Chapter 1: Human Antimicrobial Drug Use Report 2012/2013 – Physician diagnosis data

Human Antimicrobial Drug Use Report 2012/2013

1. Physician Diagnosis Data

The Canadian Disease and Therapeutic index (CDTI) dataset provides information about the patterns and treatments of disease encountered by office-based physicians (specialists and general practitioners, including those with offices in hospitals). These data are presented over three geographic regions in Canada: West (British Columbia, Alberta, Saskatchewan, and Manitoba); Central (Québec and Ontario), and East (New Brunswick, Newfoundland and Labrador, Nova Scotia, and Prince Edward Island).

The sample of physicians represents all major specialties across Canada. Data from 652 physicians were available in 2013 and projection methods used to extrapolate data to the universe of approximately 55,092 physicians in Canada.

The information contained in this analysis is for drugs for which a physician has provided a recommendation or prescription, and does not represent actual prescriptions dispensed by pharmacists or consumed by the patient. These data do not include patient visits to a primary care nurse. Furthermore, diagnosis visits do not translate into the total number of patients, as some patients visited multiple times for the same reason, or were diagnosed with multiple diseases. Due to the methods of data collection, the sample size may be considered too small for decision making. However, this information is included in this analysis to provide a view of antimicrobial recommendation practices which may require further studies.

More detailed information on IMS Health Canada data collection and PHAC's analytic methods are described in Appendix A.

National Diagnosis Data

In 2013, Canadian physicians saw patients for >293 million diagnoses, and provided more than 23.8 million antimicrobial recommendations for these diagnoses (Table 1.1). This reflects approximately 82,800 diagnoses per 10,000 Canadian inhabitants, with 8% of all diagnoses resulting with an antimicrobial recommendation.

Antimicrobial recommendations by diagnostic class

In 2013, the diagnostic classes with the greatest number of antimicrobial recommendations / 10,000 inhabitants were upper respiratory tract infections (1,061 recommendations / 10, 000 inhabitants), lower UTI or cystitis (924 recommendations / 10,000 inhabitants), and diseases of the ear (703 recommendations / 10,000 inhabitants). Although these three diagnostic classes had the greatest number of recommendations, they differ from the diagnostic classes with the highest proportion of recommendations per diagnoses. Pneumonia and acute sinusitis had antimicrobial recommendations for 84.5% and 83.5% of diagnoses, respectively. Acute bronchitis had a recommendation rate of 77.9% (Table 1.1). Similarly, these were also the diagnostic classes with the highest rate of antimicrobial recommendation in 2012 (Table 1.2 and Appendix Table B.1).

Over the 2007 – 2013 time frame, the diagnostic classes with the greatest change in recommendation rates were the upper UTI or pyelonephritis (12.5% reduction), pneumonia(9.4% increase), chronic sinusitis (6.3% reduction), and acne (6.0% reduction) (Table 1.2) (Figure 1.1).

The particular antimicrobial drug recommended varied by the class of diagnosis made (Table 1.3). These data display that for particular diagnostic classes (e.g., diseases of the ear, upper respiratory tract infections) a single antimicrobial was recommended at a much higher rate than others. Conversely, diagnostic classes such as chronic sinusitis and acute bronchitis have no single "preferred" drug. No major changes were observed in the recommendation rates for the specific diagnosis-drug combinations with the exception of the use of levofloxacin for treating pneumonia. The recommendation rate of levofloxacin dropped from 25 recommendations / 10,000 inhabitants in 2011 to 9 recommendations / 10,000 inhabitants in 2012. In 2013, the rate was 28 recommendations / 10,000 inhabitants.

