Canadian Journal of Public Health

, Volume 101, Issue 4, pp 304–308 | Cite as

Trends in Antibiotic Utilization in Vancouver Associated With a Community Education Program on Antibiotic Use

  • Elaine Isabelle Fuertes
  • Bonnie Henry
  • Fawziah Marra
  • Hubert Wong
  • David M. PatrickEmail author
Quantitative Research



“Do Bugs Need Drugs” (DBND) is a community education program that was implemented in British Columbia (BC) in September 2005 to decrease inappropriate antibiotic use. This study conducted descriptive analyses of the association between DBND and changes in overall, pediatric, drug-specific, and indication-specific antibiotic utilization rates in Vancouver, BC.


Utilization data on all oral solid and liquid antibiotics classified as “antibacterials for systemic use” were obtained from BC PharmaNet for the years 1996 to 2008. Utilization data were linked to physician billing data to allow indication-specific analyses. Following conversion to the defined daily dose (DDD), the Holt-Winters exponential smoothing method was used to project expected antibiotic use in the period after implementation based on use prior to implementation. Differences between expected and observed utilization rates were calculated.


Overall antibiotic use has stabilized in recent years (16.2 DDD/1000 population/day in 2008). Fluoroquinolone use remains high (1.5 DDD/1000 population/day), as does the steadily increasing use of newer macrolides (1.1 to 2.7 DDD/1000 population/day between 1996 and 2008). Encouraging declines in overall and indication-specific prescription rates among children were observed. Following 3 years of DBN. activities, antibiotic use was 5.8% lower than expected and the number of prescriptions dispensed to children was 10.6% lower than expected.


This ecological study reports improvements in antibiotic use that occurred simultaneously to the delivery of the DBND program in Vancouver. However, we did not find a lowering of all targeted classes. Policy directives limiting the use of certain antibiotics may be required.

Key words

Antibiotics intervention studies pediatrics macrolides 



Le programme d’éducation communautaire «Do Bugs Need Drugs» (DBND) mis en œuvre en Colombie-Britannique (C.-B.) en septembre 2005 vise à réduire l’utilisation inappropriée des antibiotiques. Nous avons mené des analyses descriptives de l’association entre ce programme et les changements dans les taux d’utilisation des antibiotiques (taux globaux, pédiatriques, par médicament et par indication thérapeutique) à Vancouver, en C.-B.


Nous avons obtenu auprès du réseau pharmaceutique de la C.-B., BC PharmaNet, des données sur tous les antibiotiques oraux sous forme solide et liquide classifiés comme «antibactériens pour un usage systémique » entre 1996 et 2008. Les données d’utilisation ont été maillées aux données de facturation des médecins pour permettre une analyse par indication thérapeutique. Après conversion des données en doses quotidiennes définies (DQD), nous avons employé la méthode de lissage exponentiel Holt-Winters pour projeter l’utilisation escomptée des antibiotiques durant la période post-mise en œuvre d’après leur utilisation antérieure à la mise en œuvre. Nous avons calculé l’écart entre les taux d’utilisation escomptés et observés.


L’utilisation globale des antibiotiques s’est stabilisée ces dernières années (16,2 DQD/1000 hab./jour en 2008). L’utilisation de fluoroquinolone demeure élevée (1,5 DQD/1000 hab./jour), et l’utilisation des nouveaux macrolides s’accroît de façon soutenue (1,1 à 2,7 DQD/1000 hab./jour entre 1996 et 2008). Nous avons observé des baisses encourageantes dans les taux de prescription globaux et par indication pour les enfants. Après trois années d’activité du programme DBND, l’utilisation des antibiotiques était 5,8 % plus faible que prévu et le nombre d’ordonnances délivrées aux enfants était 10,6 % plus faible que prévu.


Cette étude écologique fait état d’améliorations dans l’utilisation des antibiotiques simultanément avec la prestation du programme DBN. à Vancouver. Nous n’avons toutefois pas constaté une baisse dans toutes les catégories ciblées. Des directives limitant l’utilisation de certains antibiotiques pourraient être nécessaires.

