{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:24:16Z","timestamp":1783445056871,"version":"3.54.6"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"vor","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate an outpatient, antimicrobial stewardship intervention targeting broad-spectrum antimicrobials including third-generation cephalosporins, fluoroquinolones, and macrolides, during an antimicrobial shortage at a Japanese, tertiary hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This before-and-after interventional study was conducted at a tertiary hospital. The intervention included department-focused and hospital-wide education, local guidelines, weekly post-prescription review and feedback, monthly reports on days of therapy (DOT), a formulary review, and an orientation for newly transferred physicians. Counterfactual monthly outcomes (primary endpoint: DOT per 100 visits (DOT\/100V) and number of prescriptions per 1000 visits (Rx\/1000V) for the target antimicrobials) were predicted on the basis of pre-intervention data using ordinary least squares regression incorporating oral antimicrobial shortages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The post-intervention use of third-generation cephalosporins decreased (DOT\/100\u2005V mean difference [MD]: \u22120.87; 95% confidence interval [CI]: \u22120.97 to \u22120.76; Rx\/1000\u2005V MD: \u22123.85; 95% CI: \u22124.06 to \u22123.65) together with that of fluoroquinolones (DOT\/100V: \u22121.92; 95% CI: \u22122.33 to \u22121.51; Rx\/1000V MD: \u22122.14; 95% CI: \u22122.60 to \u22121.68). The volume and frequency of macrolide use did not differ significantly, but inappropriate prescriptions of fluoroquinolones (\u221226.22%) and macrolides (\u22127.92%) decreased.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This outpatient stewardship programme evaluated within a counterfactual framework accounted for supply shortages, reduced third-generation cephalosporins and fluoroquinolone use, and improved the appropriateness of prescriptions. Sustaining these gains requires on-going evidence-based data-sharing and prescriber-tailored interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jacamr\/dlag133","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T16:42:44Z","timestamp":1783442564000},"source":"Crossref","is-referenced-by-count":0,"title":["Packaged intervention targeting oral antimicrobials in Japanese tertiary care outpatient setting: a quasi-experimental study"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9684-4520","authenticated-orcid":false,"given":"Hiroshi","family":"Horiuchi","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Institute of Science Tokyo, Graduate School of Medical and Dental Sciences , 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510 ,","place":["Japan"]},{"name":"Department of Infection Control, National Hospital Organization, Yokohama Medical Center , Kanagawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3736-4046","authenticated-orcid":false,"given":"Yasuaki","family":"Tagashira","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Institute of Science Tokyo, Graduate School of Medical and Dental Sciences , 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510 ,","place":["Japan"]},{"name":"Center for Infectious Disease Education and Analysis, Institute of Science Tokyo (TCIDEA) , Tokyo ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asami","family":"Takizawa","sequence":"additional","affiliation":[{"name":"Department of Infection Control, National Hospital Organization, Yokohama Medical Center , Kanagawa ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunihiko","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, M&D Data Science 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