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Impact of Antibiotic Administrative Restrictions on Trends in Antibiotic Resistance

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Abstract

Context

In March 2001, in response to concerns about increasing resistance to fluoroquinolone (FQ) antibiotics, the Ontario Drug Benefit (ODB) program limited reimbursement of FQs to ODB beneficiaries defined as high risk or in whom other therapies are not tolerated.

Objective

To analyze the impact of the limited use (LU) policy changes on antibiotic resistance rates in Ontario, focussing on community-acquired pathogens.

Design

Ontario data submitted to the Canadian Bacterial Surveillance Network (CBSN) between January 1, 1998 and June 30, 2002 were analyzed for rates of resistance in various pathogen-antibiotic combinations. The effect of the LU policy on the level and rate of change of antibiotic resistance was estimated using time series models.

Results

Resistance rates for S. pneumoniae were 10-12% for penicillin, erythromycin and trimethoprim sulfamethoxazole (TMP/SMX) and less than 3% for amoxicillin and all three FQs tested. There was a statistically significant increasing trend in resistance rates of S. pneumoniae to amoxicillin and levofloxacin throughout the study period. Antibiotic resistance of S. pneumoniae to ciprofloxacin indicated a statistically significant decreasing trend over the study period with a statistically significant increase in the level of antibiotic resistance at the time of the LU policy implementation. No other indication of any statistically significant decrease in resistance rates associated with the LU policy was found.

Conclusions

Although no direct cause and effect can be proven with these observational data, there is no evidence that the limited use policy to restrict fluoroquinolones decreased antibiotic resistance in any of the pathogen-antibiotic combinations tested.

Résumé

Contexte

En mars 2001, en réponse aux préoccupations soulevées par la résistance accrue aux fluoroquinolones (FQ), le Programme de médicaments de l’Ontario limitait le remboursement de ces antibiotiques aux seuls bénéficiaires qui présentent un risque élevé ou qui ne tolèrent pas d’autres thérapies.

Objectif

Analyser l’impact du changement d’orientation en faveur de l’usage limité (UL) sur les taux d’antibiorésistance en Ontario, en mettant l’accent sur les agents pathogènes acquis dans la communauté.

Conception

Nous avons analysé les données ontariennes introduites dans le Réseau canadien de surveillance des bactéries (RCSB) entre le 1er janvier 1998 et le 30 juin 2002 pour obtenir les taux de résistance de diverses combinaisons d’agents pathogènes et d’antibiotiques. Nous avons évalué l’effet de la politique d’UL sur les niveaux et sur le taux de changement de l’antibiorésistance à l’aide de modèles en séries chronologiques.

Résultats

Les taux de résistance à S. pneumoniae variaient entre 10 % et 12 % pour la pénicilline, l’érythromycine et le triméthoprime-sulfaméthoxazole (TMP/SMX) et se situaient à moins de 3 % pour l’amoxicilline et les trois FQ testées. Nous avons observé une tendance à la hausse statistiquement significative dans les taux de résistance de S. pneumoniae à l’amoxicilline et à la lévofloxacine pendant toute la période d’étude. L’antibiorésistance de S. pneumoniae à la ciprofloxacine présentait une tendance à la baisse statistiquement significative sur la période d’étude, ainsi qu’une hausse significative du niveau d’antibiorésistance lors de la mise en oeuvre de la politique d’UL. Aucune autre indication d’une baisse significative des taux de résistance associés à la politique d’UL n’a été relevée.

Conclusions

Ces données d’observation ne permettent pas de prouver l’existence d’un lien causal direct, mais rien n’indique que la politique d’usage limité des FQ a diminué l’antibiorésistance dans les combinaisons d’agents pathogènes et d’antibiotiques testées.

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Authors and Affiliations

  1. Health Economics and Outcomes Research, Innovus Research Inc., 1016-A Sutton Drive, Burlington, ON, L7L 6B8, Canada

    D. A. Marshall PhD, S. Simonyi BScN, RN & S. M. MacLeod MD, PhD

  2. Toronto Medical Laboratories and Mount Sinai Hospital, Department of Microbiology, University of Toronto, Canada

    A. McGeer MD, K. Green RN, CIC & D. E. Low MD

  3. Biostatistics, Innovus Research Inc., Burlington, Canada

    J. Gough MMath & M. Buitendyk MSc

  4. Faculty of Pharmacy, University of Toronto, Canada

    P. Grootendorst PhD

  5. Health Economics and Outcomes Research, Bayer HealthCare Inc., Toronto, Canada

    B. Jaszewski MBA

  6. British Columbia Research Institute for Children’s & Women’s Health, Vancouver, BC, Canada

    S. M. MacLeod MD, PhD

Authors
  1. D. A. Marshall PhD
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  2. A. McGeer MD
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  3. J. Gough MMath
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  4. P. Grootendorst PhD
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  5. M. Buitendyk MSc
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  6. S. Simonyi BScN, RN
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  7. K. Green RN, CIC
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  8. B. Jaszewski MBA
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  9. S. M. MacLeod MD, PhD
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  10. D. E. Low MD
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Corresponding author

Correspondence to D. A. Marshall PhD.

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Source of funding: Bayer HealthCare Inc.

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Marshall, D.A., McGeer, A., Gough, J. et al. Impact of Antibiotic Administrative Restrictions on Trends in Antibiotic Resistance. Can J Public Health 97, 126–131 (2006). https://doi.org/10.1007/BF03405330

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