Mots clés

antibiotiques études interventionnelles pédiatrie macrolides 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Department of Communicable Disease Surveillance and Response. WHO Global Strategy for Containment of Antimicrobial Resistance. Geneva, Switzerland: World Health Organization, 2001.Google Scholar
  2. 2.
    Rasool N, Fuertes E, Vrbova L, Patrick DM. Antimicrobial Resistance Trends in the Province of British Columbia. Vancouver, BC: BC Centre for Disease Control, 2008.Google Scholar
  3. 3.
    Patrick DM, Hutchinson J. Antibiotic use and population ecology: How you can reduce your “resistance footprint”. CMAJ 2009;180(4):416–21.CrossRefGoogle Scholar
  4. 4.
    Ball P, Cars O, File TM, Garau J, Klugman K, Low DE, et al. Antibiotic therapy of community respiratory tract infections: Strategies for optimal outcomes and minimized resistance emergence. J Antimicrob Chemother 2002;49:31–40.CrossRefGoogle Scholar
  5. 5.
    Fishman N. Antimicrobial stewardship. Am J Med 2006;119(6):S53–S61.CrossRefGoogle Scholar
  6. 6.
    Paskovaty A, Pflomm JM, Myke N, Seo SK. A multidisciplinary approach to antimicrobial stewardship: Evolution into the 21st Century. Int J Antimicrob Agents 2005;25:1–10.CrossRefGoogle Scholar
  7. 7.
    Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev 2005;4:CD003539.Google Scholar
  8. 8.
    Ranji SR, Steinman MA, Shojania KG, Gonzales R. Interventions to reduce unnecessary antibiotic prescribing. A systematic review and quantitative analysis. Med Care 2008;46(8):847–62.CrossRefGoogle Scholar
  9. 9.
    Finch RG, Metlay JP, Davey PG, Baker LJ. Educational interventions to improve antibiotic use in the community: Report from the International Forum on Antibiotic Resistance (IFAR) Colloquium, 2002. Lancet Infect Dis 2002;4:44–53.CrossRefGoogle Scholar
  10. 10.
    Goossens H, Guillemot D, Ferech M, Schlemmer B, Costers M, van Breda M, et al. National campaigns to improve antibiotic use. Eur J Clin Pharmacol 2006;62:373–79.CrossRefGoogle Scholar
  11. 11.
    Levy AR, O’Brien BJ, Sellors C, Grootendorst P, Willison D. Coding accuracy of administrative drug claims in the Ontario Drug Benefit Database. Can J Clin Pharmacol 2003;10:67–71.PubMedGoogle Scholar
  12. 12.
    WHO Collaborating Centre for Drug Statistics Methodology, Oslo. ATC/DDD Index, 2009. Available at: (Accessed January 10, 2009).
  13. 13.
    British Columbia Stats. Population Demographics, 2009. Available at: (Accessed December 10, 2008).Google Scholar
  14. 14.
    International Classification of Diseases, 9th Revision, Clinical Modification. American Medical Association, 1997.Google Scholar
  15. 15.
    Marra F, Patrick DM, Chong M, Bowie WR. Antibiotic use among children in British Columbia, Canada. J Antimicrob Chemother 2006;58:830–39.CrossRefGoogle Scholar
  16. 16.
    Kalekar PS. Time Series Forecasting Using Holt-Winters Exponential Smoothing. Kanwal Rekhi School of Information Technology, 2004.Google Scholar
  17. 17.
    Marcusson LL, Frimodt-Moller N, Hughes D. Interplay in the selection of fluoroquinolone resistance and bacterial fitness. PloS Pathog 2009;5:e1000541.CrossRefGoogle Scholar
  18. 18.
    Kastner U, Guggenbichler JP. Influence of macrolide antibiotics on promotion of resistance in the oral flora of children. Infect Control Hosp Epidemiol 2001;29(5):251–56.Google Scholar
  19. 19.
    Karlowsky JA, Hoban DJ, DeCorby MR, Laing NM, Zhanel GG. Fluoro-quinolone-resistant urinary isolates of Escherichia coli from outpatients are frequently multidrug resistant: Results from the North American Urinary Tract Infection Collaborative Alliance-Quinolone Resistance Study. Antimicrob Agents Chemother 2006;50(6):2251–54.CrossRefGoogle Scholar
  20. 20.
    Kozyrskyj AL, Carrie AG, Mazowita GB, Lix LM, Klassen TP. Decrease in antibiotic use among children in the 1990s: Not all antibiotics, not all children. CMAJ 2004;171(2):133–36.CrossRefGoogle Scholar
  21. 21.
    MacDougall C, Polk RE. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev 2005;18:638–56.CrossRefGoogle Scholar
  22. 22.
    Marra F, Patrick DM, White R, Ng H, Bowie WR, Hutchinson JM. Effect of formulary policy decisions on antimicrobial drug utilization in British Columbia. J Antimicrob Chemother 2005;55(1):95–101.CrossRefGoogle Scholar
  23. 23.
    Nebot M. Health promotion evaluation and the principle of prevention. J Epidemiol Community Health 2006;60:5–6.PubMedPubMedCentralGoogle Scholar

Copyright information

© The Canadian Public Health Association 2010

Authors and Affiliations

  • Elaine Isabelle Fuertes
    • 1
  • Bonnie Henry
    • 1
    • 2
  • Fawziah Marra
    • 1
    • 2
  • Hubert Wong
    • 1
    • 3
  • David M. Patrick
    • 1
    • 2
    Email author
  1. 1.University of British ColumbiaVancouverCanada
  2. 2.British Columbia Centre for Disease ControlVancouverCanada
  3. 3.CIHR Canadian HIV Trials NetworkVancouverCanada

Personalised recommendations