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

Autoři: Yuki Kimura aff001;  Haruhisa Fukuda aff001;  Kayoko Hayakawa aff001;  Satoshi Ide aff003;  Masayuki Ota aff003;  Sho Saito aff003;  Masahiro Ishikane aff001;  Yoshiki Kusama aff001;  Nobuaki Matsunaga aff001;  Norio Ohmagari aff001
Působiště autorů: AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan aff001;  Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan aff002;  Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
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.

Klíčová slova:

Age groups – Antibiotics – Antimicrobials – Bronchitis – Japan – Outpatients – Pediatrics – Respiratory infections


1. The Government of Japan. National action plan on antimicrobial resistance (AMR) 2016–2020 [Internet]. 2016. Available: https://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000138942.pdf

2. World Health Organization. WHO Report on Surveillance of Antibiotic Consumption [Internet]. 2018. Available: https://apps.who.int/iris/bitstream/handle/10665/277359/9789241514880-eng.pdf?ua=1

3. Muraki Y, Yagi T, Tsuji Y, Nishimura N, Tanabe M, Niwa T, et al. Japanese antimicrobial consumption surveillance: First report on oral and parenteral antimicrobial consumption in Japan (2009–2013). J Glob Antimicrob Resist. Taibah University; 2016;7: 19–23. doi: 10.1016/j.jgar.2016.07.002 27973324

4. Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM, et al. Prevalence of inappropriate antibiotic prescriptions among us ambulatory care visits, 2010–2011. JAMA—J Am Med Assoc. 2016;315: 1864–1873. doi: 10.1001/jama.2016.4151 27139059

5. Havers FP, Hicks LA, Chung JR, Gaglani M, Murthy K, Zimmerman RK, et al. Outpatient Antibiotic Prescribing for Acute Respiratory Infections During Influenza Seasons. JAMA Netw Open. 2018;1: e180243. doi: 10.1001/jamanetworkopen.2018.0243 30646067

6. Bou-Antoun S, Costelloe C, Honeyford K, Mazidi M, Hayhoe BWJ, Holmes A, et al. Age-related decline in antibiotic prescribing for uncomplicated respiratory tract infections in primary care in England following the introduction of a national financial incentive (the Quality Premium) for health commissioners to reduce use of antibiotic. J Antimicrob Chemother. 2018;73: 2883–2892. doi: 10.1093/jac/dky237 29955785

7. Bianco A, Papadopoli R, Mascaro V, Pileggi C, Pavia M. Antibiotic prescriptions to adults with acute respiratory tract infections by Italian general practitioners. Infect Drug Resist. 2018;11: 2199–2205. doi: 10.2147/IDR.S170349 30519057

8. Lindberg BH, Gjelstad S, Foshaug M, Høye S. Antibiotic prescribing for acute respiratory tract infections in Norwegian primary care out-of-hours service. Scand J Prim Health Care. 2017;35: 178–185. doi: 10.1080/02813432.2017.1333301 28569649

9. Higashi T, Fukuhara S. Antibiotic prescriptions for upper respiratory tract infection in Japan. Intern Med. 2009;48: 1369–1375. doi: 10.2169/internalmedicine.48.1893 19687581

10. Yoshida S, Takeuchi M, Kawakami K. Prescription of antibiotics to pre-school children from 2005 to 2014 in Japan: a retrospective claims database study. J Public Health (Bangkok). 1093; 1–7. doi: 10.1093/pubmed/fdx045 28453710

11. Teratani Y, Hagiya H, Koyama T, Adachi M, Ohshima A, Zamami Y, et al. Pattern of antibiotic prescriptions for outpatients with acute respiratory tract infections in Japan, 2013–15: a retrospective observational study. Fam Pract. 2018; doi: 10.1093/fampra/cmy094 30272148

12. Denny KJ, Gartside JG, Alcorn K, Cross JW, Maloney S, Keijzers G. Appropriateness of antibiotic prescribing in the Emergency Department. J Antimicrob Chemother. 2018; 1–6. doi: 10.1093/jac/dkx349

13. The Government of Japan Ministry of Health Labour and Welfare. Manual of Antimicrobial Stewardship (1st Edition) [Internet]. 2017. Available: http://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000193504.pdf

14. Shapiro DJ, Hicks LA, Pavia AT, Hersh AL. Antibiotic prescribing for adults in ambulatory care in the USA, 2007–09. J Antimicrob Chemother. 2014;69: 234–240. doi: 10.1093/jac/dkt301 23887867

15. Tsutsui A, Yahara K, Shibayama K. Trends and patterns of national antimicrobial consumption in Japan from 2004 to 2016. J Infect Chemother. Elsevier Taiwan LLC; 2018;24: 414–421. doi: 10.1016/j.jiac.2018.01.003 29428566

