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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Impact of antibiotic administrative restrictions on trends in antibiotic resistance

D A Marshall1, A McGeer, J Gough

  • 1Health Economics and Outcomes Research, Innovus Research Inc., Burlington, ON. dmarshall@innovus.com

Canadian Journal of Public Health = Revue Canadienne De Sante Publique
|April 20, 2006
PubMed
Abstract

Insights

Ontario's limited use policy for fluoroquinolone (FQ) antibiotics did not decrease resistance rates in common pathogens. Analysis showed no evidence of reduced antibiotic resistance following the policy change.

Area of Science:

  • * Infectious Diseases
  • * Pharmacology
  • * Public Health Policy

Background:

  • * Growing concerns over fluoroquinolone (FQ) antibiotic resistance prompted policy changes in Ontario.
  • * The Ontario Drug Benefit (ODB) program restricted FQ reimbursement in March 2001 to high-risk patients or those intolerant to other treatments.

Purpose of the Study:

  • * To evaluate the impact of limited use (LU) policies on antibiotic resistance rates.
  • * Focus on community-acquired pathogens in Ontario.

Main Methods:

  • * Analysis of resistance rates from Canadian Bacterial Surveillance Network (CBSN) data (1998-2002).
  • * Time series models used to assess the effect of the LU policy on resistance trends.

Main Results:

  • * Streptococcus pneumoniae resistance to penicillin, erythromycin, and TMP/SMX ranged from 10-12%.
  • * Resistance to amoxicillin and FQs was under 3%.
  • * A significant increasing trend in S. pneumoniae resistance to amoxicillin and levofloxacin was observed.
  • * Ciprofloxacin resistance showed a decreasing trend, but a significant increase in resistance level occurred at policy implementation.
  • * No other significant decrease in resistance rates linked to the LU policy was found.

Conclusions:

  • * Observational data suggest no direct causal link between the FQ LU policy and decreased antibiotic resistance.
  • * The policy did not demonstrably reduce resistance in the tested pathogen-antibiotic combinations.

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