of 791 per 1,000—it is higher than Europe’s rates of 563 per 1,000 in England, 450 per 1,000 in Norway and 285 per 1,000 in Sweden. Addressing the issue in Canada requires better insight into antibiotic use in each jurisdiction. In 2019, the country’s Public Health agency issued a call for detailed research into interprovincial variations. The University of Toronto study found Newfoundland and Labrador had the highest antibiotic dispensing rate, at more than 920 prescriptions per 1,000 people, followed by Saskatchewan with 718 per 1,000. Compare these numbers to British Columbia, where only 543 prescriptions per 1,000 residents were dispensed in 2019. Read: McMaster research team proposes ways Canada can open the door to more antibiotics in bid to tackle 'superbugs' Researchers found additional variations when they analyzed the numbers based on drug class and age groups. Looking at three classes of antibiotics—macrolides, fluoroquinolones and penicillin with beta-lactamase inhibitors—researchers found Newfoundland and Labrador was the most prolific dispenser of all three classes. Quebec, which had an overall dispensing rate similar to the national rate, was the second highest dispenser of fluoroquinolones and macrolides. When it comes to prescribing by age groups, the study found that on a national level older adults were prescribed antibiotics significantly more than other groups, at 940 per 1,000 compared to 557 per 1,000 for adults and 550 per 1,000 for children. Newfoundland and Labrador far exceeded the national average for older adults, at 1,211 prescriptions per thousand, as well as for children at 1,007 per thousand. Ontario and Alberta followed behind Newfoundland and Labrador when it came to prescribing for adults, with Ontario at 1,030 per thousand and Alberta at 973 per thousand. Governments should look at various solutions to reduce antibiotic overuse, said Tadrous. These solutions could include developing provincial targets for antibiotic use reduction as well as interventions that target high-prescribing physicians. One such intervention that has been tried and has led to improvements involved sending letters to physicians that compared their prescribing rates to those of other doctors. "The idea is not just to measure and point out problems but to develop solutions," said Tadrous. Read: Providing physicians with feedback reduces antibiotic overprescribing

'A slower moving pandemic' that calls for urgent attention: antimicrobial resistance

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