Outpatient Antibiotic Dispensing Trends Across Canadian Provinces, 2012-2022: A Population-Based Descriptive Study

Outpatient antibiotic prescribing represents the principal source of antimicrobial exposure in Canada and a key modifiable driver of antimicrobial resistance (AMR). Prescribing patterns vary across provinces and population groups and are influenced by stewardship initiatives as well as major system-level disruptions, including the COVID-19 pandemic.

The objective of this study is to descriptively synthesize publicly available Canadian surveillance and pharmacoepidemiologic data on outpatient antibiotic dispensing trends from 2012 to 2022, with emphasis on temporal trends, interprovincial variation, age-specific prescribing patterns, and antibiotic class distribution.

A population-based ecological descriptive study was conducted using publicly available Canadian surveillance and pharmacoepidemiologic data sources. This study was designed as a descriptive ecological synthesis of aggregated publicly available data rather than an original longitudinal analysis using individual-level or complete province-level microdata. The primary unit of analysis was the province-year, and antibiotic utilization was expressed as prescriptions per 1,000 population. Data were derived from the Public Health Agency of Canada, the Canadian Antimicrobial Resistance Surveillance System (CARSS), Statistics Canada population estimates, and the National Prescription Drug Utilization Information System (NPDUIS). Analyses were descriptive and stratified by age group and antibiotic class. Given limitations in the availability of complete longitudinal province-level microdata, formal regression and time-series analyses were not performed.

Outpatient antibiotic dispensing in Canada demonstrated an overall declining trend during the early study period, reaching 642 prescriptions per 1,000 population in 2013. A pronounced reduction in prescribing occurred during the COVID-19 pandemic, with a 26.5% decrease in community antibiotic dispensing during the first eight months of 2020 compared with expected pre-pandemic levels. Substantial interprovincial variation was observed in 2019, with rates ranging from 543 to 920 prescriptions per 1,000 population across provinces, representing more than a 1.6-fold difference. Age-stratified analyses indicated persistently higher antibiotic use among older adults, whereas reductions were more pronounced among children and working-age adults. Broad-spectrum agents, including fluoroquinolones and cephalosporins, remained important contributors to outpatient antibiotic utilization.

Between 2012 and 2022, outpatient antibiotic use in Canada was characterized by an early-period decline, substantial and persistent interprovincial variation, consistent age-related differences, and a marked reduction associated with the COVID-19 pandemic. These findings underscore the need for sustained, regionally tailored antimicrobial stewardship strategies, with particular focus on high-prescribing provinces, older adult populations, and optimization of broad-spectrum antibiotic use. Continued surveillance is essential to guide policy and support efforts to mitigate AMR.