Skip to main content
Top
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Helicobacter Pylori | Research article

Antibiotic dispensation rates among participants in community-driven health research projects in Arctic Canada

Authors: Kathleen Williams, Amy Colquhoun, Rachel Munday, Karen J. Goodman, CANHelp Working Group

Published in: BMC Public Health | Issue 1/2019

Login to get access

Abstract

Background

Community-driven projects that aim to address public concerns about health risks from H. pylori infection in Indigenous Arctic communities (estimated H. pylori prevalence = 64%) show frequent failure of treatment to eliminate the bacterium. Among project participants, treatment effectiveness is reduced by antibiotic resistance of infecting H. pylori strains, which in turn, is associated with frequent exposure to antibiotics used to treat other infections. This analysis compares antibiotic dispensation rates in Canadian Arctic communities to rates in urban and rural populations in Alberta, a southern Canadian province.

Methods

Project staff collected antibiotic exposure histories for 297 participants enrolled during 2007–2012 in Aklavik, Tuktoyaktuk, and Fort McPherson in the Northwest Territories, and Old Crow, Yukon. Medical chart reviews collected data on systemic antibiotic dispensations for the 5-year period before enrolment for each participant. Antibiotic dispensation data for urban Edmonton, Alberta (average population ~ 860,000) and rural northern Alberta (average population ~ 450,000) during 2010–2013 were obtained from the Alberta Government Interactive Health Data Application.

Results

Antibiotic dispensation rates, estimated as dispensations/person-years (95% confidence interval) were: in Arctic communities, 0.89 (0.84, 0.94); in Edmonton, 0.55 (0.55, 0.56); in rural northern Alberta, 0.63 (0.62, 0.63). Antibiotic dispensation rates were higher in women and older age groups in all regions. In all regions, the highest dispensation rates occurred for β-lactam and macrolide antibiotic classes.

