Page 2: Human Antimicrobial Use Report – 2014
TO PROMOTE AND PROTECT THE HEALTH OF CANADIANS THROUGH LEADERSHIP, PARTNERSHIP, INNOVATION AND ACTION IN PUBLIC HEALTH.
— Public Health Agency of Canada
Également disponible en français sous le titre : Rapport sur l'utilisation de médicaments antimicrobiens chez les humains 2014
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© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2015
Publication date: November 2015
This publication may be reproduced for personal or internal use only without permission provided the source is fully acknowledged. However, multiple copy reproduction of this publication in whole or in part for purposes of resale or redistribution requires the prior written permission from the Minister of Public Works and Government Services Canada, Ottawa, Ontario K1A 0S5 or firstname.lastname@example.org.
Suggested citation: Government of Canada. Human Antimicrobial Use Report - 2014. Government of Canada, Guelph, Ontario, 2015.
These acknowledgements are intended to identify and thank the people that contributed to the success of this report.
Human Antimicrobial Use Surveillance Lead
- Rita FinleyFootnote a
- John Conly, University of Calgary
- Diana George, British Columbia Centre for Disease Control (BCCDC)
- Jim Hutchinson, University of British Columbia
- Fawziah Marra, University of British Columbia
- Warren McIsaac, College of Family Physicians of Canada, Mt. Sinai Hospital
- David Patrick, University of British Columbia, British Columbia Centre for Disease Control (BCCDC)
- Lynora Saxinger, University of Alberta Hospital
- Daniel Thirion, University of Montreal
- Karl Weiss, University of Montreal
Levels of antimicrobial use in Canada continue to remain relatively stable in both the community and hospital settings. In the community, a total of 6,494 antimicrobial recommendations per 10,000 inhabitants were provided in 2014 by office-based physicians for treatment, resulting in 6,467 antimicrobial prescriptions/10,000 inhabitants dispensed through community pharmacies. The majority of these recommendations were provided for the treatment of upper respiratory tract infections, lower urinary tract infections or cystitis and diseases of the ear. In 2014, on average, 63% of children (0-14 years), 58% of adults (15-59 years) and 86% of seniors (≥60 years) received an antimicrobial dispensed through the community pharmacy. While use was observed to be higher among seniors (60 years or older) compared to adults (15-59 years), the doses per prescriptions dispensed were lower. This could reflect differing disease pressures or be due to the elderly receiving lower doses for treatment as a result of declining renal function.
In 2014, 8% of all antimicrobial prescriptions dispensed were for parenteral products double that observed in 2010. This represents a total of 213 oral antimicrobials for every parenteral antimicrobial dispensed by community pharmacies. The ratio of oral to parenteral products purchased in the hospital was much smaller, where 57% of all products were purchased in an oral form. Large differences were observed between provinces in the rate of prescriptions dispensed for parenteral antimicrobials. The provinces of Québec, New Brunswick and Nova Scotia have higher dispensing rates than other provinces. The differences in magnitude are likely a reflection of differences in policies with respect to payment for outpatient parenteral drugs.
In both the community and hospital setting, the most commonly prescribed or purchased antimicrobials in 2014 were amoxicillin, ciprofloxacin and doxycycline, in addition to clarithromycin and amoxicillin and enzyme inhibitor in the community and azithromycin and ceftriaxone in the hospital setting. A total of 12 antimicrobials were identified as drugs of interest for resistant infections (DIRI) within the hospital setting. Of these, moxifloxacin and piperacillin-tazobactam products were purchased by hospitals at higher rates than the other DIRI. The purchasing of both meropenem and ertapenem has been gradually increasing over time since 2004. In 2014, the total amounts of gentamicin purchased decreased while purchases of tobramycin increased. This is due to problems with gentamicin supplies observed by hospitals during that year which lead to hospitals purchasing tobramycin instead.
Regional differences continue to be observed in the levels of antimicrobials dispensed through community pharmacies and purchased by hospitals. At the community level, the dispensing rates in Newfoundland and Labrador are more than 20% higher than Saskatchewan, the province with the next highest dispensing rate. However, in Québec, higher use of products infrequently used at the national level was observed, particularly for ertapenem, cefazolin, ceftriaxone, vancomycin and trimethoprim. Similarly, Manitoba continues to purchase more than 49% of antimicrobial doses compared to Nova Scotia (province with next highest purchasing rate). In 2014, Québec purchased 55% more doses of piperacillin-tazobactam than the next highest purchasing province (British Columbia).
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