Impact of National Policies Promoting Appropriate Antibiotic Use on Outpatient Prescriptions and Hospitalizations for Bacterial Complications of Acute Respiratory Infections in Japan: An Interrupted Time-Series Analysis.

BACKGROUND

National policies in Japan have promoted appropriate antibiotic use, but their safety across age groups remains unclear. We examined whether these policies were associated with changes in outpatient antibiotic prescriptions for nonbacterial acute respiratory infections (ARIs) and hospitalizations for bacterial complications of ARIs.

METHODS

We conducted an interrupted time-series analysis using a Japanese administrative claims database from approximately 3 million enrollees in fiscal years 2016-2019. The interventions were publication of outpatient antimicrobial prescribing guidance in June 2017 and implementation of a pediatric financial incentive with package-insert revisions in April 2018. The primary outcome was the weekly hospitalization rate for bacterial infections potentially complicating ARIs. The secondary outcome was the proportion of outpatient antibiotic prescriptions among visits for nonbacterial ARIs.

RESULTS

There was no evidence of an overall increase in hospitalizations for bacterial complications of ARIs after either intervention. For the secondary outcome, prescribing declined further after Intervention 1 (slope change, -0.06 percentage points/week; 95% confidence interval [CI], -0.12 to -.01). After Intervention 2, there was no significant level change (-0.09 percentage points; 95% CI, -1.55 to 1.37), but the slope increased by 0.07 percentage points/week (95% CI, .03 to .11), indicating attenuation of the downward trend. In age-stratified analyses, hospitalization rates remained stable in most groups, with an increase in those aged 6-18 years after Intervention 2.

CONCLUSIONS

Japan's national policies promoting appropriate antibiotic use were associated with reduced outpatient antibiotic prescribing for nonbacterial ARIs without an overall increase in hospitalizations for bacterial complications of ARIs.