Conclusions

These results show more frequent antibiotic dispensation in Arctic communities relative to an urban and rural southern Canadian population.
Literature
1.
go back to reference Perez Aldana L, Kato M, Nakagawa S, Kawarasaki M, Nagasako T, Mizushima T, et al. The relationship between consumption of antimicrobial agents and the prevalence of primary helicobacter pylori resistance. Helicobacter. 2002;7:306–9.PubMedCrossRef Perez Aldana L, Kato M, Nakagawa S, Kawarasaki M, Nagasako T, Mizushima T, et al. The relationship between consumption of antimicrobial agents and the prevalence of primary helicobacter pylori resistance. Helicobacter. 2002;7:306–9.PubMedCrossRef
2.
go back to reference McMahon BJ, Hennessy TW, Bensler JM, Bruden DL, Parkinson AJ, Morris JM, et al. The relationship among previous antimicrobial use, antimicrobial resistance, and treatment outcomes for helicobacter pylori infections. Ann Intern Med. 2003;139:463–9.PubMedCrossRef McMahon BJ, Hennessy TW, Bensler JM, Bruden DL, Parkinson AJ, Morris JM, et al. The relationship among previous antimicrobial use, antimicrobial resistance, and treatment outcomes for helicobacter pylori infections. Ann Intern Med. 2003;139:463–9.PubMedCrossRef
3.
go back to reference Megraud F, Coenen S, Versporten A, Kist M, Lopez-Brea M, Hirschl AM, et al. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut. 2013;62:34–42.PubMedCrossRef Megraud F, Coenen S, Versporten A, Kist M, Lopez-Brea M, Hirschl AM, et al. Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption. Gut. 2013;62:34–42.PubMedCrossRef
4.
go back to reference Banatvala N, Davies GR, Abdi Y, Clements L, Rampton DS, Hardie JM, et al. High prevalence of helicobacter pylori metronidazole resistance in migrants to East London: relation with previous nitroimidazole exposure and gastroduodenal disease. Gut. 1994;35:1562–6.PubMedPubMedCentralCrossRef Banatvala N, Davies GR, Abdi Y, Clements L, Rampton DS, Hardie JM, et al. High prevalence of helicobacter pylori metronidazole resistance in migrants to East London: relation with previous nitroimidazole exposure and gastroduodenal disease. Gut. 1994;35:1562–6.PubMedPubMedCentralCrossRef
5.
go back to reference Poon SK, Lai CH, Chang CS, Lin WY, Chang YC, Wang HJ, et al. Prevalence of antimicrobial resistance in helicobacter pylori isolates in Taiwan in relation to consumption of antimicrobial agents. Int J Antimicrob Agents. 2009;34:162–5.PubMedCrossRef Poon SK, Lai CH, Chang CS, Lin WY, Chang YC, Wang HJ, et al. Prevalence of antimicrobial resistance in helicobacter pylori isolates in Taiwan in relation to consumption of antimicrobial agents. Int J Antimicrob Agents. 2009;34:162–5.PubMedCrossRef
6.
go back to reference Carothers JJ, Bruce MG, Hennessy TW, Bensler M, Morris JM, Reasonover AL, et al. The relationship between previous fluoroquinolone use and levofloxacin resistance in helicobacter pylori infection. Clin Infect Dis. 2007;44:e5–8.PubMedCrossRef Carothers JJ, Bruce MG, Hennessy TW, Bensler M, Morris JM, Reasonover AL, et al. The relationship between previous fluoroquinolone use and levofloxacin resistance in helicobacter pylori infection. Clin Infect Dis. 2007;44:e5–8.PubMedCrossRef
8.
go back to reference Bernstein CN, McKeown I, Embil JM, Blanchard JF, Dawood M, Kabani A, et al. Seroprevalence of helicobacter pylori, incidence of gastric cancer, and peptic ulcer-associated hospitalizations in a Canadian Indian population. Dig Dis Sci. 1999;44:668–74.PubMedCrossRef Bernstein CN, McKeown I, Embil JM, Blanchard JF, Dawood M, Kabani A, et al. Seroprevalence of helicobacter pylori, incidence of gastric cancer, and peptic ulcer-associated hospitalizations in a Canadian Indian population. Dig Dis Sci. 1999;44:668–74.PubMedCrossRef
9.
go back to reference McKeown I, Orr P, Macdonald S, Kabani A, Brown R, Coghlan G, et al. Helicobacter pylori in the Canadian arctic: seroprevalence and detection in community water samples. Am J Gastroenterol. 1999;94:1823–9.PubMedCrossRef McKeown I, Orr P, Macdonald S, Kabani A, Brown R, Coghlan G, et al. Helicobacter pylori in the Canadian arctic: seroprevalence and detection in community water samples. Am J Gastroenterol. 1999;94:1823–9.PubMedCrossRef
