{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T15:54:42Z","timestamp":1785599682051,"version":"3.56.0"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Antimicrobial stewardship for outpatients with acute respiratory tract infections (ARTIs) should be urgently promoted in this era of antimicrobial resistance. Previous large-sample studies were based on administrative data and had limited reliability. We aimed to identify current antimicrobial prescription practices for ARTIs by directly basing on medical records. This multicenter retrospective study was performed from January to December in 2018, at five medical institutes in Japan. We targeted outpatients aged \u226518 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting ARTIs. We divided the eligible cases into three age groups (18\u201364 years, 65\u201374 years, and \u226575 years). We defined broad-spectrum antimicrobials as third-generation cephalosporins, macrolides, fluoroquinolones, and faropenem. Primary and secondary outcomes were defined as the proportion of antimicrobial prescriptions for the common cold and other respiratory tract infections, respectively. Totally, data of 3,940 patients were collected. Of 2,914 patients with the common cold, 369 (12.7%) were prescribed antimicrobials. Overall, compared to patients aged \u226575 years (8.5%), those aged 18\u201364 years (16.6%) and those aged 65\u201374 years (12.1%) were frequently prescribed antimicrobials for the common cold (odds ratio [95% confidential interval]; 2.15 [1.64\u20132.82] and 1.49 [1.06\u20132.09], respectively). However, when limited to cases with a valid diagnosis of the common cold by incorporating clinical data, no statistical difference was observed among the age groups. Broad-spectrum antimicrobials accounted for 90.2% of the antimicrobials used for the common cold. Of 1,026 patients with other respiratory infections, 1,018 (99.2%) were bronchitis, of which antimicrobials were prescribed in 49.9% of the cases. Broad-spectrum antimicrobials were the main agents prescribed, accounting for nearly 90% of prescriptions in all age groups. Our data suggested a favorable practice of antimicrobial prescription for outpatients with ARTIs in terms of prescribing proportions, or quantitative aspect. However, the prescriptions were biased towards broad-spectrum antimicrobials, highlighting the need for further antimicrobial stewardship in the outpatient setting from a qualitative perspective.<\/jats:p>","DOI":"10.1371\/journal.pone.0259633","type":"journal-article","created":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T18:28:41Z","timestamp":1636741721000},"page":"e0259633","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Antimicrobial prescription practices for outpatients with acute respiratory tract infections: A retrospective, multicenter, medical record-based study"],"prefix":"10.1371","volume":"16","author":[{"given":"Tomoharu","family":"Ishida","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5086-1891","authenticated-orcid":true,"given":"Hideharu","family":"Hagiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Honda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Nakano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroko","family":"Ogawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikako","family":"Obika","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keigo","family":"Ueda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitomi","family":"Kataoka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihisa","family":"Hanayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7014-9095","authenticated-orcid":true,"given":"Fumio","family":"Otsuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,11,12]]},"reference":[{"key":"pone.0259633.ref001","article-title":"The Review on antimicrobial Resistance","year":"2016","journal-title":"Tackling drug-resistant infections globally: Final report and recommendation."},{"key":"pone.0259633.ref002","article-title":"Global action plan on antimicrobial resistance","author":"World Health Organization","year":"2015"},{"key":"pone.0259633.ref003","article-title":"Antimicrobial resistance in G7 countries and beyond: Economic issues, policies and options for action.","author":"M Cecchini","year":"2015"},{"key":"pone.0259633.ref004","article-title":"National Action Plan on Antimicrobial Resistance (AMR).","author":"The Government of Japan","year":"2016"},{"key":"pone.0259633.ref005","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1086\/322627","article-title":"Excessive antibiotic use for acute respiratory infections in the United States","volume":"33","author":"R Gonzales","year":"2001","journal-title":"Clin Infect Dis"},{"key":"pone.0259633.ref006","doi-asserted-by":"crossref","first-page":"e956","DOI":"10.1542\/peds.2014-0605","article-title":"Bacterial prevalence and antimicrobial prescribing trends for acute respiratory tract infections","volume":"134","author":"MP Kronman","year":"2014","journal-title":"Pediatrics"},{"key":"pone.0259633.ref007","unstructured":"Tuberculosis and Infectious Diseases Control Division, Health Service Bureau M of H L and W. Manual of Antimicrobial Stewardship, first edition. 2017. [Cited 2021 January 2]. 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