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February 16, 2021

Local researchers contribute to nation-wide study on overprescribed, common antibiotic

It is expected that approximately 40% of infections will be resistant to treatment by 2050, directly resulting in 13,700 deaths each year. Those numbers tell an ominous story, but there is something that can be done to curb those estimates.

When treatments for microbials – including bacteria, fungi, parasites and some viruses – are overprescribed and overused, they become resistant to the antimicrobial drugs used to treat them. But by using antimicrobials only when they’re needed, the long-term effectiveness of these treatment options can be preserved.

“The development of resistant organisms and fewer new treatment options being created makes it increasingly important to protect the effectiveness of existing antimicrobials,” said Jacqueline Quail, an epidemiologist and senior researcher with the Saskatchewan Health Quality Council (HQC) and with the Saskatchewan office of the Canadian Network for Observational Drug Effect Studies (CNODES). “Proper stewardship is about appropriate usage and research is an extremely important part of that. You need to do the research to learn how to use drugs appropriately and that lends itself to the work that we are doing.”

CNODES is a distributed network of Canadian research centres that work together to respond to questions about the safety and effectiveness of drugs marketed in Canada. The Saskatchewan centre is located at HQC in Saskatoon.

CNODES researchers recently completed a project relating to antimicrobial stewardship that looked at improving and measuring the appropriate use of a drug called fluoroquinolone. The research found that this drug is being overprescribed and overused in instances where other treatments would have been better options.

Findings detailed the prescribing practices of fluoroquinolones for each province compared to what the rates if best practice guidelines were followed and helped identify areas that needed improvement, allowing the provinces to learn from each other on best practices.

In most cases, the research showed that fluoroquinolones were overprescribed, but Saskatchewan has some of the best fluoroquinolone prescribing practices in Canada.

Fluoroquinolones are a large group of broad-spectrum antibiotics commonly used to treat a variety of conditions including respiratory and urinary tract infections (UTIs), sinusitis, bronchitis and chest infections.

“If you have had any of these ailments, there is a good chance you have been treated by fluroquinolones,” Quail said, adding there are five different types of fluoroquinolones that are marketed in Canada including ciprofloxacin, moxifloxacin, levofloxacin, norfloxacin and ofloxacin. “They are a ‘heavy hitting’ antibiotic that can be used to treat serious infections when other antibiotics are not as effective. That is what makes them too valuable to overuse.

“That’s not to say fluroquinolones will necessarily be ineffective to those who have used them in the past, but it does highlight how everyone has a role to play when it comes to appropriately using these drugs.”

HQC participates in CNODES as part of its commitment to evaluate and monitor prescription drug usage, safety and effectiveness. HQC CEO Tracey Sherin said the work done with CNODES supports HQC’s mandate of helping make change happen faster for better health and health care in Saskatchewan.

“One of the ways we meet our mandate is through the research into the usage, safety and effectiveness of prescription drugs,” Sherin said. “Providing better care is synonymous with making sure Saskatchewan residents have the right treatment options available to them at the right time. This is important work that helps inform policy makers, care providers and patients on the safety and effectiveness of drugs.”

The request for CNODES to test fluoroquinolones was initiated by the Canadian Agency for Drugs and Technologies in Health (CADTH). There are multiple pieces of work to this CNODES project:

  • Prescribing patterns across Canada: There are best practice guidelines on how fluoroquinolones should be prescribed. This research offered a reality check on how closely these guidelines are followed, and identified which provinces need to improve for what conditions.
  • Prescribing patterns and effectiveness of fluoroquinolone antibiotics for uncomplicated urinary tract infection (UTI): This study found that fluroquinolones were the most common treatment options for simple UTIs and was associated with improved clinical outcomes, there are other antibiotics that can be used to effectively treat UTIs. Limiting the use of fluroquinolones to more severe health problems that only they can treat can slow the development of resistance to these drugs. For these reasons, the antibiotic is considered second-line treatment option, only being prescribed if a first-line option doesn’t work.
  • Prescribing patterns and effectiveness of fluoroquinolone antibiotics for acute bacterial exacerbation of chronic obstructive pulmonary disease (AE COPD) and acute bacterial sinusitis (ABS): This study looked at the prescribing patterns and effectiveness of fluoroquinolones in their treatment of the sudden worsening of simple chronic obstructive pulmonary disease (COPD) symptoms. By using these antibiotics, AE COPD patients didn’t have improved outcomes when they used these antibiotics during this study period, and the study’s findings supported current recommendations to limit the of fluoroquinolones to more complicated patients. The manuscript for the ABS research results is currently under review and hasn’t been publicly released yet.

For more information on CNODES, please visit https://hqc.sk.ca/news-and-events/hqc-blog/what-is-cnodes-and-what-does-it-do.