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
—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.
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