10.
go back to reference Sinha SK, Martin B, Sargent M, McConnell JP, Bernstein CN. Age at acquisition of helicobacter pylori in a pediatric Canadian first nations population. Helicobacter. 2002;7:76–85.PubMedCrossRef Sinha SK, Martin B, Sargent M, McConnell JP, Bernstein CN. Age at acquisition of helicobacter pylori in a pediatric Canadian first nations population. Helicobacter. 2002;7:76–85.PubMedCrossRef
14.
go back to reference Ford AC, Axon ATR. Epidemiology of helicobacter pylori infection and public health implications. Helicobacter. 2010;15(Suppl 1):1–6.PubMedCrossRef Ford AC, Axon ATR. Epidemiology of helicobacter pylori infection and public health implications. Helicobacter. 2010;15(Suppl 1):1–6.PubMedCrossRef
15.
go back to reference An international association between Helicobacter pylori infection and gastric cancer. The EUROGAST Study Group. Lancet Lond Engl. 1993;341:1359–62.CrossRef An international association between Helicobacter pylori infection and gastric cancer. The EUROGAST Study Group. Lancet Lond Engl. 1993;341:1359–62.CrossRef
16.
go back to reference Correa P, Ruiz B, Hunter F. Clinical trials as etiologic research tools in helicobacter-associated gastritis. Scand J Gastroenterol. 1991;26:15–9.CrossRef Correa P, Ruiz B, Hunter F. Clinical trials as etiologic research tools in helicobacter-associated gastritis. Scand J Gastroenterol. 1991;26:15–9.CrossRef
17.
go back to reference Rugge M, Di Mario F, Cassaro M, Baffa R, Farinati F, Rubio J, et al. Pathology of the gastric antrum and body associated with helicobacter pylori infection in non-ulcerous patients: is the bacterium a promoter of intestinal metaplasia? Histopathol. 1993;22:9–15.CrossRef Rugge M, Di Mario F, Cassaro M, Baffa R, Farinati F, Rubio J, et al. Pathology of the gastric antrum and body associated with helicobacter pylori infection in non-ulcerous patients: is the bacterium a promoter of intestinal metaplasia? Histopathol. 1993;22:9–15.CrossRef
18.
go back to reference Parsonnet J. Helicobacter pylori and gastric cancer. Gastroenterol Clin N Am. 1993;22:89–104. Parsonnet J. Helicobacter pylori and gastric cancer. Gastroenterol Clin N Am. 1993;22:89–104.
19.
go back to reference Takenaka R, Okada H, Kato J, Makidono C, Hori S, Kawahara Y, et al. Helicobacter pylori eradication reduced the incidence of gastric cancer, especially of the intestinal type. Aliment Pharmacol Ther. 2007;25:805–12.PubMedCrossRef Takenaka R, Okada H, Kato J, Makidono C, Hori S, Kawahara Y, et al. Helicobacter pylori eradication reduced the incidence of gastric cancer, especially of the intestinal type. Aliment Pharmacol Ther. 2007;25:805–12.PubMedCrossRef
20.
go back to reference Hosking SW, Ling TK, Chung SC, Yung MY, Cheng AF, Sung JJ, et al. Duodenal ulcer healing by eradication of helicobacter pylori without anti-acid treatment: randomised controlled trial. Lancet Lond Engl. 1994;343:508–10.CrossRef Hosking SW, Ling TK, Chung SC, Yung MY, Cheng AF, Sung JJ, et al. Duodenal ulcer healing by eradication of helicobacter pylori without anti-acid treatment: randomised controlled trial. Lancet Lond Engl. 1994;343:508–10.CrossRef
21.
go back to reference Buiatti E, Muñoz N, Vivas J, Cano E, Peraza S, Carillo E, et al. Difficulty in eradicating helicobacter pylori in a population at high risk for stomach cancer in Venezuela. Cancer Causes Control CCC. 1994;5:249–54.PubMedCrossRef Buiatti E, Muñoz N, Vivas J, Cano E, Peraza S, Carillo E, et al. Difficulty in eradicating helicobacter pylori in a population at high risk for stomach cancer in Venezuela. Cancer Causes Control CCC. 1994;5:249–54.PubMedCrossRef
22.
go back to reference Meyer JM, Silliman NP, Wang W, Siepman NY, Sugg JE, Morris D, et al. Risk factors for helicobacter pylori resistance in the United States: the surveillance of H. pylori antimicrobial resistance partnership (SHARP) study, 1993-1999. Ann Intern Med. 2002;136:13–24.PubMedCrossRef Meyer JM, Silliman NP, Wang W, Siepman NY, Sugg JE, Morris D, et al. Risk factors for helicobacter pylori resistance in the United States: the surveillance of H. pylori antimicrobial resistance partnership (SHARP) study, 1993-1999. Ann Intern Med. 2002;136:13–24.PubMedCrossRef
