Some GTA MDs overuse antibiotics: study

Overprescribing seen as adding to growing threat of drug resistance

Antibiotics are overprescribed in Mississauga-Halton compared to the rest of Greater Toronto, new research suggests, indicating some doctors are not getting the message that overuse contributes to the growing threat of treatment-resistant infections.

A study published Wednesday in CMAJ Open shows significant differences in prescribing rates of antibiotics across the GTA as well as across the rest of the province.

“I think what this variability indicates is that there is some degree of unnecessary prescribing going on,” said lead author Dr. Kevin Schwartz, an infectious disease physician with Public Health Ontario.

“This should concern everybody because the amount of antibiotics that we use is directly related to the increasing resistance that we see,” he added.

The study does not explain why some areas have higher prescribing rates than others. Schwartz believes a small number of high prescribers are concentrated in certain areas and that physicians working together in clinics may have similar prescribing patterns.

The most important takeaway is that there is room for improvement in stewardship efforts such as education, Schwartz noted.

Antibiotic resistance is an urgent, global public health threat. A study from the United Kingdom estimates that in the absence of significant intervention, deaths from drug-resistant infections around the world will surpass deaths from cancer by 2050, resulting in 10 million deaths annually.

Antibiotics are used to fight bacterial infections such as bladder infections and strep throat by stopping or slowing the growth of bacteria. Resistance occurs when some bac- teria develop the ability to defeat the drugs designed to kill them.

When that happens, infections can become difficult to treat and even untreatable.

“We want to make sure that we are using antibiotics when patients need them ... so that these life-saving drugs are available for future generations,” Schwartz said, noting they are sometimes improperly used to treat viral infections

The study compared the use of antibiotics by outpatients in 14 different geographic regions of the province. In Canada, 92 per cent of antibiotics are prescribed outside of hospitals, mostly by family doctors.

Researchers analyzed prescribing rates over a one-year period, running from March 2016 to February 2017.

During that time, 8.3 million doses of antibiotics were dispensed in the province for an average of 621 doses per 1,000 population. Some Ontarians would have had received multiple prescriptions during this time while others would have had none.

The region of Erie-St. Clair in southwestern Ontario has the highest prescribing rate with 778 prescriptions dispensed per 1,000 population. Mississauga-Halton comes in second with 742 prescriptions per1,000 population.

Champlain, in eastern Ontario, has the lowest use with 534 prescriptions per 1,000 population.

The rates per1,000 population are as follows in other parts of the GTA: Toronto Central, 566; Central (north of Toronto), 626; and Central East (including Scarborough), 611.

“The research team suspected that there was some variability in how often antibiotics were prescribed outside of hospitals and other health-care institutions, but the level of prescribing was surprising given how much we now know about appropriate prescribing, antibiotic resistance and the long-term dangers of excess prescribing,” Schwartz said.