Health professionals in Newfoundland and Labrador are leading the country in prescribing antibiotics, and an infectious disease specialist at Memorial University says this has to change.
Inaction, says Dr. Peter Daley, could lead to deadly consequences.
"We need to start looking over the shoulders of doctors and saying, 'this is not good practice of medicine. You need to change what you're doing,'" said Daley.
Nearly half of prescriptions unnecessary: report
Daley points to statistics that show per-capita antibiotic prescriptions are 33 per cent higher in Newfoundland and Labrador than they are in Saskatchewan, the province with the second highest prescription numbers.
And what's just as alarming to him is that anywhere from 30 to 50 per cent of prescriptions are unnecessary, according to a report by Choosing Wisely Canada, a national campaign aiming to raise awareness about unnecessary medical tests and treatments.
Daley, who is a member of Choosing Wisely, said there are two primary factors behind these trends.
"It comes down to inappropriate choices from physicians. It also comes down to the patient's demand," he explained.
Daley's warnings come at the start of World Antibiotics Awareness Week, which runs Nov. 13-19.
The overuse of antibiotics has become a global concern because it's already resulted in some bacterial infections becoming resistant to these life-saving medicines.
Financial gain may be a motive
Yet Canada remains among the world leaders with roughly 25 million courses of antibiotics prescribed in 2015, a number that has remained stable despite repeated attempts to address the problem.
Daley said some doctors are prescribing antibiotics for minor viral infections, and sometimes for patients without any infections at all.
He acknowledged that financial gain may be a motivating factor in this era of fee-for-service health care.
He said patients sometimes demand antibiotics, and doctors may write a prescription instead of taking the time to explain alternative treatments.
"The doctor gets paid according to how many patients the doctor sees, (so) the faster they can move the more money there is to be made," he said.
No oversight, audit of antibiotic usage
Daley said an awareness campaign is underway to encourage physicians, hospitals, long-term care facilities and out-patient services to make changes.
'It comes down to inappropriate choices from physicians. It also comes down to the patient's demand.' - Dr. Peter Daley
For example, Daley said doctors that excessively prescribe antibiotics are starting to receive "report cards" from Choosing Wisely, with a reminder to reconsider their treatment patterns.
Information posters and pamphlets are also turning up in clinics.
But change is not easy.
There is very little regulatory oversight of antibiotic use and prescriptions.
For example, prescriptions do not have to indicate why an antibiotic is being prescribed, and there is no audit system.
Daley sees that as a problem.
"Do we need to go into further or more strict or more regulatory interventions? At the federal level that's being discussed," said Daley.
"If we don't see any improvement over the next many decades, we will see increasing numbers of deaths due to infectious disease that we previously had been able to control. We'll see more and more simple infections becoming life-threatening."
Slashing usage by half?
The Newfoundland and Labrador Medical Association, meanwhile, is a partner with the Choosing Wisely movement, and is encouraging its members to fall in line with the campaign.
"We would like to be in line with other provinces in Canada," said NLMA president and fee-for-service family physician Dr. Lynn Dwyer, adding that an ideal scenario would see antibiotic use slashed by half.
She said such a target could take years, but physicians are buying in.
"I don't think we're having any resistance," she said, adding that she has significantly decreased the number of prescriptions in her own practice.