Changing Prescription Practices to Limit Selection for Resistant Organisms: A Population and System Approach

To evaluate the effectiveness of a three-year BC pilot of “Do Bugs Need Drugs?”, a public and professional education program developed to reduce antibiotic use and the spread of resistant organisms.

To evaluate the effectiveness of a three-year BC pilot of “Do Bugs Need Drugs?”, a public and professional education program developed to reduce antibiotic use and the spread of resistant organisms.

Research Summary

The emergence of antibiotic resistant organisms is a major and growing health care problem. The spread of resistant organisms is a function both of natural selection caused by inappropriate use of antibiotics, and the spread of established resistant organisms in the population. “Do Bugs Need Drugs?” (DBND) is a professional and public education program that has been funded and will be deployed for three years in British Columbia to help address the issues of inappropriate use of antibiotics at the individual and population levels and reduce or reverse the spread of resistant organisms.

The research team will assess the effectiveness of the program, looking in particular at:

• the overall use of antibiotics in the ambulatory population of BC;
• the use of specific classes of antibiotics which are presently overused;
• the use of antibiotics for common infections where they are not required or indicated;
• trends in antimicrobial resistance in key indicator organisms;
• knowledge, attitudes and intended behaviour of the public and physicians who prescribe antibiotics.

By carefully measuring and analyzing the outcomes of this intervention, this team will provide the evidence base for assessing its effectiveness and for making future decisions regarding its use.

Research Results

Changes in public and prescriber knowledge, attitudes, and intended behaviour regarding antibiotic use and resistance were evaluated using pre and post assessments. Epidemiological analyses of drug utilization data (descriptive and time-series) combined with periodic linkages of PharmaNet and Medical Service Plan (MSP) data were used to assess changes in prescription patterns by indication. Trends in antimicrobial resistance in key indicator organisms were updated from various diagnostic laboratory sources. When appropriate, Ontario utilization and resistance rates were used for comparison.

Parents of children who underwent the Grade 2 educational component of the program demonstrated a 9.2% increase in knowledge that viral infections do not require antibiotic therapy. Physicians who participated in the Continuing Medical Education course reported prescribing an antibiotic to a patient presenting with acute bronchitis 16.4% less of the time post-course. Overall antimicrobial utilization rates remained stable over the two years the program was on-going (0.2 daily defined doses/1000 inhabitants/day decrease). Some Gram positive organisms demonstrated increasing resistance against erythromycin (i.e. Streptococcus pneumoniae), while others demonstrated stabilization of erythromycin resistance (i.e. Streptococcus pyogenes). Gram negative organisms, most notably the urinary tract pathogens, have demonstrated an increasing resistance to fluoroquinolones. Encouraging declines in prescription rates for both bronchitis and otitis media have been demonstrated through the efficient linkage of PharmaNet and MSP data.

The results of this evaluation suggest the program has stimulated positive changes in public and prescriber knowledge and behaviour regarding antibiotic utilization and resistance. Future program efforts will include increased awareness of proper antibiotic treatment for respiratory tract infections in adults, as the utilization trends continue to be quite high. The program will be expanding its efforts to incorporate educational sessions focused on urinary tract infections due to the growing resistance to fluoroquinolones. Discussions on formulary changes at the provincial and institutional level will continue due to the large impact of these decisions on utilization trends at the population level.