Antibiotic Wisely

Using Antibiotics Wisely

Every year, over 25 million antibiotic prescriptions are written for human consumption in Canada, 30-50% of which are estimated to be unnecessary.

The overuse of antibiotics is a major contributor to antibiotic resistance and is threatening our ability to treat common infectious diseases. New resistance mechanisms are emerging and spreading globally, which has been expedited by the overuse of antibiotics. A growing list of infections – such as tuberculosis, gonorrhea, and bacteria that cause pneumonia and urinary tract infections – are becoming harder, and sometimes impossible, to treat as antibiotics become less effective.

One of the ways that we can help fight antibiotic resistance is to use antibiotics more wisely.

Using antibiotics wisely improves patient outcomes, reduces side effects and antimicrobial resistance and optimizes resource utilization. There are over 20 Choosing Wisely Canada recommendations that encourage judicious antibiotic use, created by over 15 national specialty societies. Here they are, organized by practice setting:

Recommendations for Prescribers

Primary Care
1

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 use antibiotics for upper respiratory infections that are likely viral in origin, such as influenza-like illness, or self-limiting, such as sinus infections of less than seven days of duration. Family medicine #2

Don’t prescribe antibiotics for asymptomatic bacteriuria (ASB) in non-pregnant patients. Hospital medicine #2

Don’t prescribe prophylactic antibiotics to prevent travellers’ diarrhea. Nurse Practitioner #8

Don’t use oral antibiotics as a first line treatment for patients with painless ear drainage associated with a tympanic membrane perforation or tympanostomy tube unless there is evidence of developing cellulitis in the external ear canal skin and pinna. Otolaryngology: head & neck surgery #4

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 antibiotics for acute asthma exacerbations without clear signs of bacterial infection. Respiratory medicine #6

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
Hospital
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
Long-Term Care
3

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

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Additional Resources

Tip Sheet for Prescribers

Prescription Handouts for Prescribers

Posters for Patient Waiting Rooms

Patient Resources

Antibiotics for Urinary Tract Infections in Older People Health care providers often use antibiotics to treat urinary tract infections (UTIs). However, many older people get UTI treatment even though they do not have symptoms.
Treating Sinus Infections: Don’t rush to antibiotics Millions of people are prescribed antibiotics each year for sinusitis. However, antibiotics for sinusitis typically won't help and can pose risks.
Preventing Infections in the Hospital: Watch out for these two practices If you or someone you care for is in the hospital, there are two common medical practices that you should watch out for.
Colds, Flu, and Other Respiratory Illnesses: Don’t Rush to Antibiotics Antibiotics don’t help most respiratory infections, and they can even be harmful. See ways you can help treat symptoms from colds and flu without unnecessary antibiotics.