scholarly journals Coronavirus Disease 2019, Superinfections, and Antimicrobial Development: What Can We Expect?

2020 ◽  
Vol 71 (10) ◽  
pp. 2736-2743 ◽  
Author(s):  
Cornelius J Clancy ◽  
M Hong Nguyen
Keyword(s):  
Antimicrobial Resistance ◽  
Broad Spectrum ◽  
Prospective Studies ◽  
Case Series ◽  
Empiric Therapy ◽  
Antimicrobial Treatment ◽  
Market Reform ◽  
Antimicrobial Use ◽  
Limited Data ◽  
Institutional Ecology

Abstract Coronavirus disease 2019 (COVID-19) arose at a time of great concern about antimicrobial resistance (AMR). No studies have specifically assessed COVID-19–associated superinfections or AMR. Based on limited data from case series, it is reasonable to anticipate that an appreciable minority of patients with severe COVID-19 will develop superinfections, most commonly pneumonia due to nosocomial bacteria and Aspergillus. Microbiology and AMR patterns are likely to reflect institutional ecology. Broad-spectrum antimicrobial use is likely to be widespread among hospitalized patients, both as directed and empiric therapy. Stewardship will have a crucial role in limiting unnecessary antimicrobial use and AMR. Congressional COVID-19 relief bills are considering antimicrobial reimbursement reforms and antimicrobial subscription models, but it is unclear if these will be included in final legislation. Prospective studies on COVID-19 superinfections are needed, data from which can inform rational antimicrobial treatment and stewardship strategies, and models for market reform and sustainable drug development.

scholarly journals Increasing antimicrobial resistance of Shigella isolates in Israel during the period 1984 to 1992.

1995 ◽  
Vol 39 (4) ◽  
pp. 819-823 ◽  
Author(s):  
S Ashkenazi ◽  
M May-Zahav ◽  
J Sulkes ◽  
R Zilberberg ◽  
Z Samra
Keyword(s):  
Antimicrobial Resistance ◽  
Nalidixic Acid ◽  
Broad Spectrum ◽  
Empiric Therapy ◽  
Shigella Sonnei ◽  
Shigella Spp ◽  
Stool Cultures

Recent (1984 to 1992) trends in the antimicrobial resistance of Shigella isolates in Israel were studied by analyzing the results of 106,000 stool cultures, 3,511 of which yielded Shigella spp. Over the study period, resistance to trimethoprim-sulfamethoxazole (TMP-SMX) increased from 59 to 92% (P = 0.0038) and that to ampicillin increased from 13 to 86% (P < 0.0001). Resistances to nalidixic acid, chloramphenicol, and broad-spectrum cephalosporins remained low. Shigella sonnei, which currently accounts for 90% of Shigella infections, was more resistant than S. flexneri to TMP-SMX (81 versus 57%, P < 10(-6)), ampicillin (42 versus 32%, P < 10(-5)), and tetracycline (38 versus 28%, P < 10(-5)). S. boydii and S. dysenteriae were relatively rare. Seasonality in antimicrobial resistance was found, with summer isolates being less resistant to TMP-SMX, ampicillin, or both than isolates obtained over the rest of the year (P < 10(-5)). We conclude that the resistance of shigellae, especially S. sonnei, to TMP-SMX and ampicillin is increasing to approximately 90%. Resistance should be recorded locally, and empiric therapy for suspected shigellosis should be changed accordingly.

scholarly journals Impact of a comprehensive antimicrobial stewardship program on antimicrobial utilization and clinical isolates distribution in ICUs

2020 ◽  
Author(s):  
Jiaojiao Song ◽  
Rongsheng Zhu ◽  
Leiqing Li ◽  
Lingcheng Xu ◽  
Quan Zhou ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Second Generation ◽  
Antimicrobial Treatment ◽  
Clinical Isolates ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Antimicrobial Utilization ◽  
Lactamase Inhibitor