**Table 1.1:** Total number of office-based diagnoses, diagnosis rate, total number of antimicrobial recommendations, antimicrobial recommendation rate, and percentage of diagnoses with antimicrobial recommendations by office-based physicians in Canada, by diagnostic class, 2013¹.
Diagnostic Class	Total diagnoses	Number of diagnoses / 10,000 inhabitants	Antimicrobial recommendations (N)	Number of antimicrobial recommendations / 10,000 individuals	Percentage of diagnoses with antimicrobial recommendations
Acne	2211530	623.97	452240	127.60	20.45
Acute bronchitis	2844550	802.57	2214510	624.81	77.85
Acute sinusitis	1644900	464.10	1373790	387.61	83.52
Chronic bronchitis	1114640	314.49	747200	210.82	67.04
Chronic sinusitis	1176910	332.06	608910	171.80	51.74
Disease of the gastrointestinal system	20372310	5747.93	1178850	327.74	5.79
Diseases of the ear	9686880	2733.10	2497020	702.96	25.78
Injuries and poisonings	13350560	3766.78	438040	123.59	3.28
Lower UTI or Cystitis	4755520	1341.74	3275220	924.08	68.87
Other diseases of the genitourinary system	14781490	4170.51	1467820	414.14	9.93
Other respiratory tract infections	16030240	4522.84	1190590	335.92	7.43
Other skin and soft tissue infections	16391170	4624.67	940590	212.56	5.74
Pneumonia	1258540	355.09	1062970	299.91	84.46
SSTIs	2815660	794.42	1816860	512.62	64.53
Symptoms and ill-defined conditions	21703010	6123.38	346580	92.58	1.60
Upper respiratory tract infections	11538380	3255.49	3760560	1061.02	32.59
TOTAL	293468260	82800.35	23778840	6709.06	8.10
1Data does not represent actual prescriptions dispensed by pharmacists or products consumed by the patient, as information on patient compliance was not available. Diagnosis does not represent the number of times a person visits, but represents every time a diagnosis is provided; if a person presents with multiple diseases each individual disease/diagnosis is recorded separately. Diagnostic classes were removed from this table if they represented < 1% of antimicrobial mentions in 2013. These classes were: complications of pregnancy, childbirth, and puerperium; congenital anomalities; diseases of the central nervous system; diseases of the circulatory system; diseases of the sense organs; endocrine, nutritional, metabolic, and immunity diseases; musculoskeletal diseases; neoplasms; perinatal conditions; supplementary classifications; and upper UTI or pyelonephritis.

**Table 1.2 : Percent of diagnoses receiving antimicrobial recommendations provided by office-based physicians in Canada by diagnostic class, by year, 2007–2013 1**
Diagnostic Class	2007	2008	2009	2010	2011	2012	2013	Rank^{Table 1.2 - Footnote *}
Acne	26.5	21.0	21.7	25.2	18.3	25.0	20.4	11
Acute bronchitis	78.9	77.3	80.9	85.1	82.1	77.0	77.9	4
Acute sinusitis	86.7	87.6	83.7	81.6	86.7	87.8	83.5	3
Chronic bronchitis	68.7	70.1	68.6	59.5	74.5	71.3	67.0	6
Chronic sinusitis	58.0	58.2	56.7	51.9	48.8	51.3	51.7	8
Complications of pregnancy, childbirth, and puerperal	1.0	2.1	4.5	4.1	4.9	4.1	5.1	16
Disease of the gastrointestinal system	4.6	4.8	5.1	5.3	5.0	5.9	5.7	15
Diseases of the ear	26.8	29.2	27.6	25.5	25.2	26.8	25.7	10
Lower UTI or Cystitis	73.5	73.3	76.0	69.3	68.3	67.3	68.9	5
Other diseases of the genitourinary system	6.4	6.9	6.6	10.3	9.8	9.7	9.9	12
Other respiratory tract infections	8.4	8.5	7.2	8.6	7.1	6.6	7.4	13
Other skin and soft tissue infections	2.7	3.1	2.9	4.4	3.7	4.1	4.6	17
Perinatal conditions	2.4	6.3	4.0	7.4	3.9	2.4	5.8	14
Pneumonia	75.0	80.9	77.3	84.8	76.6	82.1	84.5	2
SSTIs	58.6	59.9	64.9	62.1	60.6	65.2	64.5	7
Upper respiratory tract infections	35.1	32.1	31.2	31.5	33.3	32.8	32.6	9
Upper UTI or Pyelonephritis	97.0	74.0	^{Table 1.2 - Footnote *}	97.6	81.1	77.4	84.5	1
Footnote 1 1Data does not represent actual prescriptions dispensed by pharmacists or products consumed by the patient, as information on patient compliance was not available. Diagnosis does not represent the number of times a person visits, but represents every time a diagnosis is provided; if a person presents with multiple diseases each individual disease/diagnosis is recorded separately. Footnote * *Data for Upper UTI or Pyelonephritis in 2009 were removed due to obvious data recording errors Diagnostic classes were removed from this table if < 5% of visits resulted in an antimicrobial recommendation. These classes were: congenital anomalies; diseases of the central nervous system; diseases of the circulatory system; diseases of the sense organs; endocrine, nutritional, metabolic, and immunity diseases; injuries and poisonings; mental disorders; musculoskeletal diseases; neoplasms; supplementary classifications; and symptoms and ill-defined conditions. Ranked from highest rate of recommendation to lowest rate in 2013.

