Department of Pharmaceutical Biomedicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 1-1-1 Tsushima-naka, Kita-ku, Okayama, 7008530, Japan.
Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 5650871, Japan.
J Infect Chemother. 2020 Jul;26(7):660-666. doi: 10.1016/j.jiac.2020.02.001. Epub 2020 Mar 12.
Appropriate antibiotic prescriptions for outpatients with acute respiratory tract infections (ARTIs) are urgently needed in Japan. However, the empirical proof of this need is under-documented. Therefore, we aimed to determine antibiotic prescription rates, and the proportions of antibiotic classes prescribed for Japanese patients with ARTIs.
We analysed health insurance claims data over 2013-2015 among Japanese patients aged <75 years and determined the following indicators: 1) visit rates for patients with ARTIs and antibiotic prescription rates per 1000 person-years, and 2) proportion of visits by antibiotic-prescribed patients with ARTIs. We defined broad-spectrum antibiotics using the WHO Anatomical Therapeutic Chemical classification 4 level codes.
Among 8.65 million visits due to ARTIs at 6859 hospitals and 62,024 physicians' offices, the visit rate and antibiotic prescription rate per 1000 person-years were 990.6 (99% confidence interval [CI], 989.4-991.7) and 532.4 (99% CI, 531.6-533.3), respectively. The visit rates for patients aged 0-17, 18-59, and 60-74 years were 2410.0 (99% CI, 2407.2-2412.9), 683.6 (99% CI, 682.7-684.6), and 682.1 (99% CI, 678.2-686.0), and antibiotic prescription rates were 1093.3 (99% CI, 1091.4-1095.2), 434.1 (99% CI, 433.4-434.9), and 353.4 (99% CI, 350.7-356.1), respectively. The overall proportion of antibiotic prescriptions for ARTI visits was 52.7% and 91.3% of the antibiotics prescribed were broad-spectrum.
Both the visit rates and antibiotic prescription rates for ARTIs were high in this Japanese cohort. The proportion of antibiotic prescriptions exceeded that recommended in the clinical guidelines. Thus, there might be a scope for reducing the current antibiotic prescription rate in Japan.
在日本，迫切需要为急性呼吸道感染（ARTI）的门诊患者开出适当的抗生素处方。然而，这一需求的经验证据却记录不足。因此，我们旨在确定抗生素处方率以及为日本 ARTI 患者开处方的抗生素类别比例。
我们分析了 2013 年至 2015 年期间年龄<75 岁的日本患者的医疗保险索赔数据，并确定了以下指标：1）ARTI 患者就诊率和每 1000 人年的抗生素处方率，以及 2）抗生素处方 ARTI 患者就诊的比例。我们使用世界卫生组织解剖治疗化学分类 4 级代码来定义广谱抗生素。
在 6859 家医院和 62024 名医生的办公室中，因 ARTI 就诊的 865 万次就诊中，每 1000 人年的就诊率和抗生素处方率分别为 990.6（99%置信区间[CI]，989.4-991.7）和 532.4（99%CI，531.6-533.3）。0-17 岁、18-59 岁和 60-74 岁患者的就诊率分别为 2410.0（99%CI，2407.2-2412.9）、683.6（99%CI，682.7-684.6）和 682.1（99%CI，678.2-686.0），抗生素处方率分别为 1093.3（99%CI，1091.4-1095.2）、434.1（99%CI，433.4-434.9）和 353.4（99%CI，350.7-356.1）。ARTI 就诊的抗生素处方总体比例为 52.7%，所开抗生素中 91.3%为广谱抗生素。
在日本，ARTI 的就诊率和抗生素处方率均较高。抗生素处方的比例超过了临床指南的建议。因此，日本可能有减少目前抗生素处方率的空间。