23.
go back to reference Osato MS, Reddy R, Reddy SG, Penland RL, Malaty HM, Graham DY. Pattern of primary resistance of helicobacter pylori to metronidazole or clarithromycin in the United States. Arch Intern Med. 2001;161:1217–20.PubMedCrossRef Osato MS, Reddy R, Reddy SG, Penland RL, Malaty HM, Graham DY. Pattern of primary resistance of helicobacter pylori to metronidazole or clarithromycin in the United States. Arch Intern Med. 2001;161:1217–20.PubMedCrossRef
24.
go back to reference Fraser AG, Moore L, Hackett M, Hollis B. Helicobacter pylori treatment and antibiotic susceptibility: results of a five-year audit. Aust NZ J Med. 1999;29:512–6.CrossRef Fraser AG, Moore L, Hackett M, Hollis B. Helicobacter pylori treatment and antibiotic susceptibility: results of a five-year audit. Aust NZ J Med. 1999;29:512–6.CrossRef
25.
go back to reference Kato M, Yamaoka Y, Kim JJ, Reddy R, Asaka M, Kashima K, et al. Regional differences in metronidazole resistance and increasing clarithromycin resistance among helicobacter pylori isolates from Japan. Antimicrob Agents Chemother. 2000;44:2214–6.PubMedPubMedCentralCrossRef Kato M, Yamaoka Y, Kim JJ, Reddy R, Asaka M, Kashima K, et al. Regional differences in metronidazole resistance and increasing clarithromycin resistance among helicobacter pylori isolates from Japan. Antimicrob Agents Chemother. 2000;44:2214–6.PubMedPubMedCentralCrossRef
26.
go back to reference Elviss NC, Owen RJ, Xerry J, Walker AM, Davies K. Helicobacter pylori antibiotic resistance patterns and genotypes in adult dyspeptic patients from a regional population in North Wales. J Antimicrob Chemother. 2004;54:435–40.PubMedCrossRef Elviss NC, Owen RJ, Xerry J, Walker AM, Davies K. Helicobacter pylori antibiotic resistance patterns and genotypes in adult dyspeptic patients from a regional population in North Wales. J Antimicrob Chemother. 2004;54:435–40.PubMedCrossRef
27.
go back to reference Cheung J, Goodman K, Munday R, Heavner K, Huntington J, Morse J, et al. Helicobacter pylori infection in Canada’s arctic: searching for the solutions. Can J Gastroenterol. 2008;22:912–6.PubMedPubMedCentralCrossRef Cheung J, Goodman K, Munday R, Heavner K, Huntington J, Morse J, et al. Helicobacter pylori infection in Canada’s arctic: searching for the solutions. Can J Gastroenterol. 2008;22:912–6.PubMedPubMedCentralCrossRef
28.
go back to reference Carraher S, Chang HJ, Munday R, Goodman KJ, CANHelp Working Group. Helicobacter pylori incidence and re-infection in the Aklavik H. pylori Project. Int J Circumpolar Health. 2013;72 ctg, 9713056.CrossRef Carraher S, Chang HJ, Munday R, Goodman KJ, CANHelp Working Group. Helicobacter pylori incidence and re-infection in the Aklavik H. pylori Project. Int J Circumpolar Health. 2013;72 ctg, 9713056.CrossRef
29.
go back to reference Colquhoun A, Geary J, Goodman KJ. Challenges in conducting community-driven research created by differing ways of talking and thinking about science: a researcher’s perspective. Int J Circumpolar Health. 2013;72. Colquhoun A, Geary J, Goodman KJ. Challenges in conducting community-driven research created by differing ways of talking and thinking about science: a researcher’s perspective. Int J Circumpolar Health. 2013;72.
30.
go back to reference Morse AL, Goodman KJ, Munday R, Chang HJ, Morse JW, Keelan M, et al. A randomized controlled trial comparing sequential with triple therapy for helicobacter pylori in an aboriginal community in the Canadian North. Can J Gastroenterol. 2013;27:701–6.PubMedPubMedCentralCrossRef Morse AL, Goodman KJ, Munday R, Chang HJ, Morse JW, Keelan M, et al. A randomized controlled trial comparing sequential with triple therapy for helicobacter pylori in an aboriginal community in the Canadian North. Can J Gastroenterol. 2013;27:701–6.PubMedPubMedCentralCrossRef
31.
go back to reference Lefebvre M, Chang HJ, Morse A, van Zanten SV, Goodman KJ, CANHelp Working Group. Adherence and barriers to H. pylori treatment in Arctic Canada. Int J Circumpolar Health. 2013;72:22791.PubMedCrossRef Lefebvre M, Chang HJ, Morse A, van Zanten SV, Goodman KJ, CANHelp Working Group. Adherence and barriers to H. pylori treatment in Arctic Canada. Int J Circumpolar Health. 2013;72:22791.PubMedCrossRef
