Ontario Investigates Public Health Issues: Why Do Some Doctors Prescribe Antibiotics More Often Than Others?

Bacteria which causes infections and are non-responsive to common antibiotics are the result of antibiotic resistance. The biggest issue in public health is that some doctors prescribe antibiotics when they shouldn’t, contributing to antibiotic resistance, explains a physician at the Public Health Ontario, Dr. Kevin Schwartz:

“The single biggest driver of that resistance is the number of antibiotics that we use.”

Dr. Schwartz works in antimicrobial stewardship and infection prevention and control at the Public Health Ontario.

The Public Health Agency of Canada found that the biggest amount of antibiotics used is in the community and not the hospital, 65% of them being prescribed by family physicians or dentists.

In Canada, there are almost 625 antibiotic prescriptions per 1,000 people. However, there are huge differences between provinces (B.C 546 per 1,000 people, Newfoundland and Labrador 956 per 1,000, with Mississauga having the second highest rate).

Carrying with the abundant prescriptions, the ability to treat future infections will lower, making current drugs less effective, explained Schwartz:

“The most common reason why those procedures don’t work and never worked historically were because patients would develop complications and those can be fatal. And the most common one would be an infection.”

Why So Many Prescriptions?

A physician could prescribe more antibiotics than others for different reasons.

Schwartz noticed that it all depends on different factors like age, the severity of the illness or the patient who expects to get an antibiotic. Prescriptions also vary with periods – busy or less busy days, or with the season – winter versus summer. There is also the difference between a walk-in clinic or a patient that goes to their regular family doctor.

Schwartz believes that “the theory and the likely explanation for that is it’s physician habit. It’s the way that this doctor has always prescribed.”

What Schwartz cannot yet understand is why the physicians in Erie-St-Clair and Mississauga prescribe so many antibiotics. He hasn’t seen a factor like the difference of income, urban versus rural center, and so on, thus concluding that: “there are certain physicians who have historically prescribed a lot of antibiotics.”

Ontario is planning to begin a study with this flu season and take a similar approach used in the U.K and Australia – the Public Health officials sent letters to physicians that prescribe many antibiotics and lets them know that they’re doing it more often than other physicians. This approach reduced up to 9-12% of the antibiotics prescribed by the physicians.

Schwartz concluded that they would also have to learn which is the optimal level of prescribing before issuing a limit, adding that antibiotics are life-saving:

“Obviously antibiotics are critical, life-saving, important medications and we want patients to be getting them appropriately. But what we don’t want is people with viral illnesses that are going to get better anyway to be getting antibiotics. We also certainly don’t want people who need the antibiotics to not be getting them.”

Doris’s passion for writing started to take shape in college where she was editor-in-chief of the college newspaper. Even though she ended up working in IT for more than 7 years, she’s now back to what he always enjoyed doing. With a true passion for technology, Doris mostly covers tech-related topics.