Abstract Objective This study aimed to evaluate the effect of a comprehensive antimicrobial stewardship program (ASP) and provide clinical evidence for the scientific stewardship of antimicrobials in intensive care units (ICUs) of a teaching hospital.Methods Between January 2013 and December 2018, we conducted a prospective study, based on an antimicrobial computerized clinical decision support system (aCDSS) deployed in 2015 in ICUs of a tertiary and teaching hospital. The primary outcomes included initial and overall use prevalence of antimicrobials. The second outcomes were the detection rate of common clinical isolates before and after therapeutic antimicrobial use, and the change in patterns of resistance of 5 common clinical isolates in the ICU.Results Various types of broad-spectrum antimicrobial use prevalence continued to increase from 2013 to 2015, since 2016, where initial use of carbapenems and glycopeptides were counterbalanced by an increase in use of the first/second-generation cephalosporins, β-lactam and β-lactamase inhibitor combinations and linezolid. From 2015 to 2018, the proportion of extended-broad spectrum antimicrobials alone, wide-coverage therapy and combination therapy decreased significantly (P<0.05). Similarly, where use of carbapenems, glycopeptides, third/fourth-generation cephalosporins and anti-fungi agents were counterbalanced by an increase in overall use of the first/second-generation cephalosporins and β-lactam and β-lactamase inhibitor combinations. A total of 21891 strains of bacteria and fungi were detected in ICUs from 2015 to 2018, of them, 6.5% (1426/21891) strains were detected before antimicrobial treatment. The detection proportion of Staphylococcus aureus , Escherichia coli , Klebsiella pneumoniae and fastidious bacteria were significantly higher before antimicrobial treatment (P<0.05), while Acinetobacter baumannii , Burkholderia cepacia , and Candida spp were significantly lower in all non-repetitive clinical isolates (P<0.05).Conclusions The implementation of a comprehensive ASP combining CDSS in ICUs seems to be effective to improve outcomes on antimicrobial utilization and clinical isolates distribution in critically ill patients.

scholarly journals Assessment of antimicrobial use in private and government hospitals, a comparative study in central kerala, using who indicators

2021 ◽  
pp. 88-92
Author(s):  
Chinnu Roy ◽  
Shaji George ◽  
Aleena Issac ◽  
Arya Ponnappan ◽  
Dhanya Paul
Keyword(s):  
Broad Spectrum ◽  
Average Cost ◽  
Private Hospital ◽  
Antimicrobial Treatment ◽  
Antimicrobial Use ◽  
Government Hospital ◽  
Prescribing Pattern ◽  
Government Hospitals ◽  
The Government ◽  
Who Indicators

Background: Irrational use of antimicrobial can cause various unwanted and untoward events. It may diminish the quality of patient care, increase the cost of therapy, and involvement in various side effects. Thus, the appropriateness of antimicrobial use in hospitals plays a pivotal role in patient safety. Objective: To analyze and assess the prescribing pattern of antimicrobials in private and government hospitals as per the WHO indicators. Methodology: A prospective comparative observational study was carried out for 6 months, with the patient diagnosed with an infectious disease admitted to the medical ward of both the hospitals during the study period. The data obtained from the study sites were Compared and analyzed using WHO indicators described in WHO’s “How to Investigate Antimicrobial use in Hospitals: Selected Indicators, Feb 2012”. Results: The study involved 216 patients and the average number of antimicrobials prescribed was found to be 1.73 in a private hospital and 2.07 in the government hospital, average cost of antimicrobials was found to be 86.48 INR in private and 31.04 INR in the government hospital, average duration of antimicrobial treatment was 4.8 in private and 5.2 in the government hospital, and the percentage of antimicrobials prescribed in generic was 33.33% in private and 87.83% in the government hospital. Considering the spectrum of antibiotics, both private (94.7%) and government (88.8%) used broad-spectrum antimicrobials. In both hospitals, cephalosporins were the most frequently prescribed class of antimicrobials. Comparing the dosage of antimicrobials given, injection usage is at the highest in government (59.5%) as well as in the private hospital (68.4%). Conclusion: This study indicates that the average cost of antimicrobials was more in a private hospital than that in a government hospital and other indicators such as the number of antimicrobials per hospitalization, duration of antimicrobial treatment, and the percentage of generic antimicrobials prescribed were all found to be more in a government hospital. In both private and government hospitals broad-spectrum antimicrobials were widely used, with cephalosporin as the most prescribed class.

scholarly journals Antimicrobial Resistance and Antimicrobial Use Associated with Laboratory-Confirmed Cases ofCampylobacterInfection in Two Health Units in Ontario

