{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T22:21:01Z","timestamp":1780525261012,"version":"3.54.1"},"reference-count":30,"publisher":"BMJ","issue":"4","funder":[{"DOI":"10.13039\/501100009538","name":"Council for Science, Technology, and Innovation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009538","id-type":"DOI","asserted-by":"crossref"}]},{"name":"MEXT KAKENHI"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,2,28]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate oral antibiotic prescribing patterns and identify factors associated with antibiotic prescriptions, with the aim of guiding future interventions to reduce inappropriate prescribing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Database of public health insurance claims in Kumamoto prefecture (Japan).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Beneficiaries of the national or late elders\u2019 health insurance system between April 2012 and March 2013.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Of the 7 770 481 outpatient visits, 682\u2009822 had a code for antibiotics (860 antibiotic prescriptions per 1000 population). Third-generation cephalosporins (35%), macrolides (32%) and quinolones (21%) were the most frequently prescribed. Acute respiratory tract infections (ARTIs), including viral upper respiratory infections (URI) (22%), pharyngitis (18%), bronchitis (11%) and sinusitis (10%) were the most frequently diagnosed for antibiotic prescribing, followed by gastrointestinal (9%), urinary tract (8%) and skin, cutaneous and mucosal infections (5%). Antibiotic prescribing rates for viral URI, pharyngitis, bronchitis, sinusitis and gastrointestinal infections were 35%, 54%, 53%, 57% and 30%, respectively. In multivariable analysis for ARTIs and gastrointestinal infections, patient age (10\u201319 years especially), patient sex (male) and facility scale (free-standing clinics or small-scale hospital-based clinics) were associated with increased antibiotic prescribing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Broad-spectrum antibiotics constituted 88% of oral outpatient antibiotic prescriptions. Approximately 70% of antibiotics were prescribed for ARTIs and gastroenteritis with modest benefit from antibiotic treatment. The quality of antibiotic prescribing needs to be improved. Antimicrobial stewardship interventions should target ARTIs and gastroenteritis, as well as young patients and small-scale institutions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026251","type":"journal-article","created":{"date-parts":[[2019,4,4]],"date-time":"2019-04-04T04:34:06Z","timestamp":1554352446000},"page":"e026251","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":40,"title":["Antibiotic prescription among outpatients in a prefecture of Japan, 2012\u20132013: a retrospective claims database study"],"prefix":"10.1136","volume":"9","author":[{"given":"Hideki","family":"Hashimoto","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Matsui","sequence":"additional","affiliation":[{"name":"Data Science Center, Jichi Medical University, Shimotsuke, Tochigi, Japan"},{"name":"Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Sasabuchi","sequence":"additional","affiliation":[{"name":"Data Science Center, Jichi Medical University, Shimotsuke, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Yasunaga","sequence":"additional","affiliation":[{"name":"Data Science Center, Jichi Medical University, Shimotsuke, Tochigi, Japan"},{"name":"Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiko","family":"Kotani","sequence":"additional","affiliation":[{"name":"Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryozo","family":"Nagai","sequence":"additional","affiliation":[{"name":"President, Jichi Medical University, Shimotsuke, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuji","family":"Hatakeyama","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan"},{"name":"Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,3]]},"reference":[{"key":"2025121601590176000_9.4.e026251.1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01157-10"},{"key":"2025121601590176000_9.4.e026251.2","doi-asserted-by":"crossref","first-page":"pii=30319","DOI":"10.2807\/1560-7917.ES.2016.21.33.30319","article-title":"The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study","volume":"21","author":"Stewardson","year":"2016","journal-title":"Euro Surveill"},{"key":"2025121601590176000_9.4.e026251.3","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis1006"},{"key":"2025121601590176000_9.4.e026251.4","unstructured":"World Health Organization. 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