Prescription of Antibiotics for Adults with Acute Infectious Diarrhea in Korea: A Population-based Study

• Published in: Infection & chemotherapy Vol. 51; no. 3; pp. 295 - 304
• Main Authors: Lee, Hyo-Jin, Park, Ki-Ho, Park, Dong-Ah, Park, Joonhong, Bang, Byoung Wook, Lee, Seung Soon, Lee, Eun Jung, Kim, Youn Jeong, Hong, Sung Kwan, Kim, Yang Ree
• Format: Journal Article
• Language: English
• Published: The Korean Society of Infectious Diseases and Korean Society for Chemotherapy 01.09.2019; 대한감염학회
• Subjects: Original; 내과학
• ISSN: 2093-2340; 2092-6448
• DOI: 10.3947/ic.2019.51.3.295

BACKGROUNDAcute infectious diarrhea (AID) is a commonly observed condition globally. Several studies recommend against the use of empiric antibiotic therapy for AID, except in some cases of travelers' diarrhea. However, many physicians prescribe antimicrobial agents for AID. We aimed to determine the rate of antibiotic use and the associated prescription patterns among adults with AID. MATERIALS AND METHODSThis population-based, retrospective epidemiological study was performed using Korean National Health Insurance claims data from 2016 to 2017. The study population comprised adults (age ≥18 years) who had visited clinics with AID-related complaints. Exclusion criteria were the presence of Crohn's disease, ulcerative colitis, irritable bowel syndrome, and other non-infectious forms of colitis. Patients who underwent surgery during admission were also excluded. RESULTSThe study population comprised 1,613,057 adult patients with AID (767,606 [47.6%] men). Young patients (age 18 - 39 years) accounted for 870,239 (54.0%) of the study population. Overall, 752,536 (46.7%) cases received antibiotic prescriptions. The rate of antibiotic administration tended to be higher among elderly patients (age ≥65 years) than among younger patients (49.5% vs. 46.4%, P <0.001). The antibiotics most frequently prescribed in both monotherapy and combination regimens were fluoroquinolones (29.8%), rifaximin (26.8%), second-generation cephalosporins (9.2%), third-generation cephalosporins (7.3%), trimethoprim/sulfamethoxazole (5.5%), and β-lactam/β-lactamase inhibitors (5.3%). Patients who visited tertiary care hospitals had lower rates of antibiotic therapy (n = 14,131, 41.8%) than did those visiting private clinics (n = 532,951, 47.1%). In total, 56,275 (62.3%) admitted patients received antibiotic therapy, whereas outpatients had lower rates of antibiotic prescription (n = 694,204, 46.0%). CONCLUSIONThis study revealed differences between the antibiotics used to treat AID in Korea and those recommended by the guidelines for AID treatment. Multifaceted efforts are necessary to strengthen physicians' adherence to published guidelines.