Nearly 1 in 2 Ontario seniors prescribed unnecessary antibiotics: study

Over half of senior patients who showed symptoms of a common cold to their family physician were prescribed antibiotics, a new study says.
Over half of senior patients who showed symptoms of a common cold to their family physician were prescribed antibiotics, a new study says. Getty Images

Almost half of all seniors in Ontario have been prescribed unnecessary antibiotics for non-bacterial infections, according to a new study by the Institute for Clinical Evaluative Sciences (ICES) and Lawson Health Research Institute.

According to researchers, nearly one in two seniors have been told to take antibiotics by their family doctor to treat viral infections like the common cold, bronchitis, sinusitis and laryngitis. These needless prescriptions, researchers say, are contributing to the growing concern of antibiotic resistance.

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“About 46 per cent of people who were felt by their physician to not have a bacterial upper respiratory tract infection still received a prescription for an antibiotic,” says Dr. Michael Silverman, author of the study, and Lawson scientists and chair and chief of Infectious Diseases for London Health Sciences Centre at St. Joseph’s Health Care London and Western University. “We know that antibiotics can be associated with significant side effects, increased health-care costs and emergence of antibiotic resistance — and guidelines discourage the practice and yet still, there’s still such a high percentage were receiving [unnecessary] antibiotics.”

Silverman believes this is something that isn’t only unique to Ontario, but to the rest of Canada, and even across the world, as well.

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The team looked at 185,014 low-risk seniors in Ontario (65 years and older) who visited 8,990 primary care physicians in 2012 for non-bacterial upper respiratory infections, and for whom antibiotics would not be clinically appropriate as a treatment option.

“The reason we looked into seniors is not because we think that the problem is particular to seniors but because we thought that it would be easier to study the issue with seniors,” Silverman explains. “In Ontario, medications for seniors are covered [by the province] so we can see who fills a prescription and who didn’t. Whereas, if we looked into younger people, we would not necessarily know who got a prescription because younger people tend to pay into private insurance or pay on their own, therefore, we wouldn’t have had a large database.”

According to the findings, 53 per cent of patients who had visited with a common cold were prescribed antibiotics, as well as 31 per cent of bronchitis patients, 14 per cent with sinusitis and two per cent with laryngitis.

In fact, these types of viral illness can only often be treated with supportive measures, Silverman points out.

“If it’s truly viral — and the vast majority of those are — then the kinds of things your grandmother told you like, ‘More rest and fluids and low doses of acetaminophen,’ may be helpful. But really, we don’t have a cure for the common cold or laryngitis, but the good news is, almost everyone will recover,” Silverman says.

As well, about 70 per cent of the prescriptions were for broad-spectrum antibiotics, which are linked to other harmful outcomes including C. difficile, diarrhea, heart problems, tendon ruptures, allergic reactions and more — not to mention the development of antibiotic resistance.

Even though the research team only focused their research on seniors, they believe the results are representative of what happens in the general population. However, Silverman admits that they don’t know that for sure.

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The study also found that the physicians who tend to prescribe these medications have several things in common including: practicing medicine for over a decade, training outside of Canada and the U.S., as well as having higher patient volumes within their practices.

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The next steps, Silverman says, is to engage in targeted interventions with the aim of reducing inappropriate antibiotic prescribing, which would require an understanding of the physician factors associated with this practice.

“We hope that people take away the importance of understanding that antibiotics are not completely benign, that they have potential side effects, and that they be reserved for only when they are absolutely needed,” Silverman says. 

The study was published Monday in the Annals of Internal Medicine.

According to the 2016 Canadian Antimicrobial Resistance Surveillance System Report by the Public Health Agency of Canada, antimicrobial resistance continues to be a serious concern in Canada, as well as internationally.

While micro-organisms (especially bacteria) naturally develop resistance over time as they evolve, the report states the resistance is accelerated by the “excessive and/or unnecessary use of antimicrobial drugs used to treat bacterial infections.”

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