How to Reduce Unnecessary Antibiotic Use: Ask Quebec


Unnecessary antibiotic use is a common practice, and one result has been the increasing emergence of antibiotic resistance among the organisms the drugs were designed to kill. To help combat this problem, healthcare professionals in Quebec, Canada, developed a simple education program that has resulted in a 4.2 percent reduction in antibiotic prescriptions in that province.

Doctors and pharmacists get an education

The development of antibiotics has saved countless numbers of lives, but one of the unintended consequences of overuse of these drugs has been that the infectious organisms targeted by the medications have mutated and adapted to them, making the drugs less effectives. Therefore, according to the Centers for Disease Control and Prevention, people who become infected with antibiotic-resistant bacteria “are more likely to have longer, more expensive hospital stays, and may be more likely to die as a result of the infection.”

In Canada, the Quebec Minister of Health and the Quebec Medication Council worked with selected doctors and pharmacists to tackle the problem of antibiotic overuse and resistance by developing an education campaign designed to improve how these medical professionals prescribe antibiotics. The initiative was launched after the province experienced an outbreak of Clostridium difficile infections, which are often the result of antibiotic use.

The entities collaborated to produce eleven user-friendly guidelines, which were sent to physicians and pharmacists in Quebec in January 2005. Additional marketing of the guidelines was done by posting them on a dedicated website, and through educational events by professional organizations, universities, and experts. The pharmaceutical industry also supported the guidelines in their marketing.


Before the educational intervention, antibiotic use per capita was 23.3 percent higher across Canada than it was in Quebec. During the year after the guidelines were distributed, the number of outpatient antibiotic prescriptions in Quebec declined 4.2 percent, while these prescriptions rose 6.5 percent in other Canadian provinces during the same time period.

Quebec also saw a cost savings. Antibiotic costs declined $134.50 per 1,000 inhabitants in Quebec compared with the rest of Canada.

According to Karl Weiss, MD, of the University of Montreal and one of the study’s authors, the key to successfully reducing unnecessary antibiotic use is “having everybody involved and speaking with a common voice.” He added that “Simple, short, easy-to-use guidelines have an impact on physicians when they are readily available.” Website access, as well as downloadable guidelines on handheld electronic devices, are important tools in this effort.

Centers for Disease Control and Prevention
Weiss K et al. Clinical Infectious Diseases 2011; doi: 10.1093/cid/cir409

Picture source: Wikimedia Commons