Figure 1.1. Percent of diagnoses that received an antimicrobial recommendation by office-based physicians in Canada, 2007, 2009, 2011 and 2013¹.

Footnote _f1_1

Data for Upper UTI or Pyelonephritis in 2009 were removed due to obvious data recording errors. Classifications were removed from this figure if antimicrobial recommendation occurred in < 5% of visits in 2013. These classifications were: complications of pregnancy, childbirth, and puerperium; congenital anomalies; diseases of the gastrointestinal system; diseases of the central nervous system; diseases of the circulatory system; diseases of the sense organs; endocrine, nutritional, metabolic, and immunity diseases; injuries and poisonings; mental disorders; musculoskeletal diseases; neoplasms; other diseases of the genitourinary system; other respiratory tract infections; other skin and soft tissue infections; perinatal conditions; supplementary classifications; and symptoms and ill-defined conditions.

Return to footnote_f1_1 Referrer

Text equivalent for figure 1Percent of diagnoses that received an antimicrobial recommendation by office-based physicians in Canada, 2007, 2009, 2011 and 2013

Disease Classification	2007	2009	2011	2013
	Proportion of diagnoses receiving an antimicrobial recommendation
Upper UTI	97.0%		81.1%	84.5%
Upper RTIs	35.2%	31.2%	33.3%	32.6%
SSTIs	58.6%	64.9%	60.6%	64.5%
Pneumonia	75.0%	77.3%	76.6%	84.5%
Lower UTIs	73.5%	76.0%	68.3%	68.9%
Diseases of the ear	26.8%	27.6%	25.2%	25.7%
Chronic sinusitis	58.0%	56.7%	48.8%	51.7%
Chronic bronchitis	68.7%	68.6%	74.5%	67.0%
Acute sinusitis	86.7%	83.7%	86.7%	83.5%
Acute bronchitis	78.9%	80.9%	82.1%	77.9%
Acne	26.5%	21.7%	18.3%	20.4%

