{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T04:41:45Z","timestamp":1765082505737,"version":"3.46.0"},"reference-count":35,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2020,8,23]],"date-time":"2020-08-23T00:00:00Z","timestamp":1598140800000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,7,28]]},"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the rate of outpatient antimicrobial use and the rationale for antimicrobial prescription.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A prospective, multicentre, cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Ambulatory care settings at community general hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 1972 consecutive ambulatory visits by 1952 patients were included from 2 February 2020 to 13 February 2020. Visits resulting in hospital admission and regularly scheduled visits were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was the proportion of ambulatory visits resulting in antimicrobial drug prescriptions. The secondary outcomes were the reasons for antimicrobial drug prescription and the proportion of unnecessary antimicrobial prescriptions among all antimicrobial drugs used for treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean patient age was 53.8 (SD 25.8) years old, and the proportion of women was 52.6%. A total of 162 antimicrobial drugs were prescribed in 153 (7.8%) visits. The most common antimicrobial drugs were penicillins (n=48, 29.6%), followed by third-generation cephalosporins (n=35, 21.6%) and quinolones (n=20, 12.4%). Among all the antimicrobial drugs prescribed, 125 (77.2%), 18 (11.1%) and 11 (6.8%) were used for infection treatment, wound prophylaxis and surgical prophylaxis, respectively. Of the 125 antimicrobial drugs used for infection treatment, 60 (48.0%) were judged to be unnecessary.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>One in every 13 ambulatory visits resulted in antimicrobial use in Japan. Three-fourths of the prescribed antimicrobial drugs were used for infection treatment, but approximately half of those drugs may have been unnecessary. Further efforts to reduce unnecessary antimicrobial drug use are needed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>UMIN000039360.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-039329","type":"journal-article","created":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T03:20:57Z","timestamp":1598325657000},"page":"e039329","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Prevalence of and rationale for antimicrobial prescription during ambulatory care visits in Japan: a prospective, multicentre, cross-sectional study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5899-4760","authenticated-orcid":false,"given":"Junpei","family":"Komagamine","sequence":"first","affiliation":[{"name":"Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Geriatrics and Gerontology, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takahiro","family":"Mori","sequence":"additional","affiliation":[{"name":"Internal Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Nagasaki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,8,24]]},"reference":[{"key":"2025120619124604000_10.8.e039329.1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis1006"},{"key":"2025120619124604000_10.8.e039329.2","doi-asserted-by":"crossref","first-page":"S82","DOI":"10.1086\/499406","article-title":"The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs","volume":"42 Suppl 2","author":"Cosgrove","year":"2006","journal-title":"Clin Infect Dis"},{"key":"2025120619124604000_10.8.e039329.3","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01157-10"},{"key":"2025120619124604000_10.8.e039329.4","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-099(18)30296-2"},{"key":"2025120619124604000_10.8.e039329.5","unstructured":"World Health Organization . Global action plan on antimicrobial resistance. Available: https:\/\/www.who.int\/antimicrobial-resistance\/global-action-plan\/en\/ [Accessed 31 Mar 2020]."},{"key":"2025120619124604000_10.8.e039329.6","unstructured":"The Government of Japan . National action plan on antimicrobial resistance (AMR) 2016-2020. Available: https:\/\/www.mhlw.go.jp\/file\/06-Seisakujouhou-10900000-Kenkoukyoku\/0000138942 [Accessed 28 Mar 2020]."},{"key":"2025120619124604000_10.8.e039329.7","unstructured":"Public Health England . English surveillance programme for antimicrobial utilization and resistance (ESPAUR). Report 2018-2019. Available: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/843129\/English_Surveillance_Programme_for_Antimicrobial_Utilisation_and_Resistance_2019.pdf [Accessed 31 Mar 2020]."},{"key":"2025120619124604000_10.8.e039329.8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4151"},{"key":"2025120619124604000_10.8.e039329.9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k3155"},{"key":"2025120619124604000_10.8.e039329.