Page 4: Human Antimicrobial Use Report – 2014 - Physician Diagnosis Data

Physician Diagnosis Data

The Canadian Disease and Therapeutic Index (CDTI) dataset was purchased from IMS Health Canada Inc. and analysed by the Government of Canada. This 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) and includes those treatments recommended during hospital rounds. 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. The data is collected using a two-stage stratified design, first stratifying by region and then by physician specialty. Data from 652 physicians were available in 2014, and projection methods were used to extrapolate data to a universe of approximately 57,218 physicians in Canada.

The information contained in this analysis is for drugs for which a physician has provided a recommendation and does not represent actual antibiotics consumed by the patient. Recommendations are not necessarily tied to a prescription as the patient may have been against receiving an antimicrobial prescription, may have not filled out a prescription due to physician orders to wait a period of time, may have chosen not to fill the prescription, the physician may have provided a sample or it represented the continuation of previous prescription renewals. These data do not include patient visits to a primary care nurse. Furthermore, diagnoses or recommendations 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 at a single visit. This information does not look at recommendations provided for multiple antibiotics to treat the individual diagnoses.

Due to the methods of data collection and extrapolation, the sample size may be considered too small for decision making purposes. Furthermore, although data are presented at the per-inhabitant level, these measures do not reflect every inhabitant; they are average values across the entire Canadian population. However, data from these analyses are included to provide a view of antimicrobial recommendation practices in Canada, and to allow experts and data users identify areas where further research may be required.

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

National diagnosis data

In 2014, Canadian physicians saw patients for more than 297 million diagnoses and provided more than 23 million antimicrobial recommendations for these diagnoses (Table 1.1). This was an increase of approximately 4 million diagnoses between 2013 and 2014, but a decrease of 0.8 million antimicrobial recommendations during this same time frame. In 2014, there were approximately 8.4 diagnoses made per inhabitant in Canada similar to that observed in 2013. Although a similar diagnosis rate was observed in 2014 compared to 2013, the percentage of diagnoses resulting in an antimicrobial recommendation decreased from 8.1% to 7.7%.

Similar to what was observed in 2013, the diagnostic classes with the greatest number of antimicrobial recommendations were upper respiratory tract infections (RTI) (10% of inhabitants receiving a recommendation), lower urinary tract infections (UTI) or cystitis (9% of inhabitants receiving a recommendation) and diseases of the ear (6% of inhabitants receiving a recommendation) (Table 1.1). This is not surprising as these were the 3 most common diagnoses. Therefore, it is expected that the raw number of recommendations would be high for these classes.  These classes may be areas to target for further research to assess the appropriateness of antibiotic recommendations. However, it should be noted that the data displayed here are not patient-level data, and therefore cannot be used to determine the proportion of appropriate or inappropriate recommendations.

The diagnostic rates of acute sinusitis, acute bronchitis, and pneumonia were much lower than the upper RTI, UTI, and diseases of the ear (Table 1.1 and Figure 1.1). However, these 3 conditions were the classes most likely to receive an antimicrobial recommendation upon diagnosis. This is likely due to severity of the patient presentation, and the potential for complications.

Figure 1.1: Number of specific diagnoses per inhabitant and the percentage of those diagnoses with recommendations for an antimicrobial in 2014

Figure 1.1
Figure 1.1 - Text Description
Figure 1.1: Number of specific diagnoses per inhabitant and the percentage of those diagnoses with recommendations for an antimicrobial in 2014
Diagnostic Class Diagnoses per inhabitant % diagnoses with recommendations
Acute bronchitis 0.07 76.79
Acute sinusitis 0.05 82.35
Diseases of the ear 0.25 25.12
Lower UTI or Cystitis 0.14 67.65
Pneumonia 0.03 73.62
SSTIs 0.08 63.32
Upper RTI 0.30 33.19
TOTAL 8.37 7.73

