Antibiotic Use in NL

Newfoundland & Labrador has the highest use of antibiotics per capita in Canada, based on federal estimates among selected pharmacies. NL and the Atlantic provinces were credited with one of the largest decreases in antibiotic use from 2017-2021. During the first year of COVID-19 in NL, the rate of antimicrobial prescriptions/1,000 residents decreased by 30% and remained low for 16 months. Since mid-2021, overall rates of antimicrobial prescriptions across Canada have increased slightly, but have not returned to higher pre-pandemic levels.

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.

From 1 Aug 2021 – 31 Jul 2022, there were a total of 307,496 prescriptions with an average monthly prescription rate of 25,625.

There was a noticeable increase in monthly prescriptions after mask mandate restrictions were lifted.

The annual rate of oral antibiotic prescriptions in the community in 2021-22 increased by 6.6% compared to 2020-21.

Annual rates have yet to return to higher pre-pandemic levels.

Antibiotic rates were lowest in males and in those aged 0-19 years, and were highest in females and in rural settings.


The first figure shows the proportion of antibiotics prescribed by providers.

The use of Ciprofloxacin, to which many E. Coli in NL are resistant, has seen a slight decrease across providers and in the province (second figure).


AWaRe (Access, Watch, Reserve) is a system developed by the World Health Organization (WHO) that groups antibiotics according to spectrum of activity and risk of developing antimicrobial resistance.

  • Access group – narrower spectrum antibiotics with low resistance potential.
  • Watch group – broader spectrum with higher resistance potential.
  • Reserve group – antibiotics that should be considered as last-resort options.

The WHO target is to have at least 60% of total antibiotic consumption being Access group antibiotics at a country level. NL is above 75% across all providers and province wide.


  • Comparing 2020-21 to 2021-22, there was a 6.6% increase in antibiotic prescribing, amid easing of public health restrictions.
  • It is possible that a resurgence of influenza cases drove up antibiotic prescribing. More data are needed to assess prescribing rates if viral infections reach pre-COVID-19 levels.
  • The proportion of ciprofloxacin prescriptions has seen a slight decrease since 2017.


  • 78% of prescriptions in the community setting were for Access group antibiotics, which satisfied the WHO target of 60% that aims to optimize appropriate antibiotic use and curb antimicrobial resistance.
  • Primary care providers should continue to follow Choosing Wisely Canada guidelines on when not to use antibiotics.
  • When antibiotics are deemed necessary, ensure that the duration does not exceed maximum recommendations.