Otsubo Yuto, Matsunaga Nobuaki, Tsukada Ai, Kaneko Tetsuji, Isobe Yusuke, Horikoshi Yuho
Division of Infectious Diseases, Immunology, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu, Tokyo, 183-8561, Japan; Center for Pediatric Infectious Diseases, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu, Tokyo, 183-8561, Japan.
AMR Clinical Reference Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan.
J Infect Chemother. 2025 Feb;31(2):102508. doi: 10.1016/j.jiac.2024.08.023. Epub 2024 Aug 29.
This study aimed to clarify changes in antimicrobial prescribing trends in pediatric clinics before and after the chronic shortage of amoxicillin and amoxicillin-clavulanic acid from 2023 in Japan. Amoxicillin and amoxicillin-clavulanic acid have been in chronic short supply since May 24, 2023 due to increased demand. It is unclear whether this situation has changed the type of oral antimicrobials prescribed by clinics. A retrospective observational study was conducted to analyze antimicrobial prescriptions in pediatric clinics between January and December 2023. The data was collected using information available on a new platform, the Online Monitoring System for Antimicrobial Stewardship at Clinics (OASCIS). The period from March to May was defined as the pre-shortage period, and the period from June to August was defined as the post-shortage period. Antimicrobials were classified using the AWaRe classification proposed by the World Health Organization. The average prescription rate per AWaRe classification in the three months before and after the shortage was compared. A total of 28,888 oral antimicrobial prescriptions were collected. Due to the chronic shortage, the proportion of Access antimicrobials decreased from 53.9 % in the pre-shortage period to 46.8 % in the post-shortage period (p < 0.001). The proportion of Watch antimicrobials increased from 45.9 % to 52.8 % (p < 0.001). Among the Watch antimicrobials, prescriptions for third-generation cephalosporins increased from 18.8 % to 24.7 % (p < 0.001). The chronic shortage of amoxicillin and amoxicillin-clavulanic acid has led to the use of broad-spectrum antimicrobial agents for patients in pediatric clinics.
本研究旨在阐明2023年日本阿莫西林和阿莫西林-克拉维酸长期短缺前后儿科诊所抗菌药物处方趋势的变化。由于需求增加，自2023年5月24日起，阿莫西林和阿莫西林-克拉维酸一直处于长期短缺状态。目前尚不清楚这种情况是否改变了诊所开具的口服抗菌药物类型。本研究进行了一项回顾性观察研究，以分析2023年1月至12月期间儿科诊所的抗菌药物处方。数据收集自一个新平台，即诊所抗菌药物管理在线监测系统（OASCIS）上可用的信息。3月至5月期间被定义为短缺前时期，6月至8月期间被定义为短缺后时期。抗菌药物使用世界卫生组织提出的AWaRe分类法进行分类。比较了短缺前后三个月各AWaRe分类的平均处方率。共收集到28,888份口服抗菌药物处方。由于长期短缺，可及性抗菌药物的比例从短缺前时期的53.9%降至短缺后时期的46.8%（p<0.001）。谨慎使用类抗菌药物的比例从45.9%增至52.8%（p<0.001）。在谨慎使用类抗菌药物中，第三代头孢菌素的处方从18.8%增至24.7%（p<0.001）。阿莫西林和阿莫西林-克拉维酸的长期短缺导致儿科诊所的患者使用广谱抗菌药物。
