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Antibiotic prescription among outpatients in a prefecture of Japan, 2012–2013: a retrospective claims database study
  1. Hideki Hashimoto1,
  2. Hiroki Matsui2,3,
  3. Yusuke Sasabuchi2,
  4. Hideo Yasunaga2,3,
  5. Kazuhiko Kotani4,
  6. Ryozo Nagai5,
  7. Shuji Hatakeyama1,6
  1. 1Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
  2. 2Data Science Center, Jichi Medical University, Shimotsuke, Tochigi, Japan
  3. 3Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
  4. 4Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
  5. 5President, Jichi Medical University, Shimotsuke, Tochigi, Japan
  6. 6Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
  1. Correspondence to Dr Shuji Hatakeyama; shatake-tky{at}


Objectives To investigate oral antibiotic prescribing patterns and identify factors associated with antibiotic prescriptions, with the aim of guiding future interventions to reduce inappropriate prescribing.

Design Retrospective cohort study.

Setting Database of public health insurance claims in Kumamoto prefecture (Japan).

Participants Beneficiaries of the national or late elders’ health insurance system between April 2012 and March 2013.

Main outcome measures Of the 7 770 481 outpatient visits, 682 822 had a code for antibiotics (860 antibiotic prescriptions per 1000 population). Third-generation cephalosporins (35%), macrolides (32%) and quinolones (21%) were the most frequently prescribed. Acute respiratory tract infections (ARTIs), including viral upper respiratory infections (URI) (22%), pharyngitis (18%), bronchitis (11%) and sinusitis (10%) were the most frequently diagnosed for antibiotic prescribing, followed by gastrointestinal (9%), urinary tract (8%) and skin, cutaneous and mucosal infections (5%). Antibiotic prescribing rates for viral URI, pharyngitis, bronchitis, sinusitis and gastrointestinal infections were 35%, 54%, 53%, 57% and 30%, respectively. In multivariable analysis for ARTIs and gastrointestinal infections, patient age (10–19 years especially), patient sex (male) and facility scale (free-standing clinics or small-scale hospital-based clinics) were associated with increased antibiotic prescribing.

Conclusions Broad-spectrum antibiotics constituted 88% of oral outpatient antibiotic prescriptions. Approximately 70% of antibiotics were prescribed for ARTIs and gastroenteritis with modest benefit from antibiotic treatment. The quality of antibiotic prescribing needs to be improved. Antimicrobial stewardship interventions should target ARTIs and gastroenteritis, as well as young patients and small-scale institutions.

  • epidemiology
  • public health
  • infectious diseases

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  • Contributors HH and SH conceived the study, interpreted the data and results and drafted the manuscript. HH, HM, YS and HY collected, organised, analysed the data and performed statistical analyses. KK and RN conceived the study and collected and interpreted the data. All authors critically revised the manuscript for intellectual content. All authors read and approved the final manuscript.

  • Funding This work was funded by ImPACT Program of Council for Science, Technology and Innovation (Cabinet Office, Government of Japan) and by MEXT KAKENHI, Grant Number 16K09254.

  • Competing interests None declared.

  • Ethics approval This study was approved by the Ethics Committee of the Jichi Medical University (Number 17-002).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

  • Patient consent for publication Not required.

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