A population-based study of community antibiotic prescribing patterns in Alberta from 2010 to 2017: Implications for antibiotic stewardship.

OBJECTIVE

Develop a method for quantifying antibiotic consumption in the community and determine temporal trends in antibiotic prescribing for the most common clinical indications in Alberta residents aged 15 years and older.

METHOD: We developed an algorithm to link prescriptions in the practitioners claims database with antibiotic dispensations recorded in the pharmaceutical information system from 2010 to 2017. The antibiotic prescribing rate, measured as defined daily dose (DDD)/1000 persons/day, was stratified by age, sex, socioeconomic status, and clinical indication. Kendall's Tau was used to ascertain temporal trends.

RESULTS

In total, 9.3 million records were analyzed. The overall antibiotic prescribing rate was 10.09 DDD/1000 person-day (minimum 8.75/year, maximum 10.64/year) and remained stable over time. The highest rates were observed for senior females (13.92) and in the most deprived areas (10.44) with an increasing trend for the latter (28% increase from 8.59 in 2006 to 11.02 in 2017, P = 0.01). Acute bronchitis (1.01), acute sinusitis (0.97), acute cystitis (0.85), pharyngitis and tonsillitis (0.77), and cellulitis and abscess conditions (0.58) received the most antibiotic prescribing, with an increasing trend for cellulitis and abscess (26% increase [0.49 to 0.62], P = 0.02). In acute cystitis, ciprofloxacin and nitrofurantoin were the most prescribed, with an increasing trend for nitrofurantoin (71% increase [0.21 to 0.36], P < 0.01). Clarithromycin was the most prescribed in acute sinusitis and acute bronchitis, with a decreasing trend (47% [0.40 to 0.21] and 48% [0.58 to 0.30] decrease, respectively, P = 0.02). In pharyngitis and tonsillitis, amoxicillin was the most prescribed, with a stable rate over time. Cefalexin was the most prescribed in cellulitis and abscess, with an increasing trend (55% increase [0.20 to 0.31], P < 0.01).

CONCLUSION

Acute cystitis, upper respiratory tract, and skin and soft tissue infections warranted most antibiotic prescribing with an increasing trend for the latter. Information on area-, individual-, and prescriber-level drivers of antibiotic prescribing can improve antibiotic stewardship in the community.