**Table 1.3 : Number of antimicrobial recommendations by office-based physicians in Canada, by diagnostic class, antimicrobial and year (2007 – 2013) ¹**
Diagnostic Class	Antimicrobial recommended	Number of antimicrobial recommendations / 10,000 inhabitants
Diagnostic Class	Antimicrobial recommended	2007	2008	2009	2010	2011	2012	2013
Acute bronchitis	Amoxicillin	262	249	266	267	277	194	211
	Amoxicillin and enzyme inhibitor	124	124	96	121	139	155	160
	Ampicillin	114	132	102	92	94	87	134
	Azithromycin	69	85	65	72	69	60	52
	Cefaclor	18	17	19	16	17	8	15
	Other antimicrobials	102	71	79	68	58	57	53
	TOTAL	688	679	628	637	653	560	625
Acute sinusitis	Amoxicillin	104	110	110	106	124	120	154
	Clarithromycin	147	175	159	155	137	111	76
	Amoxicillin and enzyme inhibitor	30	34	35	24	42	25	35
	Moxifloxacin	54	45	47	50	49	54	32
	Azithromycin	48	50	38	25	34	40	29
	Other antimicrobials	133	102	122	90	90	59	61
	TOTAL	517	516	511	450	477	407	388
Chronic bronchitis	Clarithromycin	81	83	85	63	70	55	68
	Azithromycin	84	90	60	65	45	56	42
	Amoxicillin	66	64	44	33	31	58	42
	Moxifloxacin	37	39	30	29	42	33	25
	Amoxicillin and enzyme inhibitor	5	8	6	6	7	8	13
	Other antimicrobials	36	52	55	16	42	30	21
	TOTAL	309	336	279	212	237	239	211
Chronic sinusitis	Amoxicillin	51	46	75	51	56	62	44
	Clarithromycin	63	69	72	56	61	44	42
	Azithromycin	46	32	16	19	14	20	22
	Moxifloxacin	30	36	26	10	26	13	19
	Amoxicillin and enzyme inhibitor	31	29	39	19	15	24	19
	Other antimicrobials	45	33	53	38	21	29	26
	TOTAL	266	245	279	192	194	193	172
Diseases of the ear	Amoxicillin	303	390	380	373	362	386	431
	Cefprozil	76	81	60	56	66	71	66
	Clarithromycin	112	122	108	112	110	100	61
	Azithromycin	45	70	70	58	48	59	54
	Amoxicillin and enzyme inhibitor	51	41	33	39	31	44	35
	Other antimicrobials	97	84	84	48	44	31	56
	TOTAL	685	789	736	685	661	692	703
Lower UTI or Cystitis	Ciprofloxacin	467	460	471	454	437	465	426
	Nitrofurantoin	276	280	287	317	294	321	339
	Amoxicillin	34	38	36	27	33	33	42
	Norfloxacin	67	52	76	36	25	20	41
	Cephalexin	17	11	14	10	19	10	16
	Other antimicrobials	228	210	185	100	66	56	61
	TOTAL	1088	1051	1070	943	874	906	924
Pneumoniac	Clarithromycin	113	96	97	115	102	106	93
	Azithromycin	31	59	19	34	31	38	52
	Moxifloxacin	72	72	77	86	87	90	47
	Levofloxacin	25	37	25	13	25	9	28
	Amoxicillin	11	15	23	28	35	34	23
	Other antimicrobials	62	82	76	72	51	62	56
	TOTAL	314	361	317	349	331	338	300
Skin and soft tissue infections	Cephalexin	202	200	205	172	230	200	197
	Cloxacillin	73	91	69	79	59	64	59
	Amoxicillin	26	33	33	50	35	44	50
	Cefadroxil	13	31	33	15	18	36	49
	Clindamycin	26	19	39	46	26	23	38
	Other antimicrobials	168	151	178	158	142	141	121
	TOTAL	508	525	557	519	510	508	513
Upper UTI or Pyelonephritis	Ciprofloxacin	11	12	18	8	11	15	15
	Ceftriaxone	3	3	NR	5	6	4	2
	Amoxicillin	NR	NR	3	NR	NR	1	2
	Nitrofurantoin	NR	NR	NR	<1	NR	NR	2
	Ertapenem	NR	NR	NR	NR	NR	NR	1
	Other antimicrobials	9	2	9	10	3	6	NR
	TOTAL	23	18	30	23	20	26	20
Upper respiratory tract infections	Amoxicillin	596	523	567	520	560	494	537
	Clarithromycin	198	157	175	156	132	119	167
	Azithromycin	144	153	129	114	145	151	120
	Penicillin V	181	168	141	145	127	130	118
	Amoxicillin and enzyme inhibitor	15	29	32	19	28	25	36
	Other antimicrobials	188	154	137	111	137	127	83
	TOTAL	1322	1186	1181	1066	1129	1046	1061
Footnote 1 1Data does not represent actual prescriptions dispensed by pharmacists or products consumed by the patient, as information on patient compliance was not available. Diagnosis does not represent the number of times a person visits, but represents every time a diagnosis is provided; if a person presents with multiple diseases each individual disease/diagnosis is recorded separately.

Recommendations by age group and gender

The rate of antimicrobial recommendation varied in 2013 by the age and sex of the patient (Table 1.4). Although the number of diagnoses per 10,000 inhabitants was highest in the 65+ age group, this group was the least likely to receive an antimicrobial recommendation. Children aged 0-2 had the highest raw number of recommendations / 10,000 inhabitants, but children aged 3-9 had the highest percentage of diagnoses resulting in an antimicrobial recommendation.

Generally, children had a higher rate of antimicrobial recommendation than adults in 2013, and female patients were more likely to receive an antimicrobial recommendation than male patients (Table 1.4).

The class of antimicrobial recommended also varied in 2013 by the age of the patient (Figure 1.2). Children (i.e., age groups 0-2, 3-9) were more likely to receive a recommendation for penicillins or second generation cephalosporins than adults, while adults were more likely to receive quinolone or tetracycline recommendations than children. Recommendations for first generation cephalosporins were relatively similar among the age groups.

**Table 1.4 : Diagnosis rate, antimicrobial recommendation rate and percentage of diagnosis with antimicrobial recommendation provided by office-based physicians in Canada, by age and by gender, 2013¹**
Demographic (age or sex)	Number of diagnoses / 10,000 inhabitants	Number of antimicrobial recommendations / 10,000 individuals	Percentage of diagnoses with antimicrobial recommendations
Age group
0-2	113737.24	12344.61	10.13
3-9	56165.78	8644.25	15.39
10-19	49524.59	5569.25	11.20
20-39	66977.50	6413.98	9.57
40-59	92182.72	6091.54	6.59
60-64	134358.17	6640.77	4.94
65+	155558.50	7206.63	4.52
Unspecified	N/A	N/A	5.25
Sex
Female	103374.19	8012.90	7.75
Male	80064.97	5348.99	6.68
Unspecified	N/A	N/A	6.40
Footnote 1 1Data does not represent actual prescriptions dispensed by pharmacists or products consumed by the patient, as information on patient compliance was not available. Diagnosis does not represent the number of times a person visits, but represents every time a diagnosis is provided; if a person presents with multiple diseases each individual disease/diagnosis is recorded separately.

