The Public Health Agency of Canada (PHAC) has released the 2012/2013 Human Antimicrobial Drug Use Report.
Why write about this on a site dedicated to zoonotic diseases and diseases of animals? For a few different reasons, actually. One is that we have to realize that antibiotics (and bacteria) don’t care if drugs are used on animals or people, just that they are used. Antimicrobial use in any species can select for resistance, and some of those resistant bugs like to move between species. Therefore, antibiotic use in animals can lead to problems in humans, and (while often ignored), antibiotic use in humans can lead to problems in animals.
The PHAC report is a big document (with lots of pretty graphs) and I can’t do it justice in a couple of paragraphs, so if you’re interested in this area, take a look at it yourself via the link above. Here are some highlights from the executive summary:
- In 2013, office-based physicians saw patients for more than 293 million diagnoses, resulting in 23.8 million antimicrobial recommendations (8% of all diagnoses).
- A total of 22.8 million antimicrobial prescriptions were dispensed through pharmacies representing 202,000 kilograms of active ingredient.
- Pneumonia and acute sinusitis had the highest percentage of all diagnoses resulting with an antimicrobial recommendation (85% and 84%, respectively).
- Children between the ages of 3 and 9 years had the highest percentage of diagnoses with an antimicrobial recommendation, consisting mostly of penicillins or macrolides.
- Overall levels of prescriptions and costs associated with antimicrobials dispensed through community pharmacies have decreased consistently since 2011.
- Although the most commonly prescribed antimicrobials for 2013 were amoxicillin, ciprofloxacin and azithromycin, prescription rates for nitrofurantoin, moxifloxacin and azithromycin have shown dramatic changes between 2000 and 2013.
- Overall prescription rates for oral antimicrobials have not shown dramatic changes between 2010 and 2013 while increases have been seen in the volume of parenteral [injectable] products dispensed through outpatient pharmacies. However, the volume of antimicrobials for parenteral administration remained low relative to the volume of oral products; in 2013 there were more than 260 oral prescriptions dispensed for each parenteral antimicrobial prescription at the national level.
- In 2013, antimicrobial use was highest among the youngest (0-5 years) and oldest (65+) age groups with the youngest (0 to 5 years) group having observed the greatest prescription rate decline between 2010 and 2013. However, in 2013, levels of use in children between 0 and 5 years was 30% (230 prescriptions/1,000 inhabitants) more than what was observed in the general population (872 compared to 642 prescriptions/1,000 inhabitant).
- Regional differences were observed in the diagnoses and antimicrobial recommendation rates, as well as overall levels of use and cost associated with antimicrobial prescriptions. The province of Newfoundland and Labrador displayed the highest levels of use for all measures, with use 30% higher than that reported for the second highest province (Saskatchewan).
- Looking at specific antimicrobials, Newfoundland and Labrador had the lowest levels of use for vancomycin, while Québec had the highest use for cefadroxil, cefprozil, ertapenem, minocycline, moxifloxacin, penicillin v and vancomycin.
- The total mass of active ingredient purchased by hospitals was highest in Manitoba and lowest in Québec, while the cost was lowest in Ontario and highest in British Columbia. The higher levels of purchased antimicrobials in Manitoba was due to ceftriaxone purchasing.
So, where are the corresponding use data for animals? Unfortunately, for the most part in Canada, they don’t exist. Tracking of overall antibiotic use in animals is poor and that hampers efforts to improve use and better understand the relationship between use and resistance. Being able to effectively and accurately track antibiotic use (and resistance) in both humans and animals is critical, but lacking.