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Examining the quantity and quality of antibiotic use : a population-based analysis of British Columbia and Ontario Saatchi, Ariana
Abstract
BACKGROUND: In 2019, AMR was associated to 4.95 million deaths, with an additional 1.27 attributable. The aim of this thesis was to examine both the quantity, and quality, of outpatient antibiotic use in British Columbia (BC), and Ontario, Canada. Elucidating more granular interpretations of aggregate use by antibiotic class, and indication; identifying the magnitude of provincial inappropriate and/or unnecessary prescribing; and expanding interpretations of outpatient inappropriate use by dose and duration. METHODS: Administrative health data bases were utilized for retrospective cohort studies examining provincial antibiotic use between 2000 – 2018. Baseline rates of overall use were identified by drug, syndromic category and diagnosis. Then, overall appropriate use was compared in older Canadians across provinces, and unnecessary antibiotic use was quantified in BC relative to expected rates. Prescribing quality was delineated by agent, dose and duration for: (1) community-acquired pneumonia (CAP) in children (< 19 years) and older adults (≥65 years), and (2) adult cystitis (19 – 64 years). RESULTS: Outpatient antibiotic use decreased by 23% over the study period. Upper respiratory tract infections (URTI) were attributed to the highest rates of antibiotic use across all study years. (233 prescriptions per 1000 population). Provincial stewardship efforts were correlated to a 24% decrease in prescribing, when compared to a pre-stewardship era. In older adults, 50% of all indication-associated antibiotic prescribing were attributed to diagnoses for which clinical guidelines do not recommend their use. In BC, RTIs were prescribed at rates 2 – 8 higher than expected. Prescribing for pediatric CAP was 27% concordant to clinical guidelines. In older Canadians, 63% of prescribing in BC, and 75% in Ontario were considered appropriate—by guideline concordance, or clinical factors which preclude the use of first-line agents. In both cohorts, excess duration was the hallmark of inappropriate prescribing (>90%). In BC adult females, 35% of cystitis-associated prescribing was fully appropriate. CONCLUSIONS: Elevated rates of inappropriate and unnecessary antibiotic use stress the need for more rigorous national stewardship efforts and public health messaging to increase appropriate prescribing and protect the efficacy of these essential medications.
Item Metadata
Title |
Examining the quantity and quality of antibiotic use : a population-based analysis of British Columbia and Ontario
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Creator | |
Supervisor | |
Publisher |
University of British Columbia
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Date Issued |
2023
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Description |
BACKGROUND: In 2019, AMR was associated to 4.95 million deaths, with an additional 1.27 attributable. The aim of this thesis was to examine both the quantity, and quality, of outpatient antibiotic use in British Columbia (BC), and Ontario, Canada. Elucidating more granular interpretations of aggregate use by antibiotic class, and indication; identifying the magnitude of provincial inappropriate and/or unnecessary prescribing; and expanding interpretations of outpatient inappropriate use by dose and duration.
METHODS: Administrative health data bases were utilized for retrospective cohort studies examining provincial antibiotic use between 2000 – 2018. Baseline rates of overall use were identified by drug, syndromic category and diagnosis. Then, overall appropriate use was compared in older Canadians across provinces, and unnecessary antibiotic use was quantified in BC relative to expected rates. Prescribing quality was delineated by agent, dose and duration for: (1) community-acquired pneumonia (CAP) in children (< 19 years) and older adults (≥65 years), and (2) adult cystitis (19 – 64 years).
RESULTS: Outpatient antibiotic use decreased by 23% over the study period. Upper respiratory tract infections (URTI) were attributed to the highest rates of antibiotic use across all study years. (233 prescriptions per 1000 population). Provincial stewardship efforts were correlated to a 24% decrease in prescribing, when compared to a pre-stewardship era. In older adults, 50% of all indication-associated antibiotic prescribing were attributed to diagnoses for which clinical guidelines do not recommend their use. In BC, RTIs were prescribed at rates 2 – 8 higher than expected. Prescribing for pediatric CAP was 27% concordant to clinical guidelines. In older Canadians, 63% of prescribing in BC, and 75% in Ontario were considered appropriate—by guideline concordance, or clinical factors which preclude the use of first-line agents. In both cohorts, excess duration was the hallmark of inappropriate prescribing (>90%). In BC adult females, 35% of cystitis-associated prescribing was fully appropriate.
CONCLUSIONS: Elevated rates of inappropriate and unnecessary antibiotic use stress the need for more rigorous national stewardship efforts and public health messaging to increase appropriate prescribing and protect the efficacy of these essential medications.
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Genre | |
Type | |
Language |
eng
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Date Available |
2024-09-30
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Provider |
Vancouver : University of British Columbia Library
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Rights |
Attribution-NonCommercial-NoDerivatives 4.0 International
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DOI |
10.14288/1.0435496
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Program | |
Affiliation | |
Degree Grantor |
University of British Columbia
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Graduation Date |
2023-11
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Campus | |
Scholarly Level |
Graduate
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DSpace
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Rights
Attribution-NonCommercial-NoDerivatives 4.0 International