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Hi Kiera, thank you so much for your kind words and response. To answer your question, yes, I do believe that it would be worthwhile for the government to put together a committee to decide on definitive antibiotic prescribing practices to be followed at all centers, for many different reasons. A study from the United Kingdom estimates that in the absence of significant intervention, deaths from drug-resistant infections will surpass deaths from cancer by 2050, resulting in 10 million deaths annually (1). As you mentioned, and this fact supports, antimicrobial resistance is an urgent public health threat and there is a critical need for novel ways to counteract antibiotic resistance before it gets out of hand. I believe that developing a program to combat inappropriate prescription practices would be effective due to the following factors. Firstly, antibiotic use has been seen to be the most important modifiable risk factor associated with the development of antimicrobial resistance at both the individual and population levels (2). In Canada, approximately 92% of antibiotics are used outside of the acute care hospital setting and in the United States it is estimated that 30% of all antibiotics prescribed in the community are unnecessary (3). In addition, a recent study from Canada found that almost 50% of Ontario seniors with upper respiratory infections inappropriately receive antibiotics (4). As improper antimicrobial prescription is a large contributing factor to the development of antimicrobial resistance, these facts suggest that there are opportunities to reduce inappropriate community antibiotic use and help lessen the increasing antimicrobial resistance which I believe would be well tolerated through a committee-style design as you mentioned. Thanks again for your response!

1. O’Neill J (2016) Tackling drug-resistant infections globally: final report and recommendations (Wellcome Trust & HM Government, London (UK)).
2. Costelloe, C., Metcalfe, C., Lovering, A., Mant, D., & Hay, A. D. (2010). Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: Systematic review and meta-analysis. BMJ, 340(may18 2), c2096–c2096.
3. Fleming-Dutra, K. E., Hersh, A. L., Shapiro, D. J., Bartoces, M., Enns, E. A., File, T. M., Finkelstein, J. A., Gerber, J. S., Hyun, D. Y., Linder, J. A., Lynfield, R., Margolis, D. J., May, L. S., Merenstein, D., Metlay, J. P., Newland, J. G., Piccirillo, J. F., Roberts, R. M., Sanchez, G. V., … Hicks, L. A. (2016). Prevalence of inappropriate antibiotic prescriptions among us ambulatory care visits, 2010-2011. JAMA, 315(17), 1864.
4. Silverman, M., Povitz, M., Sontrop, J. M., Li, L., Richard, L., Cejic, S., & Shariff, S. Z. (2017). Antibiotic prescribing for nonbacterial acute upper respiratory infections in elderly persons. Annals of Internal Medicine, 166(11), 765.

Pierce Colpman

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