Re: BC physicians reduce unnecessary antibiotic use—and costs. Authors reply

We thank Dr Cimolai for his letter. The thrust of our short report was to provide positive feedback to BC physicians who have unequivocally achieved a 15% reduction in antibiotic prescribing over 10 years. That report also mentions a number of other initiatives and events that impacted the trend. Thus, we share Dr Cimolai’s enthusiasm for a multivariate analysis and have been engaged in that longer-term work for several months. We should note, however, that such a refined ecological analysis may strengthen a case for association with an intervention but will not prove causation. Experimental trials of interventions in family medicine promise to fill that gap.[1,2] Most likely, education alone will not lead all practitioners to optimal prescribing practices with antibiotics or any other therapeutic drug class. This may require more attention to personalized feedback and the prescribing process, especially if conducted with colleagues.

As for cost-effectiveness, we estimate that the Ministry of Health is realizing annual savings in antibiotic costs of about 38 times the cost of the Do Bugs Need Drugs? program. Even in the likely scenario that other factors contribute much of the savings, cost-effectiveness is almost certain.
—David M. Patrick, MD, FRCPC, MHSc
—Laura Dale
—Mark McCabe, MPH
—Bin Zhao, MSc
—Mei Chong, MSc
—Edith Blondel-Hill, MD, FRCPC
—Fawziah Marra, PharmD


1.    Avent ML, Hansen MP, Gilks C, et al. General Practitioner Antimicrobial Stewardship Programme Study (GAPS): Protocol for a cluster randomised controlled trial. BMC Fam Pract 2016;17:48. 
2.    Hallsworth M, Chadborn T, Sallis A, et al. Provision of social norm feedback to high prescribers of antibiotics in general practice: A pragmatic national randomised controlled trial. Lancet 2016;387(10029):1743-1752.

David M. Patrick, MD, FRCPC, MHSc, Laura Dale, Mark McCabe, MPH, Bin Zhao, MSc, Mei Chong, MSc, Edith Blondel-Hill, MD, FRCPC, Fawziah Marra, PharmD. Re: BC physicians reduce unnecessary antibiotic use—and costs. Authors reply. BCMJ, Vol. 59, No. 1, January, February, 2017, Page(s) 8-10 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply