Antibiotic prescriptions for Japanese outpatients with acute respiratory tract infections (2013–2015): A retrospective Observational Study

• Published in: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy Vol. 26; no. 7; pp. 660 - 666
• Main Authors: Koyama, Toshihiro, Hagiya, Hideharu, Teratani, Yusuke, Tatebe, Yasuhisa, Ohshima, Ayako, Adachi, Mayu, Funahashi, Tomoko, Zamami, Yoshito, Tanaka, Hiroyoshi Y., Tasaka, Ken, Shinomiya, Kazuaki, Kitamura, Yoshihisa, Sendo, Toshiaki, Hinotsu, Shiro, Kano, Mitsunobu R.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.07.2020
• Subjects: Acute Disease - epidemiology; Acute Disease - therapy; Acute respiratory tract infection; Administrative Claims, Healthcare - statistics & numerical data; Adolescent; Adult; Aged; Ambulatory Care - standards; Ambulatory Care - statistics & numerical data; Anti-Bacterial Agents - therapeutic use; Antibiotic prescription; Antimicrobial resistance; Antimicrobial stewardship; Child; Child, Preschool; Drug Prescriptions - standards; Drug Prescriptions - statistics & numerical data; Female; Health policy; Humans; Inappropriate Prescribing - prevention & control; Inappropriate Prescribing - statistics & numerical data; Infant; Japan - epidemiology; Male; Middle Aged; Practice Guidelines as Topic; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - microbiology; Retrospective Studies; Young Adult; Japan; Antibiotic prescription; Health policy; Acute respiratory tract infection; CI; AMR; ARTIs; AMS; PPVs; APQI; Antimicrobial stewardship; Antimicrobial resistance
• ISSN: 1341-321X; 1437-7780
• DOI: 10.1016/j.jiac.2020.02.001

Appropriate antibiotic prescriptions for outpatients with acute respiratory tract infections (ARTIs) are urgently needed in Japan. However, the empirical proof of this need is under-documented. Therefore, we aimed to determine antibiotic prescription rates, and the proportions of antibiotic classes prescribed for Japanese patients with ARTIs. We analysed health insurance claims data over 2013–2015 among Japanese patients aged <75 years and determined the following indicators: 1) visit rates for patients with ARTIs and antibiotic prescription rates per 1000 person-years, and 2) proportion of visits by antibiotic-prescribed patients with ARTIs. We defined broad-spectrum antibiotics using the WHO Anatomical Therapeutic Chemical classification 4 level codes. Among 8.65 million visits due to ARTIs at 6859 hospitals and 62,024 physicians’ offices, the visit rate and antibiotic prescription rate per 1000 person-years were 990.6 (99% confidence interval [CI], 989.4–991.7) and 532.4 (99% CI, 531.6–533.3), respectively. The visit rates for patients aged 0–17, 18–59, and 60–74 years were 2410.0 (99% CI, 2407.2–2412.9), 683.6 (99% CI, 682.7–684.6), and 682.1 (99% CI, 678.2–686.0), and antibiotic prescription rates were 1093.3 (99% CI, 1091.4–1095.2), 434.1 (99% CI, 433.4–434.9), and 353.4 (99% CI, 350.7–356.1), respectively. The overall proportion of antibiotic prescriptions for ARTI visits was 52.7% and 91.3% of the antibiotics prescribed were broad-spectrum. Both the visit rates and antibiotic prescription rates for ARTIs were high in this Japanese cohort. The proportion of antibiotic prescriptions exceeded that recommended in the clinical guidelines. Thus, there might be a scope for reducing the current antibiotic prescription rate in Japan.