Antimicrobial recommendations by diagnostic class

Table 1.1: Number of diagnoses, diagnoses per inhabitant, number of antimicrobial recommendations, antimicrobial recommendations per 100 inhabitants, and percentage of diagnoses with antimicrobial recommendations by office-based physicians in Canada, by diagnostic class, 2014 Footnote 1
Diagnostic Class Total diagnoses Number of diagnoses per inhabitant Number of antimicrobial recommendations Antimicrobial recommendations per 100 inhabitants % diagnoses with antimicrobial recommendations

Diagnostic classes were removed from this table if they represented < 1% (230,000) of antimicrobial mentions in 2014. 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; perinatal conditions; supplementary classifications; and upper UTI or pyelonephritis.

Acne 2,070,210 0.06 410,590 1.16 19.83
Acute bronchitis 2,495,160 0.07 1,915,950 5.41 76.79
Acute sinusitis 1,594,820 0.05 1,313,390 3.71 82.35
Chronic bronchitis 1,119,540 0.03 786,330 2.22 70.24
Chronic sinusitis 1,373,910 0.04 820,100 2.32 59.69
Disease of the gastrointestinal system 20,896,550 0.59 1,101,390 3.11 5.27
Diseases of the ear 8,808,200 0.25 2,212,860 6.25 25.12
Injuries and poisonings 12,707,970 0.36 420,130 1.19 3.31
Lower UTI or Cystitis 4,798,090 0.14 3,245,770 9.16 67.65
Neoplasms 9,577,270 0.27 159,450 0.45 1.66
Other diseases of the genitourinary system 14,608,320 0.41 1,366,290 3.86 9.35
Other respiratory tract infections 16,169,390 0.46 1,183,150 3.34 7.32
Other skin and soft tissue infections 17,093,200 0.48 773,210 2.18 4.52
Pneumonia 1,225,990 0.03 902,620 2.55 73.62
SSTIs 2,977,890 0.08 1,885,520 5.32 63.32
Symptoms and ill-defined conditions 22,702,870 0.64 326,580 0.92 1.44
Upper respiratory tract infections 10,697,470 0.30 3,550,440 10.02 33.19
TOTAL 297,468,080 8.37 23,003,450 64.72 7.73

In 2014, the diagnostic class with the largest decrease in the percentage of diagnoses receiving an antimicrobial recommendation was pneumonia, decreasing from 85% in 2013 to 74% in 2014 (Table 1.2 and Figure 1.2). Although the percentage of upper UTI or pyelonephritis diagnoses resulting in an antimicrobial recommendation decreased from 97% in 2007 to 93% in 2014, there was an increase from 2013 to 2014 (85% to 93%). Similarly, the percentage of chronic sinusitis diagnoses resulting in an antimicrobial recommendation increased from 52% in 2013 to 60% in 2014. Over the 2007 – 2014 time frame acne had the greatest reduction in the percentage of diagnoses resulting in an antimicrobial recommendation, from 27% in 2007 to 20% in 2014 (Table 1.2 and Figure 1.2).

