Targets for optimizing oral antibiotic prescriptions for pediatric outpatients in Japan.

In Japan, 92.6% of antibiotics consumed are oral agents, most of which are for outpatients. A significant proportion is known to be dispensed for children; however, the specific pattern of antibiotic prescribing according to clinical specialty is still unclear. The aim of our study was to identify key targets for optimizing oral antibiotic use in children. We analyzed data on oral antimicrobial prescription patterns for children aged < 16 years old in three urban districts using a national database in Japan. Oral prescriptions were categorized according to their class, spectrum, clinical specialty, and type of clinical setting. The antibiotic spectrum was categorized as narrow, broad, or ultra-broad. In total 132,869,332 antibiotic prescriptions were collected for analysis. The proportions of narrow-spectrum, broad-spectrum, and ultra-broad-spectrum antibiotics were 10.9%, 73.7%, and 15.4% in primary care clinics and 23.4%, 71.1%, and 5.4% in hospitals, respectively. Prescriptions from pediatricians and otolaryngologists in primary care clinics predominated in the three studied areas. Third-generation cephalosporins, quinolones, penems, and carbapenems were prescribed mostly by pediatricians and otolaryngologists as well. Ultra-broad-spectrum antibiotics used in primary care clinics and antibiotics particular to each specialty were identified as key targets to optimize oral antibiotic use for pediatric outpatients.