{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:37:24Z","timestamp":1785404244669,"version":"3.56.0"},"reference-count":24,"publisher":"University of Toronto Press Inc. (UTPress)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of the Association of Medical Microbiology and Infectious Disease Canada"],"published-print":{"date-parts":[[2020,6,23]]},"abstract":"<jats:p> Background: Antimicrobial overuse contributes to antimicrobial resistance. In the ambulatory setting, where more than 90% of antibiotics are dispensed, there are no Canadian benchmarks for appropriate use. This study aims to define the expected appropriate outpatient antibiotic prescribing rates for three age groups (&lt;2, 2\u201318, &gt;18 years) using a modified Delphi method. Methods: We developed an online questionnaire to solicit from a multidisciplinary panel (community\u2013academic family physicians, adult\u2013paediatric infectious disease physicians, and antimicrobial stewardship pharmacists) what percentage of 23 common clinical conditions would appropriately be treated with systemic antibiotics followed with in-person meetings to achieve 100% consensus. Results: The panelists reached consensus for one condition online and 22 conditions face-to-face, which took an average of 2.6 rounds of discussion per condition (range, min\u2013max 1\u20135). The consensus for appropriate systemic antibiotic prescribing rates were, for pneumonia, pyelonephritis, non-purulent skin and soft tissue infections (SSTI), other bacterial infections, and reproductive tract infections, 100%; urinary tract infections, 95%\u2013100%; prostatitis, 95%; epididymo-orchitis, 85%\u201388%; chronic obstructive pulmonary disease, 50%; purulent SSTI, 35%\u201350%; otitis media, 30%\u201340%; pharyngitis, 18%\u201340%; acute sinusitis, 18%\u201320%; chronic sinusitis, 14%; bronchitis, 5%\u20138%; gastroenteritis, 4%\u20135%; dental infections, 4%; eye infections, 1%; otitis externa, 0%\u20131%; and asthma, common cold, influenza, and other non-bacterial infections (0%). (Note that some differed by age group.) Conclusions: This study resulted in expert consensus for defined levels of appropriate antibiotic prescribing across a broad set of outpatient conditions. These results can be applied to community antimicrobial stewardship initiatives to investigate the level of inappropriate use and set targets to optimize antibiotic use. <\/jats:p>","DOI":"10.3138\/jammi.2019-0023","type":"journal-article","created":{"date-parts":[[2020,2,19]],"date-time":"2020-02-19T19:47:37Z","timestamp":1582141657000},"page":"61-69","source":"Crossref","is-referenced-by-count":7,"title":["Defining appropriate antibiotic prescribing in primary care: A\u00a0modified Delphi panel approach"],"prefix":"10.3138","volume":"5","author":[{"given":"Julie Hui-Chih","family":"Wu","sequence":"first","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Langford","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Ha","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Garber","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"},{"name":"Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Daneman","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"},{"name":"Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie","family":"Johnstone","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"},{"name":"Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren","family":"McIsaac","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Sinai Health System, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Sharpe","sequence":"additional","affiliation":[{"name":"Four Villages Community Health Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Tu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"North York General Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin L","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Public Health Ontario, Toronto, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1696","reference":[{"key":"r1","unstructured":"1.Public Health Agency of Canada (PHAC). Handle with care: preserving antibiotics now and into the future. Chief public health officer of Canada\u2019s 2019 spotlight report. Ottawa: PHAC; 2019."},{"issue":"4","key":"r2","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1086\/665010","volume":"33","author":"Society for Healthcare Epidemiology of America, Infectious Diseases Society of America, Pediatric Infectious Diseases Society","year":"2012","journal-title":"Infect Control Hosp Epidemiol"},{"key":"r3","unstructured":"3.Accreditation Canada. Required organizational practices: handbook 2016. Version 2. https:\/\/accreditation.ca\/sites\/default\/files\/rop-handbook-2016v2.pdf (Accessed Feb 21, 2017)."},{"key":"r4","unstructured":"4.Public Health Agency of Canada (PHAC). Canadian antimicrobial resistance surveillance system 2017 report. 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