Table 1.2: Percent of diagnoses receiving antimicrobial recommendations provided by office-based physicians in Canada by diagnostic class and year from 2007 to 2014 Footnote 1
Diagnostic Class 2007 2008 2009 2010 2011 2012 2013 2014 RankTable 1.2 - Footnote *
Acne 26.5 21.0 21.7 25.2 18.3 25.0 20.4 19.8 11
Acute bronchitis 78.9 77.3 80.9 85.1 82.1 77.0 77.9 76.8 3
Acute sinusitis 86.7 87.6 83.7 81.6 86.7 87.8 83.5 82.4 2
Chronic bronchitis 68.7 70.1 68.6 59.5 74.5 71.3 67.0 70.2 5
Chronic sinusitis 58.0 58.2 56.7 51.9 48.8 51.3 51.7 59.7 8
Disease of the gastrointestinal system 4.6 4.8 5.1 5.3 5.0 5.9 5.7 5.3 14
Diseases of the ear 26.8 29.2 27.6 25.5 25.2 26.8 25.7 25.1 10
Diseases of the sense organs 2.4 3.5 3.3 1.6 2.2 2.2 1.9 3.5 16
Lower UTI or Cystitis 73.5 73.3 76.0 69.3 68.3 67.3 68.9 67.6 6
Other diseases of the genitourinary system 6.4 6.9 6.6 10.3 9.8 9.7 9.9 9.4 12
Other respiratory tract infections 8.4 8.5 7.2 8.6 7.1 6.6 7.4 7.3 13
Other skin and soft tissue infections 2.7 3.1 2.9 4.4 3.7 4.1 4.6 4.5 15
Pneumonia 75.0 80.9 77.3 84.8 76.6 82.1 84.5 73.6 4
SSTIs 58.6 59.9 64.9 62.1 60.6 65.2 64.5 63.3 7
Upper respiratory tract infections 35.1 32.1 31.2 31.5 33.3 32.8 32.6 33.2 9
Upper UTI or Pyelonephritis 97.0 74.0 Table 1.2 - Footnote - 97.6 81.1 77.4 84.5 93.0 1

Figure 1.2: Percent of diagnoses that received an antimicrobial recommendation by community physicians in Canada, 2007, 2010, 2013 and 2014Footnote 1

Figure 1.2
Figure 1.2 - Text Description
Figure 1.2: Percent of diagnoses that received an antimicrobial recommendation by community physicians in Canada, 2007, 2010, 2013 and 2014
Disease Classification 2007 2008 2009 2010 2011 2012 2013 2014
Upper RTIs 35.1 32.1 31.2 31.5 33.3 32.8 32.6 33.2
Upper UTI  97.0 74.0 119.0 97.6 81.1 77.4 84.5 93.0
SSTIs 58.6 59.9 64.9 62.1 60.6 65.2 64.5 63.3
Pneumonia 75.0 80.9 77.3 84.8 76.6 82.1 84.5 73.6
Lower UTI  73.5 73.3 76.0 69.3 68.3 67.3 68.9 67.6
Diseases of the ear 26.8 29.2 27.6 25.5 25.2 26.8 25.7 25.1
Chronic sinusitis 58.0 58.2 56.7 51.9 48.8 51.3 51.7 59.7
Chronic bronchitis 68.7 70.1 68.6 59.5 74.5 71.3 67.0 70.2
Acute sinusitis 86.7 87.6 83.7 81.6 86.7 87.8 83.5 82.4
Acute bronchitis 78.9 77.3 80.9 85.1 82.1 77.0 77.9 76.8
Acne 26.5 21.0 21.7 25.2 18.3 25.0 20.4 19.8

Diagnostic classes were removed from this table if they represented < 1% of antimicrobial mentions in 2014. 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; perinatal conditions; supplementary classifications; and upper UTI or pyelonephritis.

The total number of antimicrobial recommendations per 10,000 inhabitants decreased from 7,587 recommendations in 2007 to 6,494 recommendations/10,000 inhabitants in 2014 (data not shown). In particular, the lowest recommendation rates were observed in 2014 for acute bronchitis, acute sinusitis, diseases of the ear, lower UTI or cystitis, pneumonia and upper respiratory tract infections. These decreases could be due to a number of factors, including changes in the diagnoses provided by physicians or reduction in office visits by patients for those specific diagnoses.