2013 ◽  
Vol 24 (1) ◽  
pp. e16-e21 ◽  
Author(s):  
Anne E Deckert ◽  
Richard J Reid-Smith ◽  
Susan E Tamblyn ◽  
Larry Morrell ◽  
Patrick Seliske ◽  
...  
Keyword(s):  
Minimum Inhibitory Concentration ◽  
Antimicrobial Resistance ◽  
Inhibitory Concentration ◽  
Population Based ◽  
Antimicrobial Treatment ◽  
Antimicrobial Use ◽  
Fecal Culture ◽  
Population Based Study ◽  
Development Of Resistance ◽  
Amoxicillin Clavulanic Acid

AIM: A population-based study was conducted over a two-year period in the Perth District (PD) and Wellington-Dufferin-Guelph (WDG) health units in Ontario to document antimicrobial resistance and antimicrobial use associated with clinical cases of laboratory-confirmed campylobacteriosis.METHODS: Etest (bioMérieux SA, France) was used to determine the minimum inhibitory concentration of amoxicillin/clavulanic acid, ampicillin, chloramphenicol, ciprofloxacin (CIP), clindamycin, erythromycin (ERY), gentamicin, nalidixic acid and tetracycline. Data regarding antimicrobial use were collected from 250 cases.RESULTS: Of the 250 cases, 165 (65.7%) reported staying home or being hospitalized due to campylobacteriosis. Fifty-four per cent of cases (135 of 249) reported taking antimicrobials to treat campylobacteriosis. In 115 cases (51.1%), fecal culture results were not used for treatment decisions because they were not available before the initiation of antimicrobial treatment and/or they were not available before the cessation of symptoms. Of the 250 cases, 124 (49.6%) had availableCampylobacterisolates, of which 66 (53.2%) were resistant to at least one of the antimicrobials tested. No resistance to ampicillin, chloramphenicol or gentamicin was found in these isolates. Six isolates (4.8%) were resistant to CIP. Two isolates (1.6%) were resistant to ERY; however, no isolates were resistant to both CIP and ERY.CONCLUSION: Prudent use practices should be promoted among physicians to reduce the use of antimicrobials for the treatment of gastroenteritis in general and campylobacteriosis in particular, as well as to minimize the future development of resistance to these antimicrobials inCampylobacterspecies.

Impact of Different Methods of Feedback to Clinicians After Postprescription Antimicrobial Review Based on the Centers for Disease Control and Prevention's 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults

2007 ◽  
Vol 28 (6) ◽  
pp. 641-646 ◽  
Author(s):  
Sara E. Cosgrove ◽  
Alpa Patel ◽  
Xiaoyan Song ◽  
Robert E. Miller ◽  
Kathleen Speck ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Disease Control ◽  
Broad Spectrum ◽  
Antimicrobial Therapy ◽  
Detection System ◽  
Tertiary Care ◽  
Clinical Event ◽  
Antimicrobial Use ◽  
12 Steps ◽  
Centers For Disease Control

Objectives.To evaluate (1) the framework of the 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults that is part of the Centers for Disease Control and Prevention (CDC) Campaign to Prevent Antimicrobial Resistance in Healthcare Settings, with regard to steps addressing antimicrobial use; and (2) methods of feedback to clinicians regarding antimicrobial use after postprescription review.Design.Prospective intervention to identify and modify inappropriate antimicrobial therapy.Setting.A 1,000-bed, tertiary care teaching hospital.Patients.Inpatients in selected medicine and surgery units receiving broad-spectrum antimicrobials for 48-72 hours.Interventions.We created a computer-based clinical-event detection system that automatically identified inpatients taking broad-spectrum and “reserve” antimicrobials for 48-72 hours. Although prior approval was required for initial administration of broad-spectrum and reserve antimicrobials, once approval was obtained, therapy with the antimicrobials could be continued indefinitely at the discretion of the treating clinician. Therapy that was ongoing at 48-72 hours was reviewed by an infectious diseases pharmacist or physician, and when indicated feedback was provided to clinicians to modify or discontinue therapy. Feedback was provided via a direct telephone call, a note on the front of the medical record, or text message sent to the clinician's pager. The acceptance rate of feedback was recorded and recommendations were categorized according to the 12 steps recommended by the CDC.Results.Interventions were recommended for 334 (30%) of 1,104 courses of antimicrobial therapy reviewed. A total of 87% of interventions fit into one of the CDC's 12 steps of prevention: 39% into step 3 (“target the pathogen”), 1% into step 4 (“access experts”), 3% into steps 7 and 8 (“treat infection, not colonization or contamination”), 18% into step 9 (“say ‘no’ to vancomycin”), and 26% into step 10 (“stop treatment when no infection”). The rate of compliance with recommendations to improve antimicrobial use was 72%. No differences in compliance were seen with the different methods of feedback.Conclusions.Nearly one-third of antimicrobial courses did not follow the CDC's recommended 12 steps for prevention of antimicrobial resistance. Clinicians demonstrated high compliance with following suggestions made after postprescription review, suggesting that it is a useful approach to decreasing and improving antimicrobial use among inpatients.