32.
go back to reference Cheung J, Goodman KJ, Girgis S, Bailey R, Morse J, Fedorak RN, et al. Disease manifestations of helicobacter pylori infection in Arctic Canada: using epidemiology to address community concerns. BMJ Open. 2014;4:e003689.PubMedPubMedCentralCrossRef Cheung J, Goodman KJ, Girgis S, Bailey R, Morse J, Fedorak RN, et al. Disease manifestations of helicobacter pylori infection in Arctic Canada: using epidemiology to address community concerns. BMJ Open. 2014;4:e003689.PubMedPubMedCentralCrossRef
33.
go back to reference Hastings EV, Yasui Y, Hanington P, Goodman KJ, CANHelp Working Group. Community-driven research on environmental sources of H. pylori infection in arctic Canada. Gut Microbes. 2014;5:606–17.PubMedPubMedCentralCrossRef Hastings EV, Yasui Y, Hanington P, Goodman KJ, CANHelp Working Group. Community-driven research on environmental sources of H. pylori infection in arctic Canada. Gut Microbes. 2014;5:606–17.PubMedPubMedCentralCrossRef
40.
go back to reference Statistics Canada. 2011 National Household Survey, Statistics Canada Catalogue no. 99-010-X2011016. 2011. Statistics Canada. 2011 National Household Survey, Statistics Canada Catalogue no. 99-010-X2011016. 2011.
43.
go back to reference Rothman K. Epidemiology. An introduction. 2nd ed. New York: Oxford University Press; 2012. Rothman K. Epidemiology. An introduction. 2nd ed. New York: Oxford University Press; 2012.
44.
go back to reference Rothman K, Lash T, Greenland S. Modern Epidemiology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008. Rothman K, Lash T, Greenland S. Modern Epidemiology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008.
45.
go back to reference McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA. 1995;273:214–9.PubMedCrossRef McCaig LF, Hughes JM. Trends in antimicrobial drug prescribing among office-based physicians in the United States. JAMA. 1995;273:214–9.PubMedCrossRef
46.
go back to reference Parkinson AJ, Bruce MG, Zulz T. International circumpolar surveillance, an Arctic network for the surveillance of infectious diseases. Emerg Infect Dis. 2008;14:18–24.PubMedPubMedCentralCrossRef Parkinson AJ, Bruce MG, Zulz T. International circumpolar surveillance, an Arctic network for the surveillance of infectious diseases. Emerg Infect Dis. 2008;14:18–24.PubMedPubMedCentralCrossRef
47.
go back to reference Calbo E, Alvarez-Rocha L, Gudiol F, Pasquau J. A review of the factors influencing antimicrobial prescribing. Enferm Infecc Microbiol Clin. 2013;31(Suppl 4):12–5.PubMedCrossRef Calbo E, Alvarez-Rocha L, Gudiol F, Pasquau J. A review of the factors influencing antimicrobial prescribing. Enferm Infecc Microbiol Clin. 2013;31(Suppl 4):12–5.PubMedCrossRef
48.
go back to reference Agudo S, Perez-Perez G, Alarcon T, Lopez-Brea M. High prevalence of clarithromycin-resistant helicobacter pylori strains and risk factors associated with resistance in Madrid, Spain. J Clin Microbiol. 2010;48:3703–7.PubMedPubMedCentralCrossRef Agudo S, Perez-Perez G, Alarcon T, Lopez-Brea M. High prevalence of clarithromycin-resistant helicobacter pylori strains and risk factors associated with resistance in Madrid, Spain. J Clin Microbiol. 2010;48:3703–7.PubMedPubMedCentralCrossRef
50.
go back to reference Koivisto TT, Rautelin HI, Voutilainen ME, Niemela SE, Heikkinen M, Sipponen PI, et al. Primary helicobacter pylori resistance to metronidazole and clarithromycin in the Finnish population. Aliment Pharmacol Ther. 2004;19:1009–17.PubMedCrossRef Koivisto TT, Rautelin HI, Voutilainen ME, Niemela SE, Heikkinen M, Sipponen PI, et al. Primary helicobacter pylori resistance to metronidazole and clarithromycin in the Finnish population. Aliment Pharmacol Ther. 2004;19:1009–17.PubMedCrossRef
51.
go back to reference Nahar S, Mukhopadhyay AK, Khan R, Ahmad MM, Datta S, Chattopadhyay S, et al. Antimicrobial susceptibility of helicobacter pylori strains isolated in Bangladesh. J Clin Microbiol. 2004;42:4856–8.PubMedPubMedCentralCrossRef Nahar S, Mukhopadhyay AK, Khan R, Ahmad MM, Datta S, Chattopadhyay S, et al. Antimicrobial susceptibility of helicobacter pylori strains isolated in Bangladesh. J Clin Microbiol. 2004;42:4856–8.PubMedPubMedCentralCrossRef
