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What antibiotic resistance means for Canadians

by Jerome Leis

Fourteen Canadians die each day from antibiotic resistance

In my practice as an Infectious Diseases specialist at a busy Toronto hospital, I see the impact of antibiotic resistance every day.

One hundred years ago, infections like pneumonia or cellulitis were often fatal. The discovery of antibiotics, a powerful medication that kills infection-causing bacteria, changed this. Antibiotics are one of the most important medical discoveries of the 20th century, but our tendency to overuse them has led to the spread of antibiotic resistance.  Now we are in danger of running out of antibiotics that actually work.

Earlier this year, the World Health Organization listed antibiotic resistance as one of the top 10 threats to human health. So, what does antibiotic resistance mean for Canadians?  A national report published this week estimates that at least 14 Canadians per day die from the direct consequences of antibiotic resistance meaning that these deaths would have been prevented if our first-line antibiotics were effective against the bacteria causing infection in these individuals.  Without corrective actions, by 2050, it is estimated that the number will more than double.

Both health practitioners and patients have a role to play but first it is important to understand how antibiotic resistance develops in the first place.  Antibiotics are prescribed to kill specific bacteria that cause infection, but our body also contains countless other bacteria that are important for our health.  Each time we take an antibiotic, it kills part of this community of bacteria in our body, leaving behind the strains that are resistant to this antibiotic. With the competition knocked out, these more resistant strains take over.  These strains can also spread person to person.

Here’s what this means in practice.  I may be asked to see a patient with a simple urinary tract infection that is not resolving, because none of the antibiotics taken by mouth were effective. In this situation, we have to use an antibiotic through an intravenous, which is more invasive and carries a higher risk of serious side effects and increased cost to the healthcare system.

More rarely, I have been asked to see a patient with a severe infection, for which there is no effective antibiotic. In these cases, the only treatment option we are left with may be amputation, in order to control the infection. Sometimes a patient with an antibiotic-resistant infection has had prior antibiotic exposures leading to this situation. Other times, they have never received antibiotics before and were unaware that they were harbouring antibiotic-resistant bacteria.

There is an immediate need to use antibiotics judiciously to limit the emergence of further antibiotic resistance. Yet overuse of antibiotics continues to be a problem. In Canada, it is estimated that as many as one third of the 24 million prescriptions dispensed in Canada each year are not necessary.

Why are we overusing these powerful and vital medications?

Bacterial infections can sometimes have the same symptoms as viral infections which cause most sore throats, coughs and colds. Antibiotics are not effective in killing viruses, which last only a few days before going away on their own. This is why a viral prescription pad was created for health practitioners — a hard copy “prescription” given to the patient which outlines the kind of viral infection they’ve been diagnosed with, what their symptoms may be and how long they may last, the over-the-counter medications that will alleviate their symptoms and an explanation for why an antibiotic was not prescribed.

Sometimes antibiotics are given for ‘possible’ bacterial infections when a patient has a change in their health status ‘just to be safe,’ but this reasoning underestimates the risk of antibiotics altogether. Aside from the risk of selecting for antibiotic resistance with each antibiotic course, these are among the most common medication classes to cause adverse drug reactions resulting in emergency department visits in Canada. These reactions include allergy, rashes, severe diarrhea and kidney failure.

A recent survey of Canadians conducted by Ipsos Reid and Choosing Wisely Canada found that nearly 90 per cent of Canadians are aware that unnecessary antibiotic use can drive antibiotic resistance. But it also found that that 29 per cent of Canadians incorrectly expect to receive an antibiotic for a cough or cold and that about 50 per cent incorrectly think that antibiotics are effective against viral infections.

There are solutions to tackling antibiotic resistance, which first and foremost begin with avoiding unnecessary use of these powerful medications. Both physicians and patients have a responsibility to use antibiotics wisely.

Choosing Wisely Canada, a national campaign to engage clinicians and patients in conversations about overuse, has developed tools for both doctors and patients about when antibiotics are needed and when they are not.

We have a lot of work to do to educate Canadians about the appropriate use of antibiotics. By working together to avoid unnecessary use of these lifesaving medications, we can preserve their power and effectiveness for when they are truly needed.

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