The particular antimicrobial drugs recommended varied by the class of diagnosis (Table 1.3). These data display that for the majority of the diagnostic classes (e.g., diseases of the ear, upper RTI) a single antimicrobial was recommended at a much higher rate than others. This was an exception for acute bronchitis and lower UTI or cystitis, where the majority of the recommendations were for two specific antimicrobials – clarithromycin and azithromycin for acute bronchitis and ciprofloxacin and nitrofurantoin for lower UTI or cystitis (Table 1.3). Between 2013 and 2014 recommendation rates for azithromycin for treating acute bronchitis decreased from 1.4% to 0.8% of inhabitants, while amoxicillin and enzyme inhibitor recommendations increased from 0.2% to 0.4% of inhabitants receiving recommendations. Other changes between 2013 and 2014 observed included increases among recommendation rates of amoxicillin and enzyme inhibitor for treatment of chronic bronchitis (0.2% to 0.4% of inhabitants receiving recommendations), while decreases among norfloxacin for treatment of lower UTI or cystitis (0.4% to 0.2%) and azithromycin for treating pneumonia (0.5% to 0.2%) were observed (Table 1.3).

Table 1.3: Number of antimicrobial recommendations per 10,000 inhabitants by office-based physicians in Canada, by diagnostic class and antimicrobial from 2007 to 2014 Footnote 1, Footnote 2
Diagnostic Class Antimicrobial Recommended Number of antimicrobial recommendations per 10,000 inhabitants
2007 2008 2009 2010 2011 2012 2013 2014
Acne Minocycline 110 83 80 89 54 82 62 50
Doxycycline 10 8 19 12 15 18 17 19
Cephalexin 9 13 13 9 10 16 13 17
Tetracycline 43 22 19 29 18 19 14 13
Cefadroxil NR NR 2 2 NR 2 3 3
Other antimicrobials 19 26 28 18 17 18 19 13
TOTAL 190 151 160 159 114 155 129 116
Acute bronchitis Clarithromycin 265 252 269 270 280 196 213 195
Azithromycin 125 125 97 123 141 156 162 134
Amoxicillin 115 133 103 93 95 88 135 77
Moxifloxacin 70 86 65 73 70 60 53 46
Amoxicillin and enzyme inhibitor 8 12 6 11 14 8 15 37
Other antimicrobials 113 77 93 73 62 57 54 52
TOTAL 694 685 634 643 661 566 632 541
Acute sinusitis Amoxicillin 105 111 111 107 125 121 155 131
Clarithromycin 149 176 161 157 138 112 77 78
Amoxicillin and enzyme inhibitor 31 34 35 24 43 25 35 52
Azithromycin 49 51 38 26 34 41 29 26
Moxifloxacin 55 46 48 51 50 54 33 23
Other antimicrobials 134 103 123 91 91 59 62 61
TOTAL 522 521 515 454 482 412 392 371
Chronic bronchitis Clarithromycin 82 84 86 64 71 55 68 70
Azithromycin 84 91 60 66 46 57 43 46
Amoxicillin 67 65 44 33 31 58 42 36
Moxifloxacin 37 39 30 30 42 33 25 31
Amoxicillin and enzyme inhibitor 5 8 6 6 7 8 13 16
Other antimicrobials 36 52 55 16 42 30 21 21
TOTAL 312 339 282 214 239 242 213 222
Chronic sinusitis Amoxicillin 51 47 75 51 57 62 45 75
Amoxicillin and enzyme inhibitor 31 30 39 19 16 25 19 41
Clarithromycin 63 70 72 56 61 45 42 39
Azithromycin 46 32 16 19 15 21 22 29
Cefuroxime 7 9 17 8 8 6 12 15
Other antimicrobials 69 60 62 41 39 36 34 33
TOTAL 268 248 282 194 196 195 174 232
Diseases of the ear Amoxicillin 306 394 384 377 366 391 436 394
Clarithromycin 114 123 109 113 111 101 62 48
Amoxicillin and enzyme inhibitor 51 42 33 39 31 45 35 46
Cefprozil 77 82 60 56 67 72 67 44
Azithromycin 46 71 71 58 48 60 55 30
Other antimicrobials 98 85 85 49 45 32 56 63
TOTAL 692 796 743 692 669 700 711 625
Lower UTI or Cystitis Ciprofloxacin 472 465 476 458 442 470 431 418
Nitrofurantoin 278 282 290 320 297 324 342 343
Amoxicillin 35 39 37 27 33 34 42 43
Sulfamethoxazole and trimethoprim 175 171 146 42 7 15 12 20
Norfloxacin 67 53 77 36 26 20 41 19
Other antimicrobials 72 52 55 69 80 53 66 72
TOTAL 1099 1061 1081 953 884 916 935 916
Pneumonia Clarithromycin 114 97 98 116 103 107 95 83
Moxifloxacin 73 72 78 87 88 91 48 54
Amoxicillin 11 15 23 29 35 34 24 27
Levofloxacin 26 37 25 13 25 10 28 22
Azithromycin 31 60 19 35 31 38 52 20
Other antimicrobials 63 83 77 73 52 63 57 49
TOTAL 317 365 320 353 334 342 303 255
SSTIs cephalexin 204 202 207 174 232 203 199 227
Amoxicillin 26 33 33 50 36 44 50 54
Cloxacillin 74 91 70 79 60 65 60 43
Clindamycin 26 19 40 47 27 23 38 40
Amoxicillin and enzyme inhibitor 20 25 25 36 34 30 21 28
Other antimicrobials 162 158 188 137 128 149 151 140
TOTAL 513 530 562 524 516 514 519 532
Upper UTI or Pyelonephritis Ciprofloxacin 11 12 19 8 12 15 15 7
Ceftriaxone 3 3 NR 5 6 4 2 3
Cephalexin 2 NR NR NR NR 2 NR 2
Trimethoprim NR NR NR NR NR NR NR 1
Amoxicillin NR NR 3 NR NR 1 2 NR
Other antimicrobials 8 2 9 10 3 5 2 NR
TOTAL 24 18 31 23 21 26 21 12
Upper respiratory tract infections Amoxicillin 602 528 573 525 567 500 543 505
Clarithromycin 200 159 176 158 133 120 169 136
Azithromycin 145 155 131 116 146 153 121 118
Penicillin v 183 170 142 147 129 131 120 111
Amoxicillin and enzyme inhibitor 15 30 32 19 28 26 36 38
Other antimicrobials 189 155 138 112 139 128 84 94
TOTAL 1334 1197 1192 1076 1142 1058 1073 1002

