Abstract
BACKGROUND: National Action Plan on Antimicrobial Resistance in Japan recommends further strengthening of antimicrobial stewardship (AS) for acute upper respiratory infection (URI) in outpatients. AS initiatives for outpatients include the establishment of an AS implementation fee that can be claimed when a physician does not prescribe antibiotics to a pediatric patient diagnosed with acute URI that does not require antibiotics, after providing sufficient explanation. However, in Japan, unbeneficial effects of not prescribing antibiotics for acute URIs have not been clarified. This study aimed to investigate whether there were any unbeneficial effects in pediatric patients with acute URIs who claimed the AS implementation fee and were not prescribed antibiotics using a large Japanese medical insurance claim database. METHODS: This study used a large Japanese medical insurance claim database provided by IQVIA Japan. Patients aged less than six years of age and with a definitive diagnosis of acute URI and who claimed the AS implementation fee from January 2019 to December 2021 were selected. Among these patients, those with prescriptions other than antibiotics on the date of the first definitive diagnosis of acute URI were included in this study. The prescription of medicines and hospitalization within 10 days of the date of the first definitive diagnosis of acute URI in the target patients were investigated. RESULTS: There were 967,546 patients with a definitive diagnosis of acute URI in the outpatient. Of these, 32,489 patients below six years of age who claimed the AS implementation fee for children were prescribed medications other than antibiotics were considered the target patients for this study. Of these, 12,101 (37.2%) were again prescribed drugs in the outpatient clinic within 10 days, and 2,275 (7.0%) were prescribed antibiotics. The median (interquartile range) number of days until antibiotics were prescribed was 4 (2-7). Additionally, 105 patients (0.3%) were hospitalized within 10 days. CONCLUSION: This study revealed that there may be at least one risk factor in patients with acute URIs who were not prescribed antibiotics. In case of acute URI diagnosis and absence of antibiotic prescription, patients should be warned of worsening symptoms for at least 4 days.