Antibiotic Utilization by Family Physicians in Newfoundland and Labrador

This campaign provides information on the prescribing of antibiotics by Family Physicians (FPs) in Newfoundland & Labrador.

Below are links to Choosing Wisely Canada Recommendations for antibiotic use. To review, please select the setting(s) that best relates to your practice.

Primary Care

Long Term Care

Hospitals

Summary Recommendation:

Don’t prescribe antibiotics for upper respiratory infections, sore throat and otitis media that are most likely viral in origin or for asymptomatic bacteriuria in non-pregnant women.

The Problem

Newfoundland and Labrador prescribes the most antibiotics per capita than any other province. In 2018/19, NL gave 786 prescriptions per 1,000 inhabitants.

Patients often seek antibiotics for viral infections. With time, the overuse of antibiotics can lead to the development of resistant bacteria so that even in cases in which antibiotics are appropriate, they are rendered useless.

Our Data

  • From 1 Jul 2017 – 30 Jun 2019, the total number of oral antibiotic prescriptions was 842,409, of which 645,453 (77%) were provided by FPs. Data Source: Pharmacy Network
  • The rate per 1,000 residents decreased by 4.5% in 2018/19 compared to 2017/18. Data Source: Pharmacy Network
  • Higher rates were observed in children aged 0-9 years, those over the age of 65, females, and in rural areas of the province.
  • There was a 6.4% decrease in the number of oral antibiotics prescribed by FPs from 2017/18 to 2018/19.
  • There was a 5.7% decrease in rate/1,000 residents from 2017/18 to 2018/19.
  • 62% of oral prescriptions by FPs were written for females.
  • 36% of prescriptions written by FPs were for children 0-9 years (11%) and seniors ≥65 years (25%).
  • The most prescribed antibiotic by FPs was Amoxicillin. Note: Ciprofloxacin is not appropriate empiric treatment of lower urinary tract infections.
  • 80% of prescriptions were written by 37% of FPs.
  • There is a strong correlation between the number of antibiotics prescribed and the number of billings by FPs (left). However, within each quintile of billings, there is still a wide variability by FP. R value (Correlation Coeficient): 0.74.
  • In the top 20 highest billing FPs, annual number of antibiotics prescriptions varied from 356 to 4,758.

Key Points

  • Although there was a 6% reduction in antibiotic use by FPs and a 12% reduction by dentists, there was no reduction by NPs.
  • Use of ciprofloxacin is high. Restricted use of ciprofloxacin is indicated in view of high E. coli ciprofloxacin resistance. Rates of prescriptions/1,000 people remain high in females (946), children 0-9 years (1,000), and seniors ≥ 65 years (980).  [Note: Ciprofloxacin PO is now special authorization status within the NL Prescription Drug Program. Regulatory changes are to be impemented in January, 2021.]
  • Choosing Wisely Canada guidelines on when to use antibiotics should be followed.

What You Can Do

Consider how to reduce antibiotics prescribing in your own practice.

  • Download Spectrum – a mobile app that is customized to deliver your local antimicrobial stewardship guidelines, resistance data and dosing information.
  • Look for opportunities to educate your patients on the appropriate use of antibiotics and harms associated with taking them when not needed (i.e. drug resistance).
  • Write a post-dated prescription with clear instructions for the pharmacist not to fill until the specified date.
  • Leave a prescription at the receptionist’s desk to be picked up if symptoms persist.
  • Ask the patient to re-contact the office if symptoms persist for a specific time frame.

Check out Choosing Wisely Canada’s Using Antibiotics Wisely Tools and Resources.