Indications and classes of outpatient antibiotic prescriptions in Japan: A descriptive study using the national database of electronic health insurance claims, 2012–2015

Abstract

To evaluate condition-specific antibiotic prescription rates and the appropriateness of antibiotic use in outpatient settings in Japan. Methods: Using Japan's national administrative claims database, all outpatient visits with infectious disease diagnoses were linked to reimbursed oral antibiotic prescriptions. Prescription rates stratified by age, sex, prefecture, and antibiotic category were determined for each infectious disease diagnosis. The proportions of any antibiotic prescription to all infectious disease visits and the proportions of first-line antibiotic prescriptions to all antibiotic prescriptions were calculated for each infectious disease diagnosis. Results: Of the 659 million infectious disease visits between April 2012 and March 2015, antibiotics were prescribed in 266 million visits (704 prescriptions per 1000 population per year). Third-generation cephalosporins, macrolides, and quinolones accounted for 85.9% of all antibiotic prescriptions. Fifty-six percent of antibiotic prescriptions were directed toward infections for which antibiotics are generally not indicated. The diagnoses with frequent antibiotic prescription were bronchitis (184 prescriptions per 1000 population per year), viral upper respiratory infections (166), pharyngitis (104), sinusitis (52), and gastrointestinal infection (41), for which 58.3%, 40.6%, 58.9%, 53.9%, and 26.1% of visits antibiotics were prescribed, respectively. First-line antibiotics were rarely prescribed for pharyngitis (8.8%) and sinusitis (9.8%). More antibiotics were prescribed for children aged 0-9 years, adult women, and patients living in western Japan. Conclusions: Antibiotic prescription rates are high in Japan. Acute respiratory or gastrointestinal infections, which received the majority of the antibiotics generally not indicated, should be the main targets of antimicrobial stewardship intervention.

Prevalence of and rationale for antimicrobial prescription during ambulatory care visits in Japan: a prospective, multicentre, cross-sectional study

“…The proportion of antimicrobial drugs that were unnecessary in the present study was higher than that in recent studies conducted outside Japan 8–10 but is similar to that in a recent Japanese study. 23 Even though the proportion of antimicrobial therapy for infectious diseases that generally do not require the use of antimicrobial drugs was lower in the present study than in recent studies, 8–10 23 the rate of unnecessary antimicrobial drugs in the present study still seems high. However, unlike other studies, 8–10 23 we investigated the evidence for physicians’ diagnoses of infectious diseases in addition to evaluating whether antimicrobial drugs were prescribed for infectious diseases that required antimicrobial therapy.…”

Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study

“…We also included four other antibiotics, namely metronidazole, tinidazole, ornidazole, and furazolidone. 14 The appendix (pp [16][17] gives a full list of antibiotics in this study.…”

“…Following previous studies, 17,18 second-to four-generation cephalosporins, fluoroquinolones, macrolides, combinations of penicillins, and streptomycins were classified as broad-spectrum antibacterial agents. Other antibiotics were classified as narrow-spectrum, such as beta-lactamase sensitive penicillins and first-generation cephalosporins.…”

Trends in healthcare visits and antimicrobial prescriptions for acute infectious diarrhea in individuals aged 65 years or younger in Japan from 2013 to 2018 based on administrative claims database: a retrospective observational study

“…These diseases are mostly caused by viruses and empirical antimicrobials are not necessary for otherwise healthy patients (here, ‘otherwise healthy’ indicates that except for acute infectious diarrhea, the patients had no other medical conditions requiring treatment), particularly in developed countries [ 10 , 11 ]. A previous Japanese study analyzing data from 2012 to 2015 showed that 40.5% of antimicrobials were prescribed for viral upper respiratory infections, 25.8% for gastrointestinal infections, and 6.7% for nonbacterial gastrointestinal infections [ 12 ]. In response to the Global Action Plan, similar to other nations, the Government of Japan prepared the National Action Plan on AMR in 2016 [ 13 ] and the Ministry of Health, Labour, and Welfare (MHLW) of Japan drafted the Manual of Antimicrobial Stewardship in 2017, particularly regarding acute respiratory tract infection and acute infectious diarrhea [ 14 ].…”

“…Although several studies have examined the role of antimicrobial stewardship in acute respiratory tract infections [ 6 , 15 , 16 ], few studies have examined this issue in relation to diarrhea in Japan, excluding a database study in children [ 17 ] and in all ages [ 12 ], but both of these studies were based on data up to 2015 and did not compare data between before and after the preparation of the National Action Plan and the manual. To implement measures for national antimicrobial stewardship for acute infectious diarrhea, understanding is required of the epidemiological characteristics of and antimicrobial prescriptions for acute infectious diarrhea.…”