Using Antibiotics Wisely is a national campaign to help clinicians and patients engage in conversations about unnecessary antibiotic use. Current priorities for the campaign include addressing overuse in the community, where 92% of antibiotics are prescribed. This year, the campaign is focusing its efforts on antibiotics for acute upper respiratory tract infections in primary care, as well as asymptomatic bacteriuria in long-term care.
Since the launch of Using Antibiotics Wisely in 2017, Choosing Wisely Canada has worked with partners to produce a number of resources including posters, evidence-based tools, and patient materials. In addition to these resources, there are over 20 Choosing Wisely Canada recommendations that encourage judicious antibiotic use, created by over 15 national specialty societies.
Using Antibiotics Wisely is organized by Choosing Wisely Canada, with the support from Health Canada, Public Health Agency of Canada, as well as The College of Family Physicians of Canada, and aligns with the Pan-Canadian Framework on Antimicrobial Resistance.
Don’t prescribe antibiotics in vaccinated children more than 6 months old and adults in whom you suspect acute otitis media, unless there is either a perforated tympanic membrane with purulent discharge or a bulging tympanic membrane with one of the three following criteria:
In cases that do not fit these criteria, consider either no prescription with reassessment if symptoms do not improve, or a delayed prescription approach. Don’t misinterpret patient’s or parental concern for a desire for antibiotics. Symptom control and access to follow-up if needed are often what they are looking for.
Tools to Support Practice:
Common Myths:
Don’t routinely prescribe antibiotics unless the patient’s modified Centor score is > 2 AND throat swab culture (or rapid antigen test if available) confirms presence of Group A Streptococcus.
Don’t perform throat swabs at all for patients with Centor score ≤ 1, OR if there are symptoms of a viral infection such as rhinorrhea, oral ulcers or hoarseness.
Tools to Support Practice:
Common Myth:
Don’t prescribe antibiotics unless symptoms have persisted for greater than 7-10 days without improvement.
Differentiating viral rhinosinusitis (VRS) from acute bacterial rhinosinusitis (ABRS) can be challenging. Patients not meeting the below criteria are best managed with a viral prescription. Antibiotics should only be considered if the patient has at least 2 of the below PODS symptoms, one of those being O or D, AND the patient meets one of the following criteria:
P: Facial Pain/pressure/fullness; O: Nasal Obstruction;
D: Purulent/discolored nasal or postnasal Discharge; S: Hyposmia/anosmia (Smell)
Tools to Support Practice:
Don’t prescribe antibiotics for pneumonia unless there is objective evidence.
If access to a chest x-ray is available near your clinic, don’t routinely prescribe antibiotics for suspected pneumonia without confirming the presence of a new consolidation.
Physical examination alone, demonstrating respiratory crackles, is not sufficient to establish a diagnosis of pneumonia and initiate antibiotics in the majority of situations. Patients with no vital sign abnormalities and a normal respiratory examination are unlikely to have pneumonia and most likely don’t need a chest x-ray.
Tool to Support Practice:
Don’t routinely prescribe antibiotics for exacerbations of Chronic Obstructive Pulmonary Disease unless there is clear increase in sputum purulence with either increase in sputum volume and/or increased dyspnea
Common Myth:
Facts:
Don’t prescribe antibiotics unless there is clear evidence of secondary bacterial infection (see the recommendations for otitis media, pharyngitis, sinusitis, pneumonia).
Tools to Support Practice:
Common Myth:
Don’t prescribe antibiotics unless there is clear evidence of secondary bacterial infection (see the recommendations for otitis media, pharyngitis, sinusitis, pneumonia).
The use of antivirals is outside the scope of this campaign but we provide reference guidelines for clinicians to manage influenza illness in children and youth and adults. It is not recommended to test every individual meeting influenza case definition. These tests are only really useful at the beginning of an influenza season or outbreak or if they would alter management.
Tools to Support Practice:
Don’t prescribe antibiotics for bronchitis/asthma/bronchiolitis exacerbations.
