ArticleCMAJ open
Unnecessary antibiotic prescribing in a Canadian primary care setting: a descriptive analysis using routinely collected electronic medical record data.
Registry-linked trialOpen access · diamondAbstract read
In one paragraph
Article in CMAJ open. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05557214 (Reducing Unnecessary Antibiotic Prescriptions in Primary Healthcare in Saskatchewan by Identifying High Prescribers), which is not on this map. Cited by 53 papers, 2 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 2 pooled it
5.3field-weighted citation impact, top 3% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Reducing Unnecessary Antibiotic Prescriptions in Primary Healthcare in Saskatchewan by Identifying High Prescribers
Who cites it
53 citing papers in PubMed, 2 syntheses or guidelines pooled it, 82 citations in OpenAlex.
- Audit and Feedback Interventions for Antibiotic Prescribing in Primary Care: A Systematic Review and Meta-analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Pooled it
- Factors associated with inappropriateness of antibiotic prescriptions for acutely ill children presenting to ambulatory care in high-income countries: a systematic review and meta-analysis.The Journal of antimicrobial chemotherapy · 2024Pooled it
- Effectiveness of a clinical decision support algorithm (CDSA) on reducing unnecessary antibiotic prescriptions for upper respiratory tract infections among ambulatory HIV-infected adults in Mozambique: a cluster randomized controlled trial.BMC infectious diseases · 2026Trial
- Spillover From an Intervention on Antibiotic Prescribing for Family Physicians: A Post Hoc Secondary Analysis of a Randomized Clinical Trial.JAMA network open · 2025Trial
- Mailed feedback to primary care physicians on antibiotic prescribing for patients aged 65 years and older: pragmatic, factorial randomised controlled trial.BMJ (Clinical research ed.) · 2024Trial
- Appropriateness and determinants of outpatient antibiotic use among migrants in British Columbia, Canada: a population-based study.JAC-antimicrobial resistance · 2026Article
- A population-based study of community antibiotic prescribing patterns in Alberta from 2010 to 2017: Implications for antibiotic stewardship.Canadian journal of public health = Revue canadienne de sante publique · 2026Article
- Canadian nurses' perspectives on challenges to antimicrobial stewardship in long-term care homes.Canada communicable disease report = Releve des maladies transmissibles au Canada · 2026Review
- Mailed Audit and Feedback for Antibiotic Prescribing in Primary Care.JAMA network open · 2026Article
- Barriers and enablers to using evidence-based antibiotic prescription guidelines in primary care: a qualitative systematic review and synthesis using the theoretical domains framework.Implementation science communications · 2026Review
- Association between high-intensity antibiotic prescribing and prescribing of psychotropic drugs in children: a population-based study.BMJ paediatrics open · 2026Article
- Antibiotic treatment for acute sinusitis and subsequent health care use and work absence: a nationwide registry study from Norway.Family practice · 2026Observational
- Antimicrobial resistance within the one health lens: global drivers, mechanisms and public health policy gaps in low resource settings.Frontiers in cellular and infection microbiology · 2026Review
- National retrospective study of regional prescriber-specific variation in community antibiotic prescribing Canada, 2019-2023.BMJ public health · 2026Article
- Overview of Methods for Assessing Antimicrobial Use in Outpatient Settings in High-Income Countries: A Narrative Review.Antibiotics (Basel, Switzerland) · 2025Review
- Performance evaluation of a point of care capillary blood test for C-reactive protein in community healthcare.BMC primary care · 2025Article
- Patients' perspectives regarding antibiotic treatment for acute sinusitis in Norwegian general practice. A qualitative interview study.Scandinavian journal of primary health care · 2025Article
- Article
- Impact of Adherence With In-Patient Prospective Audit and Feedback Recommendations on Patient and Economic Outcomes.Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie medicale et l'infectiologie Canada · 2025Article
- Association of patient, physician and visit characteristics with inappropriate antibiotic prescribing in Japanese primary care: a cross-sectional study.BMJ public health · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors at 6 institutions in 2 countries.
Kevin L SchwartzPublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont. Kevin.schwartz@oahpp.ca.
Bradley J LangfordPublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Nick DanemanPublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Branson ChenPublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Kevin A BrownPublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Warren McIsaacPublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Karen TuPublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Elisa CandidoPublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Jennie JohnstonePublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Valerie LeungPublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Jeremiah HweePublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Michael SilvermanPublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Julie H C WuPublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Gary GarberPublic Health Ontario (Schwartz, Langford, Brown, Johnstone, Leung, Wu, Garber); ICES Central (Schwartz, Daneman, Chen, Brown, Candido); Unity Health Network (Langford), St. Joseph Health Centre; Sunnybrook Research Institute (Daneman); Ray D. Wolfe Department of Family Medicine (McIsaac), Sinai Health System; Departments of Family & Community Medicine (McIsaac, Tu) and Laboratory Medicine and Pathobiology (Johnstone), University of Toronto; North York General Hospital (Tu); Toronto Western Hospital Family Health Team (Tu), University Health Network; Toronto East Health Network (Leung), Michael Garron Hospital; Dalla Lana School of Public Health (Hwee), University of Toronto, Toronto, Ont.; Institute for Better Health (Hwee), Trillium Health Partners, Mississauga, Ont.; London Health Sciences Centre (Silverman), London, Ont.; Ottawa Hospital Research Institute (Garber); Department of Medicine (Garber), University of Ottawa, Ottawa, Ont.
Health Net · USLondon Health Sciences Centre · CASunnybrook Health Science Centre · CAOttawa Hospital · CASunnybrook Research InstituteUniversity of Toronto · CA
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUnnecessary antibiotic use in the community in Canada is not well defined. Our objective was to quantify unnecessary antibiotic prescribing in a Canadian primary care setting.
methodsWe performed a descriptive analysis in Ontario from April 2011 to March 2016 using the Electronic Medical Records Primary Care database linked to other health administrative data sets at ICES. We determined antibiotic prescribing rates (per 100 patient-physician encounters) for 23 common conditions and estimated rates of unnecessary prescribing using predefined expected prescribing rates, both stratified by condition and patient age group.
resultsThe study included 341 physicians, 204 313 patients and 499 570 encounters. The rate of unnecessary antibiotic prescribing for included conditions was 15.4% overall and was 17.6% for those less than 2 years of age, 18.6% for those aged 2-18, 14.5% for those aged 19-64 and 13.0% for those aged 65 or more. The highest unnecessary prescribing rates were observed for acute bronchitis (52.6%), acute sinusitis (48.4%) and acute otitis media (39.3%). The common cold, acute bronchitis, acute sinusitis and miscellaneous nonbacterial infections were responsible for 80% of the unnecessary antibiotic prescriptions. Of all antibiotics prescribed, 12.0% were for conditions for which they are never indicated, and 12.3% for conditions for which they are rarely indicated. In children, 25% of antibiotics were for conditions for which they are never indicated (e.g., common cold).
interpretationAntibiotics were prescribed unnecessarily for 15.4% of included encounters in a Canadian primary care setting. Almost one-quarter of antibiotics were prescribed for conditions for which they are rarely or never indicated. These findings should guide safe reductions in the use of antibiotics for the common cold, bronchitis and sinusitis.
Indexed as
Anti-Bacterial AgentsPrimary Health CareAdolescentAdultCanadaChildChild, PreschoolDrug PrescriptionsElectronic Health RecordsFemaleHumansInappropriate PrescribingMaleMiddle AgedPractice Patterns, Physicians'Young AdultAnti-Bacterial Agents
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Registered trials
NCT05557214ClinicalTrials.gov
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.