Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
News

Antibiotic overprescribing a growing problem

Paul Webster
CMAJ February 06, 2017 189 (5) E222; DOI: https://doi.org/10.1503/cmaj.1095383
Paul Webster
Toronto, Ontario
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF
Loading

A multi-site, multi-study investigation of prescribing patterns among American physicians is revealing widescale overuse and misuse of antibiotics.

The revelations carry “powerful” implications for Canadian physicians as well, says Edmonton-based Dr. Lynora Saxinger, past-chair of the Antimicrobial Stewardship and Resistance Committee of the Association of Medical Microbiology Infectious Disease Canada. “Our overall prescribing pattern in Canada is fairly similar.”

Initial study findings, published in May 2016 in the Journal of the American Medical Association (JAMA), showed upwards of 30% of prescriptions written by US doctors for all indications during 2010–2011 may have been inappropriate. For example, half of prescriptions for acute respiratory conditions — 110 million — may not have been needed.

The study was conducted by the Outpatient Antibiotic Use Target-Setting Workgroup, comprised of 20 investigators in almost as many US states, and was spearheaded by the US Centers for Disease Control and Pew Charitable Trusts.

A follow-on study from the workgroup, published in JAMA Internal Medicine in December 2016, concluded that in 2010–2011 physicians correctly prescribed recommended first-line antibiotics only half of the time during patient visits for otitis media, sinusitis and pharyngitis — some 40 million incorrect prescriptions in all.

Both studies rely on data from 184 032 ambulatory care visits from the National Ambulatory Medical Care Survey, which samples office-based physicians, and the National Hospital Ambulatory Medical Care Survey, which samples hospital outpatient and emergency departments.

Figure1

Upwards of 30% of antibiotic prescriptions written by US doctors for all indications during 2010–11 may have been inappropriate.

Image courtesy of DNY59/iStock

“We knew that misuse was occurring based on local studies,” says Dr. David Hyun, a coauthor of both studies. “But at the national level what surprised us was the vast scale of unnecessary prescriptions, and inappropriate prescription.”

These two studies have created “an initial baseline” for further investigations, says Hyun. The workgroup is now combing through data from walk-in community clinics, and long-term care and urgentcare facilities.

The workgroup’s goal is to quantify antibiotic misuse to inform the 2015 US National Action Plan for Combating Antibiotic-Resistant Bacteria. That five-year, $1.2-billion plan aims to reduce inappropriate outpatient antibiotic use by 50% by 2020.

Based on what the workgroup has now revealed, says Hyun, a 15% reduction in overall antibiotic use would be necessary to reduce misuse by 50%.

Saxinger says Canada should be emulating this research. “I’m not aware anyone is doing anything like this here in Canada,” she says.

At the Public Health Agency of Canada in Winnipeg, Dr. Michael Mulvey, chief of Antimicrobial Resistance and Nosocomial Infections at the National Microbiology Laboratory, says that although hospital levels of antimicrobial resistance are being tracked, national antibiotic resistance surveillance does not include Canadian communities. He warns that this gap is worrisome.

His concern echoes the warning in a 2014 report coauthored by Saxinger and others. The need for Canadian surveillance is “at a critical point, as antimicrobial resistance [AMR] is becoming a preeminent worldwide threat to the public health,” the report states.

“Current systems do not track evolving AMR in the community or hospital and thus cannot support development of meaningful responses through better stewardship of antimicrobial use in community or hospital settings, or in veterinary and in food animal production.”

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 189 (5)
CMAJ
Vol. 189, Issue 5
6 Feb 2017
  • Table of Contents
  • Index by author

Article tools

Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Antibiotic overprescribing a growing problem
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Antibiotic overprescribing a growing problem
Paul Webster
CMAJ Feb 2017, 189 (5) E222; DOI: 10.1503/cmaj.1095383

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Antibiotic overprescribing a growing problem
Paul Webster
CMAJ Feb 2017, 189 (5) E222; DOI: 10.1503/cmaj.1095383
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
  • Figures & Tables
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Unpacking “long COVID”
  • Canada’s long road to a vaccine injury compensation program
  • Health advocates want help handling online harassment
Show more News

Similar Articles

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of the resources on this site in an accessible format, please contact us at cmajgroup@cmaj.ca.

Powered by HighWire