scholarly journals Effects of the cefazolin shortage on the sales, cost, and appropriate use of other antimicrobials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ryuji Koizumi ◽  
Yoshiki Kusama ◽  
Yusuke Asai ◽  
Gu Yoshiaki ◽  
Yuichi Muraki ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Prediction Model ◽  
Broad Spectrum ◽  
Early Recognition ◽  
Antimicrobial Use ◽  
Appropriate Use ◽  
Sales Data ◽  
Defined Daily Doses ◽  
Before And After ◽  
Appropriate Antimicrobial Use

Abstract Background Shortages of antimicrobials lead to treatment failures, increase medical costs, and accelerate the development of antimicrobial resistance. We evaluated the effects of the serious cefazolin shortage in 2019 in Japan on the sales, costs, and appropriate use of other antimicrobials. Methods We evaluated monthly defined daily doses/1000 inhabitants/day (DID) values of antimicrobial sales from January 2016 to December 2019 using wholesaler’s sales databases. Using 2016–2018 sales data, we generated a prediction model of DID in 2019 under the assumption that the cefazolin shortage did not occur. We then compared the predicted DID and actual DID. Cefazolin, government-recommended alternatives, and government-not-recommended broad-spectrum alternatives were assessed. Antimicrobial groups according to the AWaRe classification were also assessed to evaluate the effect on appropriate antimicrobial use. In addition, we evaluated changes in costs between 9 months before and after the cefazolin shortage. Results DID values of total antimicrobials increased sharply 1 month before the decrease in cefazolin. Actual DIDs were higher than predicted DIDs for ceftriaxone, flomoxef, clindamycin, cefotiam, piperacillin/tazobactam, and meropenem. Actual DID values were higher than the predicted DID values in the Watch group. The costs of antimicrobials between pre- and post- cefazolin shortage were unchanged. Conclusion The cefazolin shortage brought confusion to the antimicrobial market and led to a setback in the appropriate use of antimicrobials. Early recognition and structures for prompt reactions to antimicrobial shortages are needed. Moreover, development of a system to secure the supply of essential antimicrobials is required.

scholarly journals 2583. Short-term Impact of Antimicrobial Exposure on Fecal Carriage of Resistant Microorganisms

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S897-S897
Author(s):  
Abdul Ahmad ◽  
Carla Amundson ◽  
Connie Clabots ◽  
Stephen Porter ◽  
James R Johnson ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antimicrobial Resistance ◽  
Antimicrobial Treatment ◽  
Multi Drug Resistance ◽  
Antimicrobial Use ◽  
Fecal Flora ◽  
Short Term ◽  
Paired Samples ◽  
Fecal Carriage ◽  
Stool Samples

