Vol.73 No.5 September 2025
Observational study on the use of antimicrobial agents for acute respiratory tract infections in Hakusan-Nonoichi district: Comparison of the results of the 2019 and 2023 surveys by propensity score analysis
1)Hakusan-Nonoichi Network for Infection Control
2)Division of Infection Control, Public Tsurugi Hospital
3)Division of Pharmacy, Public Central Hospital of Matto Ishikawa
4)Aoimori Pharmacy
5)Bando Respiratory Clinic, 1-113 Nunoichi, Hakusan, Ishikawa, Japan
6)Department of Infectious Diseases, Kanazawa Medical University
Abstract
Antimicrobial resistance (AMR) due to antibiotic use is a major public health concern. In Japan, a National Action Plan on AMR (NAPAR) has been developed to address this issue. We conducted surveys of physicians at medical institutions in Ishikawa Prefecture in 2019 and 2023 to obtain fundamental data on their use of oral antibiotics in outpatient care. This study was aimed at comparing the use of antibiotics by physicians in this prefecture between the two surveys and their awareness level about appropriate antibiotic use.
We conducted a questionnaire survey of physicians affiliated with medical institutions in Hakusan City and Nonoichi City in Ishikawa Prefecture. The questionnaires were distributed and collected anonymously. The primary survey items included the physicians' medical specialty and type of medical institution, whether infection control surcharges were applied, age, their antibiotic prescription practice for acute respiratory infections, and the factors influencing antibiotic use. To ensure comparability among the respondents, we applied propensity score matching, and extracted 85 cases from each survey for comparative analysis.
Comparing the results of the two surveys revealed a change in the trends of antibiotic selection for patients without underlying diseases. In 2019, the most frequently prescribed antibiotics were macrolides, followed by cephems and then penicillins, in that order of frequency. In contrast, by 2023, the order shifted to macrolides as the most frequently prescribed antibiotics, followed by penicillins and cephems, although this difference was not statistically significant. In contrast, for patients with underlying comorbidities, significant changes were observed in the most frequently prescribed antibiotics: prescriptions for penicillins and cephems increased, while those for macrolides and fluoroquinolones decreased significantly from 2019 to 2023. Furthermore, awareness about NAPAR showed a slight downward trend from 2019 to 2023.
The observed shift in treatment selection for acute respiratory tract infections, characterized by an increase in penicillin use and a decrease in macrolide use, was consistent with the goals of NAPAR. Therefore, going forward, continued efforts to raise awareness about the fundamental principles of the NAPAR, along to promote antimicrobial stewardship in clinical practice are deemed increasingly important.
Key word
antimicrobial stewardship, acute respiratory infection, national action plan, propensity score matching
Received
April 1, 2025
Accepted
June 12, 2025
Jpn. J. Chemother. 73 (5): 368-377, 2025