Figure 1.2. Total number of antimicrobial recommendations / 10,000 inhabitants provided by office-based physicians in Canada, by age and antimicrobial classification, 2013^{Footnote 1} ^{Footnote 2}.

Footnote _f1_2a

Data does not represent actual prescriptions dispensed by pharmacists or products consumed by the patient, as information on patient compliance was not available. Diagnosis does not represent the number of times a person visits, but represents every time a diagnosis is provided; if a person presents with multiple diseases each individual disease/diagnosis is recorded separately.

Return to footnote_f1_2a Referrer

Footnote _f1_2b

Antimicrobial classifications are displayed in Appendix C, Table C.1

Return to footnote_f1_2b Referrer

Text equivalent for figure 1.2Total number of antimicrobial recommendations / 10,000 inhabitants provided by office-based physicians in Canada, by age and antimicrobial classification, 2013

Antimicrobial Therapeutic Classification	Number of antimicrobial recommendations per 10,000 inhabitants, by age group
Antimicrobial Therapeutic Classification	0-2	3-9	10-19	20-39	40-59	60-64	65+
J01DB First-generation cephalosporins	352	357	492	534	498	602	567
J01F Macrolides, lincosamides and streptogramins	2427	1671	1019	1540	1625	2046	1551
J01X Other antimicrobials	110	59	534	825	740	550	999
J01CA & J01CR Penicillins with extended spectrum	6749	5562	2049	1461	1391	1141	1156
J01MA Quinolone antibacterials	0	52	198	1027	1080	1643	1954
J01DC Second-generation cephalosporins	1204	716	204	130	134	86	252
J01AA Tetracyclines	0	0	418	377	231	240	220
J01DD Third-generation cephalosporins	366	136	90	98	112	108	171

Recommendations by region

In 2013, the diagnosis rate, antimicrobial recommendation rate and percentage of diagnoses with antimicrobial recommendations varied by region in Canada (Table 1.5). The Eastern region had a higher number of diagnostic classes for which a higher rate of diagnosis and antimicrobial recommendations were provided. However, the Central region had more diagnostic classes with higher percentage of diagnoses with antimicrobial recommendations compared to the other two Canadian regions.

The “preferred” antimicrobial drug recommended for treating the different diagnoses seemed consistent across the regions, with the exception of three diagnoses: acute bronchitis, chronic bronchitis and chronic sinusitis (Table 1.6). Although the West and Central regions primarily recommended the same drug for the treatment of both acute bronchitis (clarithromycin) and chronic sinusitis (amoxicillin), the East region recommended a different drug for these two diagnoses (azithromycin and clarithromycin, respectively). These data display that for particular diagnostic classes (e.g. chronic sinusitis, upper respiratory tract infections, pneumonia and SSTIs) a single antimicrobial is recommended at a much higher rate than others.

Table 1.5 : Diagnosis rate, antimicrobial recommendation rate and percentage of diagnoses with antimicrobial recommendations provided by office-based physicians in Canada, by diagnostic class and region, 2013 ¹
Diagnostic Class	Region	Number of antimicrobial recommendations / 10,000 individuals	Number of diagnoses / 10,000 inhabitants	Percentage of diagnoses with antimicrobial recommendations
Acne	Central	141	670	21
	East	148	771	19
	West	97	500	19
Acute bronchitis	Central	691	916	75
	East	271	355	76
	West	570	675	84
Acute sinusitis	Central	444	503	88
	East	472	557	85
	West	258	366	71
Chronic bronchitis	Central	198	288	69
	East	323	559	58
	West	212	314	68
Chronic sinusitis	Central	157	282	56
	East	311	583	53
	West	170	377	45
Disease of the gastrointestinal system	Central	326	5389	6
	East	437	8929	5
	West	307	5768	5
Diseases of the ear	Central	810	2761	29
	East	578	4741	12
	West	519	2243	23
Injuries and poisonings	Central	113	3364	3
	East	117	2368	5
	West	147	4866	3
Lower UTI or Cystitis	Central	908	1262	72
	East	885	1459	61
	West	964	1475	65
Other diseases of the genitourinary system	Central	402	4097	10
	East	490	4601	11
	West	422	4223	10
Other respiratory tract infections	Central	284	4579	6
	East	624	5099	12
	West	375	4287	9
Other skin and soft tissue infections	Central	185	4460	4
	East	460	5118	9
	West	213	4844	4
Pneumonia	Central	355	395	90
	East	306	436	70
	West	191	259	74
SSTIs	Central	445	717	62
	East	460	687	67
	West	658	970	68
Upper respiratory tract infections	Central	999	3337	30
	East	1615	3576	45
	West	1064	3025	35
Footnote 1 1Data does not represent actual prescriptions dispensed by pharmacists or products consumed by the patient, as information on patient compliance was not available. Diagnosis does not represent the number of times a person visits, but represents every time a diagnosis is provided; if a person presents with multiple diseases each individual disease/diagnosis is recorded separately.