Recommendations by age group and gender

The rate of antimicrobial recommendations varied in 2014 by age and gender of the patient (Table 1.4). As expected, the highest numbers of diagnoses per inhabitant were seen at the lowest and highest age groups. Although 15.4 diagnoses per inhabitant were observed in the 65+ age group, this group was the least likely to receive an antimicrobial recommendation; likely due to an increased number of diagnoses for chronic conditions not requiring antimicrobial treatment. Children aged 0-2 had a slightly lower diagnosis rate (11.3 diagnoses per inhabitant), but were the age group most likely to receive an antimicrobial recommendation; nearly 9 out of 10 inhabitants in this age group received a recommendation in 2014.  In contrast, children aged 3-9 had a diagnosis rate half that of the 0-2 age group and were slightly less likely to receive an antimicrobial recommendation (3 out of 4 inhabitants in this age group receiving a recommendation).

In 2014, the number of diagnoses per individual decreased among all age groups with the exceptions of adults between the ages of 40 and 59 years (3% increase) and 60-64 years (2% increase). Simultaneous reductions were observed in the number of antimicrobials recommended per inhabitant, with the highest decreases observed among the 0-2 (29% decrease), 3-9 (13% decrease) and 10-19 (9%) age groups. A 2% decrease was observed in the percentage of diagnoses among the 0-2 and 3-9 age groups resulting in an antimicrobial recommendation.

Table 1.4: Diagnosis rate, antimicrobial recommendation rate and percentage of diagnoses with antimicrobial recommendations provided by office-based physicians in Canada, by age and by gender, 2014 Footnote 1
Demographic Diagnoses per inhabitant Number of antimicrobial recommendations per inhabitant Percentage of diagnoses with antimicrobial recommendations
Age Group
0-2 11.3 0.9 7.8
3-9 5.6 0.8 13.5
10-19 4.9 0.5 10.3
20-39 6.6 0.6 9.6
40-59 9.5 0.6 6.1
60-64 13.7 0.7 5.1
65+ 15.4 0.7 4.5
Unspecified  N/A   N/A  6.3
Gender
Female 10.4 0.8 7.2
Male 8.1 0.5 6.4
Unspecified  N/A   N/A  7.9

The choice of antimicrobial recommended varied by age of the patient in 2014 (Figure 1.3), as in previous years of surveillance. Children aged 0 to 19 years were more likely to receive a recommendation for a penicillin than any other antimicrobial class. While penicillins were among the most common recommendations for adults (20+), adults were more likely to receive a quinolone or "other antibacterials" recommendation than children. Recommendations for macrolides, second-, and third-generation cephalosporins were relatively similar among the age groups (Figure 1.3).

From 2013 to 2014, recommendation rates for the 0-2 age group changed (data not shown); large reductions occurred for the second-generation cephalosporins (10% to 1.6% of the population in this age group receiving a recommendation) and third-generation cephalosporins (3.2% to <1%), while increases were observed for penicillins (58.6% to 68.2%). Recommendation rates for second-generation cephalosporins increased among the 60-64 age group over the same time frame (1.3% to 3.1% of the population in this age group receiving a recommendation) while recommendations for first-generation cephalosporins (9.1% to 7.3%) decreased during this time period (Figure 1.3).

Figure 1.3: Number of antimicrobial recommendations per 10,000 inhabitants provided by office-based physicians in Canada, by age and antimicrobial classification, 2014Footnote 1

Figure 1.3
Figure 1.3 - Text Description
Figure 1.3: Number of antimicrobial recommendations per 10,000 inhabitants provided by office-based physicians in Canada, by age and antimicrobial classification, 2014
0-2 3-9 10-19 20-39 40-59 60-64 65+

"Other antibacterials" include: daptomycin, fidaxomicin, fosfomycin, fusidic acid, linezolid, metronidazole, metronidazole and nystatin, nitrofurantoin, and vancomycin.

Aminoglycosides 22 7 0 0 18 49 10
Carbapenems 0 0 0 3 13 75 21
1st-generation cephalosporins 596 357 339 511 542 514 814
Macrolides 1829 1159 1109 1507 1440 1785 1333
Other antibacterials 77 60 329 828 709 668 1020
Penicillins 5981 5157 2344 1891 1393 1858 1452
Quinolone antibacterials 0 10 239 1042 1129 1497 1683
2nd-generation cephalosporins 147 494 170 134 186 216 226
Sulfonamides 0 43 15 30 32 0 52
Tetracyclines 0 0 431 301 264 235 129
3rd-generation cephalosporins 97 211 92 113 110 153 205
Trimethoprim 23 7 0 0 2 8 9

Recommendations by region

The diagnosis rate, antimicrobial recommendation rate and percentage of diagnoses with antimicrobial recommendations varied by region in Canada during 2014 (Table 1.5). The eastern region had a higher diagnosis rate compared to the central and western regions, consistent with previous years, but a lower percentage of diagnoses resulting with an antimicrobial recommendation than the central region. Over time, a consistent decrease in the percentage of diagnoses with an antimicrobial recommendation has been observed in the central region, while maintaining a constant diagnosis rate (Figure 1.4). These changes may reflect an increase in the diagnosis of chronic (non-infectious) conditions, and/or a move towards more prudent use.

In 2014, the eastern region had a much smaller diagnosis rate for acute bronchitis (2.8% of inhabitants receiving a diagnosis) compared to central (7.6% of inhabitants) and western Canada (6.8% of inhabitants). However, the eastern region had the highest percentage of acute bronchitis diagnoses resulting with an antimicrobial recommendation (Table 1.5). In contrast, the eastern region has a higher diagnosis rate for diseases of the ear (4.4% of the population) but a lower percentage of these diagnoses resulting with an antimicrobial recommendation (20%) (Table 1.5).

