Et Tu Canada? Like their U.S. counterparts, Canadian doctors are handing out antibiotics like candy

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We’re getting it wrong almost half the time: 46% of Canadian seniors who saw their doctors because of a nonbacterial respiratory infection were nevertheless prescribed an antibiotic, says a study published this week in Annals of Internal Medicine.

Physicians know the rule: antibiotics only work on bacterial-driven infections, not viral-driven ones, and the classic viral infections are the common cold & acute bronchitis. Yet in a sample of 8,990 Ontario primary care physicians and 185,014 of their patients who presented with a nonbacterial respiratory infection, typically the common cold or acute bronchitis, antibiotics were given to a whopping 85,106 people (46%).

So why the huge error rate? Lead researcher Michael Silverman MD, chief of infectious diseases at Western University in London, Ontario, told the CBC there are two main reasons: (1) the time pressure to see more and more patients, which is driven by financial incentives, and (2) “decision fatigue,” the idea that physicians who have to say no all day to patients asking for antibiotics just get tired of saying no. Which comports with US research suggesting doctors tend to prescribe more antibiotics later in the day, Silverman said.

Handing out antibiotics when you shouldn’t, says Silverman, matters because they have serious side effects such as diarrhea from C. difficile, a big issue in Canada and around the world; irregular heartbeats and sudden death; tendon rupture; adverse drug interaction; and antibiotic resistance, i.e. the more you use these drugs, the less effective they become.

While the study was conducted in Ontario with patients 66 years of age and older (because researchers had access to data on nearly all prescriptions for this age group), Silverman believes these findings generalize to all age groups and to the rest of the country.

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