Newfoundland and Labrador’s health minister – whose province leads Canada and the U.S. for antibiotics overuse – is warning that drug resistance could bring a wave of deaths by infection.

John Haggie, a former surgeon, says he fears health care could be thrown back to the 1920s, an era before penicillin when pneumonia and other infections were among the most serious medical threats.

“They’re thrown at the common cold,” Haggie, who served as president of the Canadian Medical Association before entering politics, said of antibiotics.

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“I know in surgical fields when I was still in practice, anybody with an open wound would end up with a prescription for multiple courses of antibiotics.”

That’s despite the fact medical literature did not suggest such treatment, he said in an interview.

Newfoundland and Labrador typically uses antibiotics twice as much per person as other provinces but over-prescribing is a problem throughout the world, Haggie stressed.

“There has certainly been a tradition, shall we say, going back 30 or 40 years that antibiotics were safe, they were foolproof, they were going to be around forever and it was better to have some than not.

“People have now woken up to the fact that it isn’t risk free, there is a downside and they won’t be around forever if we use them this way.”

A federal study found that Newfoundland and Labrador had the country’s highest prescription rate in 2016, with 955 prescriptions per 1,000 residents, compared to about 625 prescriptions per 1,000 people nationally. Prescription rates were lowest in British Columbia, according to the Canadian Antimicrobial Resistance Surveillance System report published last November.

It also found that while the use of most antimicrobials was higher in Newfoundland and Labrador than in other provinces, amoxicillin – an antibiotic used for bacterial infections like pneumonia – was prescribed at particularly high rates.

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The study also looked at the purchasing rates of antibiotics for hospitals, finding that Manitoba, and Prince Edward Island and Newfoundland and Labrador combined, had the highest rates per capita.

Haggie said concerns over antibiotics will come up when medical experts meet later this spring in St. John’s.

The Canadian College of Health Leaders and HealthCareCAN, the national voice of health care groups and hospitals across the country, gather June 4 and 5 before taking the issue to meetings of G7 leaders later this year, Haggie said.

“I know there is concern at the federal (government) level,” Haggie said. “It’s not as loud as perhaps it could be. To be fair, they’ve been distracted quite rightly by other prescribing issues around opioids, for example.”

Dr. Patrick Parfrey, a St. John’s nephrologist and provincial leader of the national Choosing Wisely campaign to cut needless medical procedures, said Haggie is not overstating the problem.

“The risk is that antibiotic-resistant bacteria will develop in the community. And if that happens, that will be a catastrophe so we need to reduce our antibiotic use – particularly as the quantity and development of new antibiotics is decreasing.”

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Parfrey said doctors are not being identified or singled out but can see through the province’s online Pharmacy Network how their prescription rates stack up.

“They’re getting information in the system that allows them to compare themselves to their peers.”

It’s hoped those prods, along with a public education campaign about when antibiotics are truly needed, will curb overuse, Parfrey said.

“I think this is a first step. If these interventions don’t work then other more directive measures will be required.”

Parfrey said he’s not sure what more governments can do aside from funding public outreach along with efforts such as Choosing Wisely.

“I think it’s a culture issue where there’s a combination of demand from the public and doctors providing the antibiotics,” he said in an interview. “The use includes viral infections for which antibiotics are useless.

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“There is no doubt in many instances the harm outweighs the benefit.”