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

PLoS One. 2019 Oct 16;14(10):e0223835. doi: 10.1371/journal.pone.0223835. eCollection 2019.

Abstract

Background: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Inappropriate Prescribing / statistics & numerical data*
  • Infant
  • Infant, Newborn
  • Insurance Claim Review
  • Japan / epidemiology
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Respiratory Tract Infections / drug therapy*
  • Respiratory Tract Infections / microbiology
  • Retrospective Studies
  • Risk Factors
  • Young Adult

Substances

  • Anti-Bacterial Agents

Grants and funding

This study was supported by a Ministry of Health, Labour and Welfare research grant of Japan (H29-H30-shinkougyousei-shitei-005). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.