Longitudinal trends of and factors associated with inappropriate antibiotic prescribing for non-bacterial acute respiratory tract infection in Japan: A retrospective claims database study, 2012-2017

• Published in: PloS one Vol. 14; no. 10; p. e0223835
• Main Authors: Kimura, Yuki, Fukuda, Haruhisa, Hayakawa, Kayoko, Ide, Satoshi, Ota, Masayuki, Saito, Sho, Ishikane, Masahiro, Kusama, Yoshiki, Matsunaga, Nobuaki, Ohmagari, Norio
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16.10.2019; Public Library of Science (PLoS)
• Subjects: Adolescent; Adolescents; Adult; Adults; Age Distribution; Aged; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; Antimicrobial resistance; Antimicrobial Stewardship; Biology and Life Sciences; Child; Child, Preschool; Disease control; Disease prevention; Drug resistance; Female; Geriatrics; Health care facilities; Health insurance; Hospital facilities; Humans; Inappropriate Prescribing - statistics & numerical data; Infant; Infant, Newborn; Infections; Insurance Claim Review; Internet; Japan - epidemiology; Longitudinal Studies; Male; Medicine; Medicine and Health Sciences; Methods; Middle Aged; Patients; Pediatrics; People and Places; Pharynx; Physicians; Population; Prescriptions; Primary care; Respiratory tract; Respiratory tract diseases; Respiratory tract infection; Respiratory Tract Infections - drug therapy; Respiratory Tract Infections - microbiology; Retrospective Studies; Risk Factors; Target recognition; Trends; Young Adult; Japan; United States > US; Italy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0223835

Inappropriate antibiotic prescribing is a cause of antimicrobial resistance. Acute Respiratory Tract Infections (ARTI) are common diseases for those antibiotics are most likely prescribed in outpatient setting. To clarify factors associated with antibiotic prescribing for non-bacterial acute respiratory tract infections (NB-ARTI) and identify targets for reducing inappropriate prescribing for NB-ARTI in Japan. We conducted a retrospective, observational study using longitudinal claims data between April 2012 and June 2017. We assessed the rate of and factors associated with inappropriate antibiotic prescribing in outpatient settings for all NB-ARTI consultations included in the database. The mean monthly antibiotic prescribing rate per 100 NB-ARTI consultations during the study period was 31.65. The monthly antibiotic prescribing rate per 100 NB-ARTI consultations decreased by 19.2% from April 2012 to June 2017. Adolescents (13-18 years) and adults of working age (19-29 and 30-39 years) were more likely prescribed antibiotics compared with elderly patients ≥ 60 years (aOR: 1.493 [95%CI: 1.482-1.503], 1.585 [95%CI: 1.575-1.595], and 1.507 [95%CI: 1.498-1.516], respectively). Outpatient clinics registered as internal medicine or ear, nose, and throat specialty were more likely to prescribe antibiotics than those of paediatric specialty or other specialties. Among health facility type, clinics without beds (aOR 2.123 [95%CI: 2.113-2.133]) and clinics with beds (aOR: 1.752 [95%CI: 1.7371-1.767]) prescribed significantly more antibiotics for NB-ARTI than outpatient departments inside general hospitals. Inappropriate antibiotic prescribing for NB-ARTI is common in Japan. Although the antibiotic prescribing rate has decreased, further interventions are required to promote antimicrobial stewardship (ASP). Education and awareness for adults and promotion of ASP among physicians in clinics without beds are key drivers to reduce inappropriate antibiotic prescribing in Japan.