Exploration of Trends in Antimicrobial Use and Their Determinants Based on Dispensing Information Collected from Pharmacies throughout Japan: A First Report

Abstract

The purpose of this study was to evaluate the defined daily doses (DDD)/1000 prescriptions/month (DPM) as a new indicator that can be used in pharmacies, and to describe antimicrobial use patterns in pharmacies nationwide in Japan. Dispensing volumes, number of prescriptions received, and facility information were obtained from 2638 pharmacies that participated in a survey. DPM was calculated based on the dispensing volume and number of prescriptions, which are routinely collected data that are simple to use. Use of third-generation cephalosporins, quinolones, and macrolides in pharmacies that received prescriptions primarily from hospitals or clinics decreased from January 2019 to January 2021. In particular, the antimicrobial use was higher in otorhinolaryngology departments than in other departments, despite a decrease in the antimicrobial use. In the linear multiple regression analysis, otorhinolaryngology department was independently associated with the third-generation cephalosporin, quinolone, and macrolide prescription in all periods. This study reveals for the first-time trends in antimicrobial use through a new indicator using the volume of drugs dispensed in pharmacies throughout Japan. Antimicrobial use differed by the medical department, suggesting the need to target interventions according to the department type.

Surveillance of Antimicrobial Prescriptions in Community Pharmacies Located in Tokyo, Japan

“…However, the use of narrow-spectrum antimicrobials is low, and that of broad-spectrum antimicrobials is still high. Muraki et al reported similar data from a nationwide investigation [12]. Since the focus is on the number of antimicrobial prescriptions and the amount of antimicrobial use, it will be necessary to monitor whether the average recovery cycle of patients lengthens in the future while antimicrobial prescriptions decrease, specifically with regard to the percentage of patients who have become severely ill. Antimicrobial prescriptions should be reduced, the patients who need antimicrobials should be prescribed them, and the choice of antimicrobials should be appropriate.…”

“…This study can serve as a guideline for understanding the efficiency of the AMR Action Plan, thereby facilitating the improved implementation of the plan in Japanese community pharmacies, and promoting more suitable infection control measures and prescription practices. A nationwide study of antimicrobial prescriptions in pharmacies between 2019 and 2021 reported that the use of third-generation cephalosporins, quinolones, and macrolides in pharmacies that received prescriptions primarily from hospitals or clinics decreased [ 12 ]. However, the previous report did not cover the AMR Action Plan or the impact of the addition of the pediatric antimicrobial regimen on the appropriate use of antimicrobials.…”

“…To effectively control AMR, it is necessary to have a detailed understanding of the community situation and to have process indicators, such as antimicrobial use, so that pharmacists can intervene and dispense antibiotics judiciously at pharmacies. To evaluate the promotion of appropriate antimicrobial use by pharmacists working in community pharmacies, it is necessary to identify trends in antimicrobial use in each pharmacy and the characteristics of antimicrobial use according to the institutional setting [ 12 ]. In this context, additional measures were taken to support the appropriate use of pediatric antimicrobial agents in 2018.…”

“…Limited studies have focused on actual antimicrobial prescriptions dispensed by pharmacies. Studies have examined the intermittent changes in the quantity of antibiotics used between January 2019 and June 2020 [ 12 ]. However, these were based on intermittent usage data and did not portray data over a continuous period.…”

Antimicrobial use and combination of resistance phenotypes in bacteraemic Escherichia coli in primary care: a study based on Japanese national data in 2018

“… 3 , 4 , 7–10 In Japan, the Ministry of Health, Labour and Welfare (MHLW) launched the National Action Plan (NAP) on AMR (2016–20), published the Manual of Antimicrobial Stewardship in 2017, which was mainly targeted at primary care, 11 and introduced financial incentives for appropriate outpatient AMU for paediatric patients in 2018 and for otorhinolaryngological patients in 2022. 12 , 13 Although NAP-based national interventions have reduced oral AMU to some extent, 14 their impact on AMR has not yet been assessed. National intervention through financial incentives to reduce AMU in primary care has been attempted in several countries, such as Denmark, Sweden and the UK, 15–18 but the impact of these interventions on AMR at the national level has been longitudinally assessed only in the UK.…”