The "preferred" antimicrobial drug recommended for treating the different diagnoses seemed consistent across the regions, with the exception of acne, acute bronchitis, and chronic sinusitis (Table 1.6). While both the central and western regions most commonly recommend the use of minocycline for the treatment of acne, the eastern region most commonly recommended the use of amoxicillin or amoxicillin and enzyme inhibitor for treatment, both of which are not reported to be used in the other regions. Azithromycin was the preferred drug for treatment of acute bronchitis in both western and eastern regions, while clarithromycin is the most recommended antimicrobial in the central region, with azithromycin coming in second (Table 1.6). Although not used for treatment of acute sinusitis in the western and central regions, ciprofloxacin is the preferred antimicrobial used in the eastern region, representing more than half of the recommendations provided in that region.

Figure 1.4: Number of diagnoses and percentage of diagnoses with antimicrobial recommendations by region, 2007 to 2014

Figure 1.4
Figure 1.4 - Text Description
Figure 1.4: Number of diagnoses and percentage of diagnoses with antimicrobial recommendations by region, 2007 to 2014
area year Number of diagnoses
per 10,000 inhabitants
Percentage of diagnoses with
antimicrobial recommendations
West 2007 97305.12 7.89
2008 92924.24 7.78
2009 89521.11 7.41
2010 92828.36 6.36
2011 93008.96 6.66
2012 93047.45 6.68
2013 92592.26 7.05
2014 96849.23 6.53
Central 2007 87968.36 8.26
2008 87619.98 8.63
2009 86958.58 8.86
2010 94229.34 8.01
2011 91572.57 7.85
2012 90984.56 7.66
2013 91563.37 7.42
2014 90713.42 7.15
East 2007 116732.32 8.59
2008 117259.77 8.21
2009 114292.86 7.10
2010 117974.90 7.35
2011 116667.48 6.40
2012 115522.44 6.82
2013 112288.30 7.05
2014 111487.94 6.60
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, 2014 Footnote 1
Diagnostic Class Region Number of diagnoses per 10,000 inhabitants Number of antimicrobial recommendations per 10,000 inhabitants Percentage of diagnoses with antimicrobial recommendations
Acne Central 609 116 19
East 810 93 11
West 488 120 25
Acute bronchitis Central 762 589 77
East 278 227 82
West 681 514 75
Acute sinusitis Central 509 436 86
East 428 351 82
West 340 247 73
Chronic bronchitis Central 290 216 74
East 771 527 68
West 270 170 63
Chronic sinusitis Central 361 242 67
East 569 401 70
West 401 175 44
Diseases of the ear Central 2,433 653 27
East 4,358 873 20
West 2,194 517 24
Lower UTI or Cystitis Central 1,283 893 70
East 1,273 788 62
West 1,513 988 65
Pneumonia Central 363 290 80
East 315 226 72
West 319 192 60
SSTIs Central 776 493 63
East 937 690 74
West 946 576 61
Upper respiratory tract infections Central 3,113 996 32
East 2,276 1,044 46
West 2,995 1,005 34
