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Change in clinical practice variations for antibiotic prescriptions across different pediatric clinics: A Japan's nationwide observational study.
Okubo, Yusuke; Nariai, Hiroki; Michels, Karin B; Kim-Farley, Robert J; Nishi, Akihiro; Arah, Onyebuchi A; Kinoshita, Noriko; Uda, Kazuhiro; Miyairi, Isao.
Afiliación
  • Okubo Y; Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA. Electronic address: okubo-y@ncchd.go.jp.
  • Nariai H; Department of Pediatrics, UCLA Mattel Children's Hospital, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA.
  • Michels KB; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA.
  • Kim-Farley RJ; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA.
  • Nishi A; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA.
  • Arah OA; Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA.
  • Kinoshita N; Department of Infectious Diseases, National Center for Global Health and Medicine, Tokyo, Japan.
  • Uda K; Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
  • Miyairi I; Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan; Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, USA.
J Infect Chemother ; 27(11): 1621-1625, 2021 Nov.
Article en En | MEDLINE | ID: mdl-34376349
BACKGROUND: In 2016, the Japanese government set the National Action Plan on antimicrobial resistance to reduce antibiotic prescriptions. However, the trends and variations of antibiotic prescription patterns in a routine healthcare setting during the fiscal year 2013-2018 across different clinics at a national level are unclear. METHODS: This retrospective cohort study included all clinics with >100 pediatric outpatients with infectious diseases per month during the fiscal year 2013-2018 using a national database in Japan. We investigated the trends in antibiotic prescription rates and their patterns and variations across different clinics over the six years following the 2019 World Health Organization Access, Watch, Reserve antibiotic groups, and Amoxicillin Index. RESULTS: A total of 2278 clinics with 94,414,170 infectious disease-related visits were eligible for the study. Most clinics showed higher Watch percentages (median 85.4%; IQR, 68.5-95.1) than Access percentages (median, 13.8%; IQR, 4.2-30.7) and Amoxicillin Index (median, 13.3%; IQR, 3.9-30.4). The introduction of the Action Plan changed annual absolute reductions in the antibiotic prescription rates from -16.0 DOTs/1000 visitors (95%CI, -16.4-15.6) to -239.3 per 1000 visitors (95%CI, -240.0-238.6). However, these impacts were heterogeneous across clinics. From 2013 to 2018, 41.4% reduced the antibiotic prescription rates by >33.3% (median, -1035.5 DOTs/1000 visitors; IQR, -1519.4-680.2), 18.7% did not change the rates (median, -40.3 DOTs/1000 visitors; IQR, -168.4-68.6), and 7.3% increased the rates by >10% (499.5 DOTs per 1000 visitors; IQR, 232.6-837.5). CONCLUSIONS: We observed the National Action Plan's impacts and extensive prescription variations across different pediatric clinics. However, one-fourth of clinics did not improve antibiotic prescription patterns even after introducing the Action Plan.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Prescripciones de Medicamentos / Antibacterianos Tipo de estudio: Observational_studies Límite: Child / Humans País/Región como asunto: Asia Idioma: En Revista: J Infect Chemother Asunto de la revista: MICROBIOLOGIA / TERAPIA POR MEDICAMENTOS Año: 2021 Tipo del documento: Article Pais de publicación: Países Bajos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Prescripciones de Medicamentos / Antibacterianos Tipo de estudio: Observational_studies Límite: Child / Humans País/Región como asunto: Asia Idioma: En Revista: J Infect Chemother Asunto de la revista: MICROBIOLOGIA / TERAPIA POR MEDICAMENTOS Año: 2021 Tipo del documento: Article Pais de publicación: Países Bajos