Abstract
Objective
“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.
Methods
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.
Results
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.
Conclusions
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
Résumé
Objectif
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.
Méthode
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.
Résultats
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.
Conclusion
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
Footnotes
Conflict of Interest: None to declare.
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