Table 1.6: Antimicrobial recommendation rate provided by office-based physicians in Canada, by diagnostic class, antimicrobial and region, 2014 Footnote 1
Diagnostic Class Antimicrobial Recommended Antimicrobial recommendations per 10,000 inhabitants
West Central East
Acne Minocycline 48.0 56.2 -
Cephalexin 26.5 11.9 25.4
Tetracycline 21.4 10.5 -
Doxycycline 20.3 18.9 8.6
Clindamycin 1.9 - -
Amoxicillin - - 25.4
Amoxicillin and enzyme inhibitor - - 24.9
Other antimicrobials 1.7 18.9 8.2
Acute bronchitis Azithromycin 144.1 129.5 125.6
Clarithromycin 137.5 237.2 76.3
Amoxicillin 87.4 80.6 -
Amoxicillin and enzyme inhibitor 59.7 29.3 -
Moxifloxacin 29.5 58.6 -
Cefuroxime 16.0 18.3 -
Doxycycline 15.5 2.7 -
Cephalexin 5.4 - 25.4
Other antimicrobials 18.5 32.5 -
Acute sinusitis Amoxicillin 118.9 142.7 75.2
Azithromycin 37.4 20.8 25.4
Clarithromycin 37.0 98.3 75.8
Amoxicillin and enzyme inhibitor 16.2 74.0 24.9
Doxycycline 16.0 - -
Moxifloxacin 5.2 34.8 -
Ciprofloxacin - - 125.0
Cefixime - 18.9 -
Other antimicrobials 16.0 46.6 24.9
Chronic bronchitis Clarithromycin 65.8 61.4 175.9
Azithromycin 34.1 49.4 75.2
Amoxicillin 21.2 34.2 125.6
Cefuroxime 18.7 - -
Amoxicillin and enzyme inhibitor 10.6 21.0 -
Moxifloxacin - 42.2 75.8
Cefixime - - 74.7
Other antimicrobials 19.2 7.3 -
Chronic sinusitis Amoxicillin 47.7 86.0 101.2
Clarithromycin 37.0 30.3 125.6
Azithromycin 27.0 25.4 74.7
Cefuroxime 20.7 13.2 -
Amoxicillin and enzyme inhibitor 10.4 55.5 49.8
Other antimicrobials 32.4 31.4 49.8
Diseases of the ear Amoxicillin 325.0 418.0 503.4
Amoxicillin and enzyme inhibitor 55.4 38.2 75.2
Clarithromycin 47.7 50.1 25.4
Cephalexin 38.2 13.8 -
Azithromycin 18.7 27.4 101.2
Moxifloxacin 5.4 4.2 25.4
Cefprozil 5.2 63.8 49.8
Ciprofloxacin 5.2 12.9 38.4
Other antimicrobials 15.7 24.7 54.4
Lower UTI or Cystitis Ciprofloxacin 427.4 415.5 401.6
Nitrofurantoin 361.6 340.6 285.5
Amoxicillin 57.2 40.9 -
Sulfamethoxazole and trimethoprim 47.7 8.1 -
Cephalexin 35.1 8.2 -
Cefuroxime 5.4 1.2 50.9
Norfloxacin 5.2 25.8 25.4
Cefprozil - 2.8 24.9
Other antimicrobials 48.7 50.4 -
Pneumonia Clarithromycin 75.5 87.2 75.8
Azithromycin 28.3 13.2 50.3
Levofloxacin 27.0 22.1 -
Moxifloxacin 23.8 71.8 25.4
Amoxicillin 10.8 38.3 -
Cefixime - 2.7 24.9
Cefuroxime - 5.5 24.9
Ciprofloxacin - 10.1 24.9
Other antimicrobials 26.7 39.0 0.0
SSTIs Cephalexin 323.1 163.0 367.9
Clindamycin 81.0 21.1 25.4
Amoxicillin and enzyme inhibitor 37.4 26.4 -
Amoxicillin 28.5 56.2 149.9
Ceftriaxone 16.2 9.4 25.4
Cloxacillin 10.8 61.0 25.4
Minocycline 10.4 - 24.9
Ciprofloxacin 5.4 25.0 24.9
Cefadroxil - 44.4 -
Other antimicrobials 63.6 86.3 46.5
Upper respiratory tract infections Amoxicillin 493.0 496.4 638.6
Clarithromycin 201.1 112.7 49.8
Azithromycin 83.3 121.3 251.2
Penicillin v 71.9 143.6 -
Amoxicillin and enzyme inhibitor 50.4 30.2 50.3
Cefuroxime 16.0 7.9 15.5
Clindamycin 10.6 10.1 38.4
Other antimicrobials 78.8 74.2 -

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