Abstract Background The relationship between antimicrobial use and subsequent resistance is complicated; this study assesses the short-term impact of antimicrobial use on fecal carriage of resistant microorganisms. This is a sub-study of an ongoing trial comparing 7 vs. 14 days of antimicrobial treatment for male urinary tract infection. This analysis quantifies the effect of 1–2 weeks of systemic antimicrobial use on the fecal flora within 1 week of completing therapy. Methods The parent study has enrolled 216 subjects, with 178 enrolled in the optional resistance sub-study. Subjects received either ciprofloxacin or trimethoprim/sulfamethoxazole (SXT), randomized to 7 vs. 14 days therapy. Subjects provided 2 stool specimens, 1 during treatment and 1 a week after completing study medication. Samples were plated on media for Gram-positive and negative growth, including T-7 plates with ciprofloxacin and SXT added to select for resistant organisms. Resistance to 22 antimicrobials was assessed, with resistance reported by: number of isolates with any antimicrobial resistance, total number of resistant drugs/isolate, and number of isolates with multi-drug resistance (resistance to 3 or more different antimicrobial classes). Results Overall, 143 (80%) subjects provided 2 stool samples, with 104 (73%) having growth from at least 1 of the samples. Fifty-one of 143 (36%) had microbial growth from both samples. From these 51 paired samples, there were 255 total strains isolated (117 from the first sample, 138 from the second), with some yielding multiple organisms (range, 1–5). From sample 1, 110/117 (94%) isolates had any antimicrobial resistance, vs. 131/138 (95%) from sample 2 (P = .79). Mean number of resistant drugs/isolate was 7.4 in sample 1 and 5.8 in sample 2 (P = .009). Multi-drug resistance was seen in 102/117 (87%) isolates from sample 1 vs. 85/138 (62%) isolates in sample 2 (P < .001). Conclusion The fecal flora of patients on antimicrobial therapy for UTI has a significant increase in resistant microorganisms compared with samples obtained shortly after antimicrobial completion. This may reflect repopulation of the fecal flora with less-resistant strains after the selection pressure of therapy has been removed. After unblinding, we will assess if differences in resistance are affected by therapy duration. Disclosures All authors: No reported disclosures.

scholarly journals Clinically Important Resistance among Salmonella enterica Serotype Typhi Isolates—United States, 2003–2015

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S365-S365
Author(s):  
Felicita Medalla ◽  
Louise Francois Watkins ◽  
Kevin Chatham-Stephens ◽  
Jared Reynolds ◽  
Amelia Bicknese ◽  
...  
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
Typhoid Fever ◽  
Treatment Options ◽  
The United States ◽  
Empiric Therapy ◽  
Salmonella Typhi ◽  
Antimicrobial Treatment ◽  
Delayed Response ◽  
Azithromycin Resistance

Abstract Background Salmonella Typhi (Typhi) causes typhoid fever, accounting for an estimated 5,700 illnesses and 623 hospitalizations per year in the United States. Most infections are acquired during travel to regions outside the United States where typhoid fever is prevalent and antimicrobial resistance is a problem. Fluoroquinolones (e.g., ciprofloxacin) are considered the treatment of choice for susceptible Typhi infections due to their superior ability to concentrate intracellularly and in bile, however, nonsusceptibility has been associated with treatment failure or delayed response. Azithromycin and ceftriaxone are treatment options. We describe antimicrobial susceptibility among Typhi isolates in the United States and the implications for management. Methods The National Antimicrobial Resistance Monitoring System at CDC conducts susceptibility testing on all Typhi isolates submitted by public health laboratories. We used broth microdilution to determine minimum inhibitory concentrations (MICs) to agents representing 9 antimicrobial classes and categorized isolates according to criteria from the Clinical and Laboratory Standards Institute. We defined ciprofloxacin nonsusceptibility as MIC ≥0.12 μg/mL, ciprofloxacin resistance as MIC ≥1, azithromycin resistance as MIC ≥32, and ceftriaxone resistance as MIC ≥4. Results From 2003–2015, isolates were tested from 4,550 patients; 2,760 (61%) were ciprofloxacin nonsusceptible, 4% were ciprofloxacin resistant. One isolate was azithromycin resistant and none were ceftriaxone resistant. Ciprofloxacin nonsusceptibility increased from 39% in 2003 to 66% in 2015; resistance increased from 0.3% to 8%. Median age of patients was 23 years (range 1–99 years), 53% were male, most were from the Northeast (33%) or the West (29%), and 74% had an isolate from blood. Conclusion Two thirds of Typhi isolates exhibited ciprofloxacin nonsusceptibility, which has increased over the last decade, and full resistance is increasing. Clinicians should be aware of high rates of fluoroquinolone nonsusceptibility when selecting empiric therapy and should tailor antimicrobial treatment to susceptibility results when feasible. Azithromycin and ceftriaxone remain important treatment options. Disclosures All authors: No reported disclosures.

scholarly journals Combined influence of practice guidelines and prospective audit and feedback stewardship on antimicrobial treatment of community-acquired pneumonia and empyema in children: 2012 to 2016