16. Sakamoto H, Rahman M, Nomura S, Okamoto E, Koike S, Yasunaga H, et al. Japan Health System Review. Vol. 8 No. 1. World Heal Organ Reg Off South-East Asia. 2018;8. Available: http://apps.who.int/iris/bitstream/handle/10665/259941/9789290226260-eng.pdf;jsessionid=793E7F28273806A2F763882D242BCB1A?sequence=1

17. Miyawaki A, Noguchi H, Kobayashi Y. Impact of medical subsidy disqualification on children’s healthcare utilization: A difference-in-differences analysis from Japan. Soc Sci Med. Elsevier Ltd; 2017;191: 89–98. doi: 10.1016/j.socscimed.2017.09.001 28917140

18. Dekker ARJ, Verheij TJM, van der Velden AW. Inappropriate antibiotic prescription for respiratory tract indications: Most prominent in adult patients. Fam Pract. 2015;32: 401–407. doi: 10.1093/fampra/cmv019 25911505

19. Nakahama C, Muratani T. The problem of bacterial antimicrobial resistance in outpatients and the appropriate use of oral antimicrobial agents [in Japanese]. Japanese J Chemother. 2017;66: 185–202.

20. Kamata K, Tokuda Y, Gu Y, Ohmagari N, Yanagihara K. Public knowledge and perception about antimicrobials and antimicrobial resistance in Japan: A national questionnaire survey in 2017. PLoS One. 2018;13: e0207017. doi: 10.1371/journal.pone.0207017 30395640

21. Fletcher-Lartey S, Yee M, Gaarslev C, Khan R. Why do general practitioners prescribe antibiotics for upper respiratory tract infections to meet patient expectations: A mixed methods study. BMJ Open. 2016;6: 1–8. doi: 10.1136/bmjopen-2016-012244 27798010

22. O’Connor R, O’Doherty J, O’Regan A. Antibiotic use for acute respiratory tract infections (ARTI) in primary care; what factors affect prescribing and why is it important? A narrative review. Ir J Med Sci. Irish Journal of Medical Science (1971 -); 2018; 1–18. doi: 10.1007/s11845-018-1774-5 29532292

23. King LM, Fleming-Dutra KE, Hicks LA. Advances in optimizing the prescription of antibiotics in outpatient settings. BMJ. 2018;363: k3047. doi: 10.1136/bmj.k3047 30420401

24. Davis ME, Liu TL, Taylor YJ, Davidson L, Schmid M, Yates T, et al. Exploring patient awareness and perceptions of the appropriate use of antibiotics: A mixed-methods study. Antibiotics. 2017;6: 1–12. doi: 10.3390/antibiotics6040023 29088074

25. Bert F, Gualano MR, Gili R, Scaioli G, Lovato E, Angelillo IF, et al. Knowledge and attitudes towards the use of antibiotics in the paediatric age group: A multicenter survey in Italy. Eur J Public Health. 2017;27: 506–512. doi: 10.1093/eurpub/ckw209 27836969

26. Napolitano F, Izzo MT, Di Giuseppe G, Angelillo IF. Public knowledge, attitudes, and experience regarding the use of antibiotics in Italy. PLoS One. 2013;8: 1–6. doi: 10.1371/journal.pone.0084177 24376793

27. Anderson A. Online health information and public knowledge, attitudes, and behaviours regarding antibiotics in the UK: Multiple regression analysis of wellcome monitor and eurobarometer data. PLoS One. 2018;13: 1–15. doi: 10.1371/journal.pone.0204878 30356302

28. Zucco R, Lavano F, Anfosso R, Bianco A, Pileggi C, Pavia M. International Journal of Medical Informatics Internet and social media use for antibiotic-related information seeking : Findings from a survey among adult population in Italy. Int J Med Inform. Elsevier; 2018;111: 131–139. doi: 10.1016/j.ijmedinf.2017.12.005 29425624

29. Takahashi Y, Ohura T, Ishizaki T, Okamoto S, Miki K, Naito M, et al. Internet use for health-related information via personal computers and cell phones in Japan: a cross-sectional population-based survey. J Med Internet Res. 2011;13. doi: 10.2196/jmir.1796 22169526

30. Minitry of Health Labour and Welfare. Table 2–26 Number of Medical Institutions and rates of institutions per 100,000 population by type of institution, by year [Internet]. Handbook of Health and Welfare Statistics 2017. 2017. Available: https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/topics/bukyoku/kenkou/suido/kijun/kijunchi.html

31. Silverman M, Povitz M, Sontrop JM, Li L, Richard L, Cejic S, et al. Antibiotic prescribing for nonbacterial acute upper respiratory infections in elderly persons. Ann Intern Med. 2017;166: 765–774. doi: 10.7326/M16-1131 28492914

32. Schwartz KL, Achonu C, Brown KA, Langford B, Daneman N, Johnstone J, et al. Regional variability in outpatient antibiotic use in Ontario, Canada: a retrospective cross-sectional study. C Open. 2018;6: E445–E452. doi: 10.9778/cmajo.20180017 30381321

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2019 Číslo 10