169. Targets for optimizing oral antibiotic prescriptions for pediatric outpatients in Japan
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions in Pediatric Populations
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • IDweek_2018_final.pdf (391.9 kB)
  • Background: In Japan, 92% of antibiotics consumed are oral agents most of which are prescribed at outpatient clinics. Universal health insurance and the full reimbursement program for children enables to patients to be treated and obtain prescriptions without any charge in the majority of institutions. Thus, it is possible that unnecessary antibiotic prescription for viral illnesses is common due to free medical access in Japan. As part of a national project to formulate an effective method of antimicrobial stewardship for pediatric outpatients, the aim of our study was to identify key targets for optimizing oral antibiotic use in children by analyzing what factors are related to their prescription in three pilot districts.

    Methods: We analyzed data on oral antimicrobial prescription patterns for children aged <16 years old in three districts (Setagaya ward, Fuchu city, and Kobe city) using national database in Japan. Oral prescriptions were categorized according to their class, spectrum, clinic specialization, and type of clinical setting. The antibiotic spectrum was categorized as narrow, broad, or ultra-broad.

    Results: In total 13,869,332 antibiotic prescriptions were collected for analysis. The proportions of narrow, broad, and ultra-broad spectrum antibiotics were 12.4%, 73.3%, and 14.2%, respectively. The proportions of narrow and ultra-broad spectrum antibiotics were 10.8% and 15.4% in primary care clinics and 23.4% and 5.4% in hospital, respectively. Otolaryngologists prescribed the most antibiotics to children at a rate 1.3 times higher than pediatricians (Figure 1). Dermatologists prescribed 58.7% of all tetracyclines (Figure 2). Three classes of third generation cephalosporins, quinolones, and penems were prescribed mostly by pediatricians and otolaryngologists.

    Conclusion: Ultra-broad spectrum antibiotics were prescribed more often in primary care clinics. As the use of specific oral antibiotics differ according to the specialty of each clinic, targeting the clinics specialty and the antibiotic agents used may be key to optimizing oral antibiotic use for pediatric outpatients.

    Figure 1: Day of therapy in the hospitals and clinics

    Figure 2: Ratio of clinics and hospitals in each type of antibiotics.

    Kazuhiro Uda, MD, Division of Infectious Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan; Division of Infectious Diseases, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan, Noriko Kinoshita, MD, Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan, Naho Morisaki, MD, MPH, PhD, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan, Yusuke Okubo, MD, MPH, Social Medicine, National Center for Child Health and Development, Tokyo, Japan; Department of Epidemiology, UCLA Fielding School of Public Health,, Los Angeles, CA, Masashi Kasai, MD, Department of Infectious Disease Medicine, Hyogo Prefectural Kobe Children’s Hospital, Hyogo, Japan, Yuho Horikoshi, MD, Infectious Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan and Isao Miyairi, MD, Infectious Disease, National Center for Child Health and Development, Tokyo, Japan

    Disclosures:

    K. Uda, None

    N. Kinoshita, None

    N. Morisaki, None

    Y. Okubo, None

    M. Kasai, None

    Y. Horikoshi, None

    I. Miyairi, None

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