Antimicrobial resistance programs in Canada 1995-2010: a critical evaluation

Data was collected from multiple sources to determine the components of four major AMR programs that were considered national based on their scope or in the delivery of their mandates. Assessment of program components was adapted from the report from the International Forum on Antibiotic Resistance colloquium. Most of the programs used similar tools but only the Do Bugs Need Drugs Program (DBND) had components directed towards day cares and schools. Surveillance programs for antimicrobial resistant pathogens have limitations and/or significant sources of bias. Overall, there has been a 25.3% decrease in oral antimicrobial prescriptions in Canada since 1995, mainly due to decreases in β lactams, sulphonamides and tetracyclines in temporal association with multiple programs with the most comprehensive and sustained national programs being CCAR and DBND.Although there has been a substantial decrease in oral antimicrobial prescriptions in Canada since 1995, there remains a lack of leadership and co-ordination of antimicrobial resistance activities.Antimicrobial resistance (AMR) has dramatically increased since the 1990s, and it is widely acknowledged to be a global public health threat [1-4]. In Canada, systematic efforts for controlling antibiotic resistance began in 1997 following a national Consensus Conference held in Montreal entitled "Controlling Antimicrobial Resistance: An Integrated Action Plan for Canadians" [5]. The conference, co-sponsored by Health Canada and the Canadian Infectious Disease Society, developed a plan which emphasized 3 core areas: antimicrobial stewardship, surveillance to monitor resistance trends and infection prevention and control (IPC). The Canadian strategy produced 27 recommendations, one of which was the formation of the Canadian Committee on Antibiotic Resistance (CCAR), a multidisciplinary committee which performed a collating and coordinating role for stakeholder groups across Canada. In addition several other organizations began