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1 Indications and classes of outpatient antibiotic prescriptions in Japan: A descriptive study using the national database of electronic health insurance claims, 2012–2015
نشانه ها و کلاسهای تجویز آنتی بیوتیک سرپایی در ژاپن: یک مطالعه توصیفی با استفاده از بانک اطلاعاتی ملی ادعاهای بیمه الکترونیکی بهداشت ، 2012-2015-2020
Objectives: 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 quinolonesaccountedfor 85.9%ofall antibiotic prescriptions.Fifty-sixpercent of antibioticprescriptionsweredirectedtowardinfectionsforwhichantibioticsaregenerallynotindicated.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.
Keywords: National administrative claims database | Big data | Antibiotic | Antimicrobial stewardship
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