Tool to Support Practice:
Common Myths:
Download the PDF version of Key Practice Statements to help you optimize your antibiotic prescribing.
Download Key Practice Statements
Please click below to download and print a PDF version of the Viral Prescription Pad and Delayed Prescription.
You can also integrate the Viral Prescription Pad and Delayed Prescription tools in your existing EMR. The e-forms and accompanying instructions were co-developed by OntarioMD and Choosing Wisely Canada in collaboration. For any questions related to these materials, please contact: info@choosingwiselycanada.org
Accuro EMR |
TELUS Health – PS Suite EMR |
OSCAR EMR |
Posters and prescription pads are now available in Simplified Chinese, Punjabi, and Spanish. Visit the College of Family Physician’s website to access these resources.
Don’t prescribe antibiotics for asymptomatic bacteriuria (ASB) in non-pregnant patients. Hospital medicine #2
Don’t treat adult cough with antibiotics even if it lasts more than 1 week, unless bacterial pneumonia is suspected (mean viral cough duration is 18 days). Respiratory medicine #4
Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present. Geriatrics #1
Don’t routinely prescribe intravenous forms of highly bioavailable antimicrobial agents for patients who can reliably take and absorb oral medications. Infectious disease #1
Don’t prescribe alternate second-line antimicrobials to patients reporting non-severe reactions to penicillin when beta-lactams are the recommended first-line therapy. Infectious disease #2
Don’t recommend antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present. Nursing #8
Don’t use antimicrobials to treat asymptomatic bacteriuria in the elderly. Urology #4
Do not treat asymptomatic urinary tract infections in catheterized patients. Physical medicine and rehabilitation #1
Don’t recommend antibiotics for infections that are likely viral in origin, such as an influenza-like illness. Nursing: Infection and Prevention Control #2
Don’t prescribe antibiotics after incision and drainage of uncomplicated skin abscesses unless extensive cellulitis exists. Emergency medicine #5
Don’t prescribe antibiotics in adults with bronchitis/asthma and children with bronchiolitis. Emergency medicine #2
Don’t routinely use antibiotics in adults and children with uncomplicated sore throats. Emergency medicine #8
Don’t use antibiotics in adults and children with uncomplicated acute otitis media. Emergency medicine #10
Don’t treat adult cough with antibiotics even if it lasts more than 1 week, unless bacterial pneumonia is suspected (mean viral cough duration is 18 days). Respiratory medicine #4
Don’t prescribe antibiotics for asymptomatic bacteriuria (ASB) in non-pregnant patients. Hospital medicine #2
Don’t use antibiotics for acute asthma exacerbations without clear signs of bacterial infection. Respiratory medicine #6
Don’t order peri-operative antibiotics beyond a 24-hour post-operative period for non-complicated instrumented cases in patients who are not at high risk for infection or wound contamination. Administration of a single pre-operative dose for spine cases without instrumentation is adequate. Spine #5
Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present. Geriatrics#1
Don’t routinely prescribe intravenous forms of highly bioavailable antimicrobial agents for patients who can reliably take and absorb oral medications. Infectious disease #1
Don’t prescribe alternate second-line antimicrobials to patients reporting non-severe reactions to penicillin when beta-lactams are the recommended first-line therapy. Infectious disease #2
Don’t recommend antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present. Nursing #8
Don’t use antimicrobials to treat asymptomatic bacteriuria in the elderly. Urology #4
Do not treat asymptomatic urinary tract infections in catheterized patients. Physical medicine and rehabilitation #1
Don’t recommend antibiotics for infections that are likely viral in origin, such as an influenza-like illness. Nursing: Infection and Prevention Control #2
Don’t start or prolong broad-spectrum antibiotic treatment unless clinically indicated. Hospital Pharmacy Recommendation #4
We have developed a communications toolkit to help you share information about the Using Antibiotics Wisely campaign. This toolkit includes social media posts, graphics, and direct links to resources to support your communication efforts of the campaign.
Download Communications Toolkit