52.
go back to reference Zullo A, Perna F, Hassan C, Ricci C, Saracino I, Morini S, et al. Primary antibiotic resistance in helicobacter pylori strains isolated in northern and Central Italy. Aliment Pharmacol Ther. 2007;25:1429–34.PubMedCrossRef Zullo A, Perna F, Hassan C, Ricci C, Saracino I, Morini S, et al. Primary antibiotic resistance in helicobacter pylori strains isolated in northern and Central Italy. Aliment Pharmacol Ther. 2007;25:1429–34.PubMedCrossRef
53.
go back to reference O’Connor A, Taneike I, Nami A, Fitzgerald N, Murphy P, Ryan B, et al. Helicobacter pylori resistance to metronidazole and clarithromycin in Ireland. Eur J Gastroenterol Hepatol. 2010;22:1123–7.PubMedCrossRef O’Connor A, Taneike I, Nami A, Fitzgerald N, Murphy P, Ryan B, et al. Helicobacter pylori resistance to metronidazole and clarithromycin in Ireland. Eur J Gastroenterol Hepatol. 2010;22:1123–7.PubMedCrossRef
54.
go back to reference Kostamo P, Veijola L, Oksanen A, Sarna S, Rautelin H. Recent trends in primary antimicrobial resistance of helicobacter pylori in Finland. Int J Antimicrob Agents. 2011;37:22–5.PubMedCrossRef Kostamo P, Veijola L, Oksanen A, Sarna S, Rautelin H. Recent trends in primary antimicrobial resistance of helicobacter pylori in Finland. Int J Antimicrob Agents. 2011;37:22–5.PubMedCrossRef
55.
go back to reference Boyanova L, Ilieva J, Gergova G, Davidkov L, Spassova Z, Kamburov V, et al. Numerous risk factors for helicobacter pylori antibiotic resistance revealed by extended anamnesis: a Bulgarian study. J Med Microbiol. 2012;61(Pt 1):85–93.PubMedCrossRef Boyanova L, Ilieva J, Gergova G, Davidkov L, Spassova Z, Kamburov V, et al. Numerous risk factors for helicobacter pylori antibiotic resistance revealed by extended anamnesis: a Bulgarian study. J Med Microbiol. 2012;61(Pt 1):85–93.PubMedCrossRef
56.
go back to reference Fischer MA, Stedman MR, Lii J, Vogeli C, Shrank WH, Brookhart MA, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010;25:284–90.PubMedPubMedCentralCrossRef Fischer MA, Stedman MR, Lii J, Vogeli C, Shrank WH, Brookhart MA, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010;25:284–90.PubMedPubMedCentralCrossRef
57.
go back to reference Tamblyn R, Eguale T, Huang A, Winslade N, Doran P. The incidence and determinants of primary nonadherence with prescribed medication in primary care: a cohort study. Ann Intern Med. 2014;160:441–50.PubMedCrossRef Tamblyn R, Eguale T, Huang A, Winslade N, Doran P. The incidence and determinants of primary nonadherence with prescribed medication in primary care: a cohort study. Ann Intern Med. 2014;160:441–50.PubMedCrossRef
58.
go back to reference Tan C, Graves E, Lu H, Chen A, Li S, Schwartz KL, et al. A decade of outpatient antimicrobial use in older adults in Ontario: a descriptive study. CMAJ Open. 2017;5:E878–85.PubMedPubMedCentralCrossRef Tan C, Graves E, Lu H, Chen A, Li S, Schwartz KL, et al. A decade of outpatient antimicrobial use in older adults in Ontario: a descriptive study. CMAJ Open. 2017;5:E878–85.PubMedPubMedCentralCrossRef
59.
go back to reference Lee GC, Reveles KR, Attridge RT, Lawson KA, Mansi IA, Lewis JS, et al. Outpatient antibiotic prescribing in the United States: 2000 to 2010. BMC Med. 2014;12:96.PubMedPubMedCentralCrossRef Lee GC, Reveles KR, Attridge RT, Lawson KA, Mansi IA, Lewis JS, et al. Outpatient antibiotic prescribing in the United States: 2000 to 2010. BMC Med. 2014;12:96.PubMedPubMedCentralCrossRef
61.
go back to reference Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Social Sciences and Humanities Research Council of Canada. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. 2014. Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Social Sciences and Humanities Research Council of Canada. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. 2014.
Metadata
Title
Antibiotic dispensation rates among participants in community-driven health research projects in Arctic Canada
Authors
Kathleen Williams
Amy Colquhoun
Rachel Munday
Karen J. Goodman
CANHelp Working Group
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7193-3

Other articles of this Issue 1/2019

BMC Public Health 1/2019 Go to the issue