Antibiotic Prescribing: More than a Medical Decision

Nov 18, 2019 - Viewpoints

A special guest post from the Chief Public Health Officer of Canada, Dr. Therea Tam, on the importance of reducing unnecessary antibiotic use.

Antibiotic Prescribing: More than a Medical Decision

Nov 18, 2019 - Viewpoints

A special guest post from the Chief Public Health Officer of Canada, Dr. Therea Tam, on the importance of reducing unnecessary antibiotic use.

Antibiotics are critically important medications for treating serious and often life-threatening infections. Yet, the more we use antibiotics unnecessarily, the less effective they become as some bacteria develop resistance to the medications. This puts us all at greater risk of having infections that cannot be treated.

Antimicrobial resistance (AMR) is now one of the greatest health threats in the world. The rise in the number of antibiotic-resistant bacteria could eventually make many common medical treatments (such as C-sections, hip replacements, and chemotherapy) too dangerous to perform because of the increased risk of potentially untreatable infections. According to a recent report by the Canadian Council of Academies, an estimated 5,400 deaths, or close to 15 deaths each day, were due to antibiotic resistant infections in 2018.

My spotlight report from earlier this year looks at why antibiotics are prescribed unnecessarily, and how patients, providers, and health system leaders can help preserve antibiotic effectiveness in Canada.  This Antibiotic Awareness Week, I want to look back on one of my report’s key findings: the impact of patient-provider relationships on unnecessary or inappropriate prescribing practices.

A Decision Shaped by Relationships and Norms

The relationship that nurses, doctors, and other health care providers build with their patients is one of the most important predictors of antibiotic use. (CPHO Spotlight Report, 2019, p. 10)

For many patients, antibiotics represent a magic-bullet solution that can be used for any infection. Some patients arrive at clinics expecting to be prescribed antibiotics for all illnesses, which can create a challenging environment and can lead to misunderstandings and unnecessary prescribing. Building a trusting relationship with patients fosters clearer communication and an openness to discussing appropriate antibiotic use.

There are a number of strategies that can help foster this relationship:

  • Implement shared decision making in your practice. Understand your patients’ concerns and take the time to address them. When discussing treatment options, remember that antibiotic resistance is a complex problem. Your patients may not understand the risks and harms of unnecessary antibiotic use.
  • Explore using delayed or viral prescription pads. Choosing Wisely Canada provides free, downloadable viral prescription pads that help explain to the patient why they are not being prescribed antibiotics. These pads often describe other strategies that patients with viral infections can take to feel better.
  • Talk to your colleagues. Stay up to date on prescribing guidelines and make appropriate antibiotic practices the accepted norm in your clinic or practice.

Everyone has a role to play in addressing antimicrobial resistance in Canada. Changing the way you communicate about antibiotics with your patients is one of the ways you can personally contribute to tackling this important issue.

Encouraging Progress

I am encouraged by some of the progress we have made in Canada so far. The “Do Bugs Need Drugs” program in British Columbia has shown promising results in terms of decreasing antibiotic prescription rates. Other efforts, such as the newly released practice change recommendations for health professionals in long-term care settings, are good examples of health system leaders working together to promote positive antibiotic prescribing practices.

Despite positive progress, many challenges remain. Today, more than 50% of gonorrhoea infections in Canada are due to bacteria that are resistant to at least one antibiotic.

Greater education and awareness is needed to ensure that everyone understands the differences between viral and bacterial infections, and why antibiotics don’t work against viruses. A world without antibiotics is not a world we would wish on our children or grandchildren. Together, we can take action to preserve the infection-fighting ability of antibiotics now and into the future.

Learn more

For more information on preserving antibiotics now and into the future, visit There are many things that Canadians and health system leaders can do to help preserve antibiotic effectiveness that will protect our future health.

Dr. Theresa Tam
Chief Public Health Officer of Canada
Twitter: @CPHO_Canada