UPDATE: MARCH 2007:
Bugs and Drugs Reference Guide
The new 2006
Bugs and Drugs Reference Guide is now available through Capital Health and Bizworx. To order your copy, please contact Bizworks:
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BACKGROUND:
The driving force in the development of antibiotic resistant micro-organisms is the widespread use of antibiotics in hospitals and outpatient settings. An urgent need exists for less frequent use and more appropriate selection of antimicrobial drugs, especially for infections of the respiratory tract.

While antibiotics have unquestionable benefit, often these agents are used inappropriately by physicians, nurse-practitioners, and the public. Inappropriate use results from physicians providing antibiotics to treat viral infections, using inadequate diagnosis, unnecessarily prescribing broad-spectrum agents, and not following established recommendations for infection prevention. It is also likely that patients (or parents of ill children) contribute to antibiotic misuse by pressuring physicians to provide treatment or by failing to take the full course of their prescription.

General practitioners and family medicine practitioners are responsible for about 80 per cent of the antimicrobial prescriptions in Canada. Yet individual physicians may not be aware of the impact that each can have on minimizing antibiotic resistance both in the inpatient and outpatient settings.

The use of antibiotics has caused more and more bacteria to become resistant to the same elements that once defeated them.

In health care institutions in particular, the inappropriate use of antimicrobials has been estimated to occur in more than 50% of cases.

Good stewardship implies a careful assessment of the actual need and selection of an agent, its dose and duration.

The vast majority of infections for which physicians prescribe antibiotics are diseases of the respiratory or genitourinary systems, skin and sense organs. However, most of these infections, particularly respiratory and ear infections, are caused by viruses for which antibiotics have no effect. Antibiotics prescribed for viral infections are wasted and directly contribute to increasing resistance rates. A study on antibiotic prescribing for Canadian preschool children revealed that 51% of 66,419 antibiotic prescriptions were unncessary.

A recent study of antibiotic prescribing for children in Ontario indicates that urgent care physicians are significantly more likely than pediatricians or family physicians to prescribe immediate antibiotics and to disregard guidelines when dealing with complaints of acute otitis media (middle ear infection).

Overall, physicians must become more selective when deciding whether and for how long to prescribe antibiotics for the three most common conditions that accounted for more than 80 per cent of antibiotic prescriptions: acute otitis media, pharyngitis and bronchitis.

Physicians sometimes acquiesce to requests from patients ("The daycare won't take my child back unless she's on antibiotics&") and prescribe antibiotics without sufficient indication that a bacterial infection is present.

Medical practitioners can have an immediate effect on limiting antibiotic resistance. The following tips provided by the Alliance for Prudent Use of Antibiotics (APUA) can help:

• Do not accede to patients' demands for unneeded antibiotics.
• When possible, prescribe antibiotics that target only a narrow range of bacteria.
• Isolate hospital patients with multidrug-resistant infections.
• Familiarize yourself with local data on antibiotic resistance.