RT Journal Article
SR Electronic
T1 Antibiotic prescription among outpatients in a prefecture of Japan, 2012–2013: a retrospective claims database study
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e026251
DO 10.1136/bmjopen-2018-026251
VO 9
IS 4
A1 Hideki Hashimoto
A1 Hiroki Matsui
A1 Yusuke Sasabuchi
A1 Hideo Yasunaga
A1 Kazuhiko Kotani
A1 Ryozo Nagai
A1 Shuji Hatakeyama
YR 2019
UL http://bmjopen.bmj.com/content/9/4/e026251.abstract
AB 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.