The World Health Organization (WHO) declared 18–24 November as World Antimicrobial Resistance Awareness Week. Antimicrobial resistance is one of the WHO’s top 10 threats to global health and was estimated to be directly responsible for 5400 deaths and $1.4 billion in health care costs in Canada in 2018.[1]

The misuse and overuse of antibiotics from inappropriate prescribing accelerates antibiotic resistance.[2,3] It is essential to prescribe antibiotics only when needed and according to current evidence-based guidelines. Staying up-to-date on prescribing guidelines can be challenging, but there are tools to make it easier for prescribers.

Bugs & Drugs

Bugs & Drugs is a regularly updated, local, evidence-based prescribing guideline for antimicrobial therapy in frontline practice. The guide is available as a website (www.bugsanddrugs.org) and an app (on iOS and Android) and is free for all BC prescribers. Bugs & Drugs contains the latest evidence-based, peer-reviewed, antibiogram-directed guidelines and recommendations. It offers empiric management advice for more than 140 clinical syndromes in adult and pediatric patients (including fungal, parasitic, and ophthalmic infections), clinical significance and management of 172 potential pathogens, and information on over 70 antimicrobials (e.g., spectrum of activity and/or dosing recommendations).

Pathways

Pathways (https://pathwaysbc.ca/login) is a quick-to-use curated repository of websites, handouts, forms, and clinical tools that acts as a gateway to the Internet to make it quick and easy to find the handouts, websites, and services that patients need. Users can also access links to Bugs & Drugs treatment recommendations for common infections. For community-based infections, simply type the name of the infection in the Pathways search bar.

Pathways also contains Bugs & Drugs information for patients, which can be shared via email from the secure Pathways website during an office visit. When patients ask for an antibiotic but do not need one for a viral illness, the helpful patient-facing documents about self-care without antibiotics can validate patients’ concerns while giving them a way to manage their symptoms.

When searching for the infection you are treating in Pathways, Choosing Wisely Canada recommendations often come up as well. Sometimes patients with a urinary tract infection will request ciprofloxacin, and a Pathways search quickly reveals recommendations from the Provincial Antimicrobial Clinical Expert group to avoid fluoroquinolones. Check these specific recommendations by typing a drug name in the Pathways search bar.

Community Antimicrobial Stewardship continuing education course

An online continuing education course (www.antibioticwise.ca/course) developed by the Community Antimicrobial Stewardship program at the BCCDC provides community-based practitioners with the latest evidence and treatment guidelines for the use of antibiotics in primary care and basic principles and strategies for antimicrobial stewardship. The course features 13 modules with case studies for some of the most common conditions requiring or leading to antibiotic prescribing in primary care settings.

Penicillin allergy delabeling

Up to 98% of patients who are identified as penicillin allergic are actually able to safely receive it.[4] A simple decision-making tool[5] (https://app.firstline.org/en/clients/39-bc-womens-hospital/steps/61581) available through BC Women’s Hospital and Health Centre and BC Children’s Hospital can help you work with your patient to determine if they are among those who have grown out of a penicillin allergy or never truly had one. An enhanced version of the penicillin allergy delabeling tool is available in Pathways.

Drop the Label (www.dropthelabel.ca) also has great information for patients and providers to help patients understand why delabeling is beneficial.

Wise use of antibiotics in primary care combats antibiotic resistance and allows effective treatment while protecting patients from harm caused by inappropriate prescribing. Using Pathways or Bugs & Drugs during a client consultation allows you to quickly find evidence-based recommendations and provide health promotion materials. These tools also allow for a thorough review of the recommendations to strengthen your understanding of antibiotic prescribing.
—Lynsey Hamilton, MSc
Knowledge Translation and Exchange Specialist, BCCDC
Member, BCCDC Community Antimicrobial Stewardship Team
—Tracy Monk, MD
Physician Lead, Pathways BC
Member, Pathways BC Provincial Resource Committee
—Nick Smith, MPH
Project Manager, BCCDC
Member, BCCDC Community Antimicrobial Stewardship Team

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This article is the opinion of the BC Centre for Disease Control and has not been peer reviewed by the BCMJ Editorial Board.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

1.    The Expert Panel on the Potential Socio-Economic Impacts of Antimicrobial Resistance in Canada. When antibiotics fail. Council of Canadian Academies, 2019. Accessed 15 August 2023. https://cca-reports.ca/reports/the-potential-socio-economic-impacts-of-antimicrobial-resistance-in-canada.

2.    Chatterjee A, Modarai M, Naylor NR, et al. Quantifying drivers of antibiotic resistance in humans: A systematic review. Lancet Infect Dis 2018;18:e368-e378.

3.    Holmes AH, Moore LS, Sundsfjord A, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet 2016;387(10014):176-187.

4.    Saravanabavan S, Aulakh A, Douglas J, et al. Penicillin de-labelling in Vancouver, British Columbia, Canada: Comparison of approaches, outcomes and future directions. Allergy Asthma Clin Immunol 2023;19:30.

5.    BC Women’s Hospital and Health Centre. Peni­cillin allergy de-labeling tool. Accessed 15 August 2023. https://app.firstline.org/en/clients/39-bc-womens-hospital/steps/61581.