2020 ◽  
Author(s):  
Nicole M A Le Saux ◽  
Jennifer Bowes ◽  
Isabelle Viel-Thériault ◽  
Nisha Thampi ◽  
Julie Blackburn ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Empiric Therapy ◽  
Community Acquired Pneumonia ◽  
Antimicrobial Treatment ◽  
Audit And Feedback ◽  
Third Generation ◽  
Prospective Audit ◽  
Stewardship Program ◽  
Prospective Audit And Feedback ◽  
Third Generation Cephalosporins

Abstract Background Aminopenicillins are recommended empiric therapy for community-acquired pneumonia (CAP). The aim of the study was to assess treatment over a 5-year period after CAP guideline publication and introduction of an antimicrobial stewardship program (ASP). Methods Using ICD-10 discharge codes for pneumonia, children less than 18 years admitted to the Children’s Hospital of Eastern Ontario January 1, 2012 and December 31, 2016 were identified. Children ≥ 2 months with consolidation were included. One day of therapy (DOT) was one or more doses of an antimicrobial given for 1 day. Results Of 1,707 patients identified, 713 met inclusion criteria. Eighteen (2.5%) had bacteria identified by culture and 79 of 265 (29.8%) had Mycoplasma pneumoniae detected. Mean DOT/1,000 patient days of aminopenicillins/penicillin (AAP) increased by 18.1% per year (95% confidence interval [CI] −0.2, 39.9%) and decreased by 37.6% per year (95% CI −56.1, −11.3%) for second- and third-generation cephalosporins in the post-ASP period. The duration of discharge antimicrobials decreased. Of 74 (10.4%) patients who had pleural fluid drained, 35 (47.3%) received more than 5 days of AAP and ≤ 5 days of second-/third-generation cephalosporins with no difference in median length of stay nor mean duration of antimicrobials. Conclusions Implementation of CAP management guidelines followed by prospective audit and feedback stewardship was associated with a sustained decrease in the use of broad-spectrum antibiotics in childhood CAP. Use of AAP should also be strongly considered in patients with effusions (even if no pathogen is identified), as clinical outcome appears similar to patients treated with broad-spectrum antimicrobials.

scholarly journals Longitudinal surveillance of outpatient β-lactam antimicrobial use in Canada, 1995 to 2010

2014 ◽  
Vol 25 (2) ◽  
pp. 107-112 ◽  
Author(s):  
Shiona K Glass-Kaastra ◽  
Rita Finley ◽  
Jim Hutchinson ◽  
David M Patrick ◽  
Karl Weiss ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Broad Spectrum ◽  
Population Data ◽  
Time Frame ◽  
Repeated Measurements ◽  
Antimicrobial Use ◽  
Defined Daily Doses ◽  
Canadian Provinces ◽  
Statistics Canada ◽  
Over Time

INTRODUCTION: β-lactam antimicrobials are the most commonly prescribed group of antimicrobials in Canada, and are categorized by the WHO as critically and highly important antimicrobials for human medicine. Because antimicrobial use is commonly associated with the development of antimicrobial resistance, monitoring the volume and patterns of use of these agents is highly important.OBJECTIVE: To assess the use of penicillin and cephalosporin antimicrobials within Canadian provinces over the 1995 to 2010 time frame according to two metrics: prescriptions per 1000 inhabitant-days and the average defined daily doses dispensed per prescription.METHODS: Antimicrobial prescribing data were acquired from the Canadian Integrated Program for Antimicrobial Resistance Surveillance and the Canadian Committee for Antimicrobial Resistance, and population data were obtained from Statistics Canada. The two measures developed were used to produce linear mixed models to assess differences among provinces and over time for the broad-spectrum penicillin and cephalosporin groups, while accounting for repeated measurements at the provincial level.RESULTS: Significant differences among provinces were found, as well as significant changes in use over time. A >28% reduction in broad-spectrum penicillin prescribing occurred in each province from 1995 to 2010, and a >18% reduction in cephalosporin prescribing occurred in all provinces from 1995 to 2010, with the exception of Manitoba, where cephalosporin prescribing increased by 18%.DISCUSSION: Significant reductions in the use of these important drugs were observed across Canada from 1995 to 2010. Newfoundland and Labrador and Quebec emerged as divergent from the remaining provinces, with high and low use, respectively.

Sign in / Sign up

Export Citation Format

Share Document