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k5092"},{"key":"2025120619124604000_10.8.e039329.11","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2015.113"},{"key":"2025120619124604000_10.8.e039329.12","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1017\/ice.2017.250","article-title":"The value of electronically extracted data for auditing outpatient antimicrobial prescribing","volume":"39","author":"Livorsi","year":"2018","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2025120619124604000_10.8.e039329.13","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkp367"},{"key":"2025120619124604000_10.8.e039329.14","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1002\/jgf2.252","article-title":"Building primary care in Japan: literature review","volume":"20","author":"Kato","year":"2019","journal-title":"J Gen Fam Med"},{"key":"2025120619124604000_10.8.e039329.15","unstructured":"Ministry of Health, Labor and Welfare . Health statistics in Japan, 2010. Available: https:\/\/www.mhlw.go.jp\/toukei\/saikin\/hw\/hoken\/national\/dl\/22-00.pdf [Accessed 6 Jun 2020]."},{"key":"2025120619124604000_10.8.e039329.16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.12923"},{"key":"2025120619124604000_10.8.e039329.17","doi-asserted-by":"publisher","DOI":"10.7326\/M15-1840"},{"key":"2025120619124604000_10.8.e039329.18","unstructured":"Infectious diseases Society of America . IDSA practice guidelines. Available: https:\/\/www.idsociety.org\/practice-guideline\/practice-guidelines\/#\/name_na_str\/ASC\/0\/+\/ [Accessed 22 Mar 2019]."},{"key":"2025120619124604000_10.8.e039329.19","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt301"},{"key":"2025120619124604000_10.8.e039329.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-026251"},{"key":"2025120619124604000_10.8.e039329.21","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkx504"},{"key":"2025120619124604000_10.8.e039329.22","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ076"},{"key":"2025120619124604000_10.8.e039329.23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijid.2019.11.009","article-title":"Indications and classes of outpatient antibiotic prescriptions in Japan: a descriptive study using the National database of electronic health insurance claims, 2012-2015","volume":"91","author":"Hashimoto","year":"2020","journal-title":"Int J Infect Dis"},{"key":"2025120619124604000_10.8.e039329.24","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1038\/sj.bdj.2016.496","article-title":"Antimicrobial prescribing by dentists in Wales, UK: findings of the first cycle of a clinical audit","volume":"221","author":"Cope","year":"2016","journal-title":"Br Dent J"},{"key":"2025120619124604000_10.8.e039329.25","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1038\/sj.bdj.4814261","article-title":"The impact of clinical audit on antibiotic prescribing in general dental practice","volume":"201","author":"Chate","year":"2006","journal-title":"Br Dent J"},{"key":"2025120619124604000_10.8.e039329.26","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/j.adaj.2019.08.020","article-title":"Evidence-Based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: a report from the American dental association","volume":"150","author":"Lockhart","year":"2019","journal-title":"J Am Dent Assoc"},{"key":"2025120619124604000_10.8.e039329.27","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkx502"},{"key":"2025120619124604000_10.8.e039329.28","unstructured":"One Health . Nippon AMR one health report (NAOR) [in Japanese], 2019. Available: https:\/\/www.mhlw.go.jp\/content\/10900000\/000571551.pdf [Accessed 11 Jun 2020]."},{"key":"2025120619124604000_10.8.e039329.29","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.1001\/jamainternmed.2018.1632","article-title":"Comparison of antibiotic prescribing in retail clinics, urgent care centers, emergency departments, and traditional ambulatory care settings in the United States","volume":"178","author":"Palms","year":"2018","journal-title":"JAMA Intern Med"},{"key":"2025120619124604000_10.8.e039329.30","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp120568"},{"key":"2025120619124604000_10.8.e039329.31","doi-asserted-by":"publisher","DOI":"10.1016\/0735-6757(95)90122-1"},{"key":"2025120619124604000_10.8.e039329.32","unstructured":"Ministry of Health, Labor and Welfare . Manual of antimicrobial stewardship [in Japanese]. 2nd edition, 2020. https:\/\/www.mhlw.go.jp\/content\/10900000\/000573655.pdf"},{"key":"2025120619124604000_10.8.e039329.33","unstructured":"Ministry of Health, Labor and Welfare . Current status of computerization in the medical field [in Japanese]. Available: https:\/\/www.mhlw.go.jp\/stf\/seisakunitsuite\/bunya\/kenkou_iryou\/iryou\/johoka\/index.html [Accessed 26 Jul 2020]."},{"key":"2025120619124604000_10.8.e039329.34","doi-asserted-by":"publisher","DOI":"10.1197\/jamia.M1780"},{"key":"2025120619124604000_10.8.e039329.35","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2008.00873.x"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-039329","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T03:12:54Z","timestamp":1765077174000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-039329"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8]]},"references-count":35,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020,8,24]]},"published-print":{"date-parts":[[2020,8]]}},"alternative-id":["10.1136\/bmjopen-2020-039329"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-039329","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2020,8]]}}}