Antimicrobial Resistance Action Plans Drives Down Antibiotic Use in Japan

National plans optimizing and narrowing the use of antibiotics without requiring substantial resources could be effective in the fight against antimicrobial resistance.

A team, led by Taketo Zamami, Department of Pharmacy, University of the Ryukyus Hospital, evaluated the impact of a revised antibiotic formulary on in- and out-hospital oral antibiotic prescribing practices at a 600-bed university hospital.

“Revising the spectrum of antibiotics available to doctors for prescriptions brings a reduction in total antimicrobial consumption for both in- and out-hospital prescriptions and promotes a shift wards narrow-spectrum antibiotic usage,” the authors wrote. “We consider this approach to be a useful intervention tool for changing trends in antimicrobial use.”

National Action Plan

With antimicrobial resistance problems currently seen in Japan, the country has set goals of reducing the use of oral cephalosporins, quinolones, and macrolides per day per 1000 inhabitants in 2020 by 50% from the levels found in 2013.

“Antimicrobial resistance (AMR) of microorganisms to antibiotics has been declared a serious threat to global public health and an issue that requires intervention across all social and government sectors,” the authors wrote. “The emergence and spread of AMR threaten our ability to treat common infectious diseases, resulting in prolonged illness, disability, increasing healthcare costs, and higher mortality rates.”

The Japanese government created a national plan in 2016 after finding that approximately 90% of antimicrobials consumed in Japan are oral medications, which are prescribed to patients over an extensive age range.

A Closer Look

In the retrospective before and after comparison study, the researchers examined all antimicrobial consumption data in the reviewed classes between 2013-2018. The team extracted the data from the hospital’s database’s electronic medical records and measured it in the defined daily dose and antibiotic use density, defined daily dose per 1000 patient days.

There was a total oral antibiotic use density for in-hospital prescriptions of 117.95 in 2013, compared to 75.42 in 2018. For out-hospital prescription this was 239.83 in 2013 and 193.88 in 2018.

One trend in the 5 year study period was antibiotic use densities of second- and third-generation cephalosporins, macrolides, and fluoroquinolones for in-hospital prescriptions changed dramatically by -49.00%, -92.67%, 0.49%, and 48.19%, respectively.

The out-hospital prescriptions of these antibiotics changed by 76.69%, -86.37%, -16.29%, and -51.75% during the same study period.

On the other hand, penicillin prescriptions increased by 71.31% for in-hospital and 42.72% for out-hospital prescriptions between 2013-2018.

“In the present study, although the revised antibiotic formulary decreased both in- and out-hospital oral antibiotic consumption, narrow-spectrum oral antibiotic usage increased while no fluctuations were observed in the other classes,” the authors wrote. “These results suggest that the hospital-wide revision of antibiotics formulary resulted in an overall decrease in antimicrobial consumption and usage.”

The study, “Revised hospital antibiotic formulary reduces antimicrobial consumption and promotes a shift towards narrow-spectrum antibiotic usage,” was published online in the International Journal of Clinical Practice.