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JAC Advance Access published online on October 28, 2009
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkp391
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Canadian province-level risk factor analysis of macrolide consumption patterns (2000–2006)

Shiona K. Glass1,*, David L. Pearl1, Scott A. McEwen1 and Rita Finley1,2

1 Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada 2 Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada

Received 26 June 2009; returned 17 August 2009; revised 25 September 2009; accepted 6 October 2009

* Corresponding author. Tel: +1-519-824-4120, ext. 54728; Fax: +1-519-763-3117; E-mail: sglass{at}uoguelph.ca

Objectives: To assess provincial-level predictors among socioeconomic and influenza rate data for the use of different macrolide antimicrobials in Canada from 2000 to 2006.

Methods: Multivariable models were developed to describe macrolide defined daily doses per capita.

Results: Use was highest during October to March for all macrolides. Investigated yearly and provincial patterns differed considerably among the macrolide agents. Associations with socioeconomic variables were similar between clarithromycin and erythromycin, while azithromycin consumption showed some differences in its association with these variables. Consistently, the rate of influenza was significantly associated with increased macrolide use. The influenza rate interacted with socioeconomic variables in some models; as the influenza rate increased, the greatest increase in demand for macrolides occurred in populations with high percentages of low-income individuals, high unemployment levels and low percentages of individuals with bachelor's degrees.

Conclusions: The impact of associations among macrolide consumption, influenza and socioeconomic factors may reflect inappropriate use of these agents to treat viral infections and/or prescribing for secondary infections, and knowledge of the virus versus bacteria problem and accessibility of healthcare. Further research surrounding differences in access to antimicrobial prescriptions and treatment options between advantaged and disadvantaged populations is suggested to further understand the dynamics of antimicrobial use in Canada.

Key Words: antibiotic policy , influenza , antibiotic usage


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