{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:06:14Z","timestamp":1780131974718,"version":"3.54.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"JSPS","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"KAKENHI","doi-asserted-by":"publisher","award":["23K14710"],"award-info":[{"award-number":["23K14710"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an interrupted time-series analysis using a Japanese administrative claims database from approximately 3 million enrollees in fiscal years 2016\u20132019. 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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, \u22120.06 percentage points\/week; 95% confidence interval [CI], \u22120.12 to \u2212.01). After Intervention 2, there was no significant level change (\u22120.09 percentage points; 95% CI, \u22121.55 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\u201318 years after Intervention 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag312","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T11:33:06Z","timestamp":1779190386000},"source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3207-8403","authenticated-orcid":false,"given":"Shungo","family":"Yamamoto","sequence":"first","affiliation":[{"name":"Department of Transformative Protection to Infectious Disease, Graduate School of Medicine, The University of Osaka , Osaka ,","place":["Japan"]},{"name":"Department of Infection Control and Prevention, Graduate School of Medicine, The University of Osaka , Osaka ,","place":["Japan"]},{"name":"Center for Infectious Disease Education and Research (CiDER), The University of Osaka , Osaka ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6612-5613","authenticated-orcid":false,"given":"Michihiko","family":"Goto","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, Iowa ,","place":["USA"]},{"name":"Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System , Iowa City, Iowa ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3717-8788","authenticated-orcid":false,"given":"Tatsuyoshi","family":"Ikenoue","sequence":"additional","affiliation":[{"name":"Department of Public Health, Miyazaki University School of Medicine , Miyazaki ,","place":["Japan"]},{"name":"Data Science and AI Innovation Research Promotion Center, Shiga University , Shiga ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4679-3862","authenticated-orcid":false,"given":"Kazuaki","family":"Jindai","sequence":"additional","affiliation":[{"name":"Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University , Kyoto ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4127-7500","authenticated-orcid":false,"given":"Noriaki","family":"Kurita","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Tokai University School of Medicine , Kanagawa ,","place":["Japan"]},{"name":"Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital , Fukushima ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"2026053004512958200_ofag312-B1","author":"O'Neill"},{"key":"2026053004512958200_ofag312-B2","doi-asserted-by":"crossref","first-page":"181","DOI":"10.2169\/internalmedicine.4760-20","article-title":"Narrative review: the process of expanding the manual of antimicrobial stewardship by the government of 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