**Table 1.6 : Antimicrobial recommendation rate provided by office-based physicians in Canada, by diagnostic class, antimicrobial and region, 2013¹**
Diagnostic Class	Antimicrobial Recommended	Number of antimicrobial recommendations / 10,000 inhabitants
Diagnostic Class	Antimicrobial Recommended	West	Central	East
Acute bronchitis	Amoxicillin	107	155	59
	Clarithromycin	198	238	24
	Azithromycin	186	152	116
	Moxifloxacin	24	69	24
	Cefixime	5	3	48
	Other antimicrobials	49	75	0
	Total	570	691	271
Acute sinusitis	Amoxicillin	114	178	117
	Clarithromycin	42	97	47
	Amoxicillin and enzyme inhibitor	5	43	95
	Cefuroxime	5	26	94
	Azithromycin	31	26	48
	Other antimicrobials	62	74	70
	Total	258	444	472
Chronic bronchitis	Amoxicillin	36	48	12
	Clarithromycin	104	36	189
	Azithromycin	10	55	70
	Moxifloxacin	15	32	NR
	Cefuroxime	10	3	23
	Other antimicrobials	36	23	29
	Total	212	198	323
Chronic sinusitis	Clarithromycin	49	27	143
	Amoxicillin	51	41	36
	Amoxicillin and enzyme inhibitor	26	10	62
	Azithromycin	31	17	23
	Cefuroxime	5	14	24
	Other antimicrobials	8	47	23
	Total	170	157	311
Diseases of the ear	Amoxicillin	341	491	294
	Cefprozil	8	90	119
	Clarithromycin	57	67	23
	Azithromycin	34	65	47
	Amoxicillin and enzyme inhibitor	28	38	36
	Other antimicrobials	50	58	59
	Total	519	810	578
Lower UTI or Cystitis	Amoxicillin	26	52	24
	Ciprofloxacin	446	409	483
	Nitrofurantoin	340	340	319
	Norfloxacin	23	51	36
	Cephalexin	31	11	NR
	Other antimicrobials	99	46	23
	Total	964	908	885
Pneumonia	Clarithromycin	72	96	166
	Azithromycin	21	68	47
	Moxifloxacin	26	61	23
	Levofloxacin	22	32	23
	Amoxicillin	23	26	NR
	Other antimicrobials	27	72	46
	Total	191	355	306
SSTIs	Cephalexin	349	117	223
	Amoxicillin	59	43	67
	Clindamycin	77	17	47
	Cloxacillin	48	69	12
	Clarithromycin	28	24	43
	Other antimicrobials	97	174	69
	Total	658	445	460
Upper UTI or Pyelonephritis	Ciprofloxacin	16	16	NR
	Ceftriaxone	5	NR	NR
	Nitrofurantoin	5	NR	NR
	Amoxicillin	NR	3	NR
	Ertapenem	NR	1	NR
	Total	26	20	0
Upper respiratory tract infections	Amoxicillin	554	481	961
	Azithromycin	72	131	238
	Clarithromycin	238	133	153
	Penicillin V	43	161	72
	Amoxicillin and enzyme inhibitor	47	29	48
	Other antimicrobials	109	63	142
	Total	1064	999	1615

1 Data does not represent actual prescriptions dispensed by pharmacists or products consumed by the patient, as information on patient compliance was not available. Diagnosis does not represent the number of times a person visits, but represents every time a diagnosis is provided; if a person presents with multiple diseases each individual disease/diagnosis is recorded separately.

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Date modified:: 2015-05-08

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