Search

For more than 50 years, the importance of studying new medicines in childhood has been widely recognized. Nonetheless, Health Canada has eschewed policies requiring such evaluation, despite effective reforms elsewhere. In 2012, the Council of Canadian Academies convened an expert panel to assess Canada’s research base for labelling of pediatric therapies. The September 2014 report has not yet resulted in action, but it deserves consideration by the new government with timely recognition of the high priority that evidence-based treatment of children deserves.

Objective: In a potential attempt to guide antibiotic prescribing based on current clinical evidence and mitigate the spread of antibiotic resistance, in March 2001 the Ontario Drug Benefit programme restricted reimbursement of two fluoroquinolone antibiotics – ciprofloxacin and ofloxacin – to its beneficiaries. Our objective was to determine the impact of this policy on the volume and cost of antibiotic prescribing. Method: Weekly administrative data on antibiotic prescribing volumes and expenditures were analysed between January 1999 and September 2002 to estimate the effect of the policy changes using time series analysis. Results: The policy changes were associated with a statistically significant shift downwards for the fluoroquinolones as a category (1905 fewer prescriptions each week, representing a saving of Can$105,707 a week), driven by a decrease in prescriptions for ciprofloxacin (2084 fewer prescriptions a week, saving Can$129,421 a week). Nitrofurantoin (200 more prescriptions a week, costing an extra Can$2082 a week) and trimethoprim-sulphamethoxazole (532 more prescriptions a week, costing an extra Can$1473 a week) demonstrated a statistically significant shift upwards. The latter also showed a decrease in trend and nitrofurantoin an increase in trend during the time period. There was no statistically significant change in either the total number of antibiotic prescriptions or expenditures associated with the policy of limiting their use. Conclusions: Although no direct cause and effect can be shown with these observational data, the results suggest that the change in reimbursement policy to restrict prescribing of fluoroquinolones decreased their use and associated expenditures. These decreases were offset by increases in the use of other antibiotics. The balance of consequent benefit and harm of these shifts in prescribing patterns needs to be examined carefully. Alternative solutions to encourage appropriate use of antibiotics deserve exploration.

5-Fluorocytosine (5-FC), a systemic antifungal drug, has recently been approved for oral use in North America; however, the parenteral preparation remains an investigational drug. This report describes the use of parenteral 5-FC in nine patients with candidiasis. Six patients had invasive fungal infection and three patients had colonization. Eight patients received 5-FC intravenously and one received an intraperitoneal infusion. Of the six patients with invasive candidiasis, four received concurrent amphotericin B therapy. Candidiasis was cleared in eight of the nine patients. One patient died during therapy with combined 5-FC and amphotericin B. No clinically significant adverse effects of parenteral 5-FC were observed; however, two patients showed a transient increase in SGOT.