National retrospective study of regional prescriber-specific variation in community antibiotic prescribing Canada,...

Antimicrobial resistance (AMR) is a growing public health challenge in Canada and globally, largely driven by unnecessary or suboptimal antimicrobial use (AMU). Effective responses require regionally tailored solutions that reflect local prescribing patterns, healthcare infrastructure and stewardship capacity. Understanding interprovincial and prescriber-type based variations in antibiotic prescriptions is essential to promoting judicious prescribing and strengthening focused stewardship efforts.

To examine outpatient antibiotic prescribing trends across Canadian provinces and prescriber types from 2019 to 2023, and to identify potential targets for antimicrobial stewardship interventions.

This retrospective observational study used IQVIA's Geographic Prescription Monitoring database to analyse outpatient antibiotic prescriptions dispensed between 1 January 2019 and 31 December 2023. Prescription rates were stratified by province, prescriber specialty and AWaRe classification. Negative binomial regression models were adjusted for age, sex, population size, year and seasonality.

Antibiotic prescribing varied significantly across provinces, with Prince Edward Island (PEI) and Newfoundland and Labrador (NFLD) combined showing the highest rates and British Columbia (BC) the lowest. Rates declined during the COVID-19 pandemic (2020-2021), followed by a partial rebound (2022-2023); some provinces, such as Alberta and PEI/NFLD, remained below prepandemic levels. Quebec had the highest adjusted use of Reserve antibiotics (incidence rate ratio, IRR=1.31), while BC had the lowest (IRR=0.81). Family physicians accounted for 60.0% of prescriptions; dentists and pharmacists contributed 13% and 6%, respectively. Fluoroquinolone use declined by 29.7%, while beta-lactamase inhibitor prescribing rose 20.3% postpandemic. Respiratory infections accounted for 54.6% of prescriptions, followed by urinary (12.7%) and skin infections (12.0%).

Substantial variation in prescribing patterns across provinces and provider types highlights opportunities for tailored antimicrobial stewardship initiatives. Expanding stewardship to include non-physician prescribers and region-specific strategies will be key to improving AMU and addressing AMR in Canada.