How’s Your Antibiotic Prescribing in the Community?

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How’s Your Antibiotic Prescribing in the Community?

30-Jan-2018

The Canadian Antimicrobial Resistance Surveillance System (CARSS) has released their 2017 Report and Saskatchewan still shows room for improvement in community-based antimicrobial use.

Across Canada, approximately 92% of antimicrobial doses are dispensed in the community, making it a key realm of engagement for antimicrobial stewardship. Unfortunately, Saskatchewan remains the second highest user of community-prescribed antimicrobials when compared to the other provinces and territories.

The Antimicrobial Stewardship Program has completed a three-year (2015-2017) analysis of antimicrobial use in a group of urban and rural community clinics in the Regina area. This analysis allows community-based prescribers to compare their prescribing habits to their colleagues both within their clinic and among the larger group of clinics. The data were captured from the MedAccess database run through Primary Health Care. Only approved, short-term (1-14 day) antimicrobial prescriptions with no substitutions allowed were included in the data set.

One interesting piece of information that was retrieved from the data was the high level of use of azithromycin among the local clinics; over three years, azithromycin accounted for 24% of antimicrobial prescriptions. Amoxicillin, the next most frequently used drug, accounted for 18% of prescriptions over three years. This trend is opposite of the national data, which show amoxicillin as the most frequently used drug (25% of prescriptions) and azithromycin in second place (10% of prescriptions).

This information is also a concern as the 2016 RQHR antibiogram indicates that resistance to macrolides (azithromycin, erythromycin, etc.) among Gram-positive bacteria isolated from local outpatients is quite high (21-65% resistance).

The Antimicrobial Stewardship Program would like to remind all prescribers to make use of their local antibiogram to help guide empiric prescribing. The RQHR antibiogram can be accessed through the laboratory services website where it can be viewed online, downloaded as a .pdf, or the database file can be downloaded for use with the free Antibiogram app (for Apple or Android).

CARSS data source:
Public Health Agency of Canada, Canadian Antimicrobial Resistance Surveillance System 2017 Report, 2017, Ottawa, Canada

Submitted by: Robert Parker, Program Manager, Antimicrobial & Clinical Stewardship