The Japanese government implemented an incentive program in 2018 to reduce antibiotic prescriptions in pediatric outpatient clinics. Since its initial rollout, the program has been expanded to cover more patients, more clinics, and a wider variety of diseases.

Under the program, pediatricians receive a financial reward of approximately $5 per claim when they choose not to prescribe an antibiotic in specific cases. This initiative addresses concerns regarding antibiotic use in Japan, where 90% of overall antibiotic prescriptions originate from outpatient clinics. "90% of prescriptions are [from] outpatient clinics, not hospitals," said Yusuke Okubo, chief of clinical epidemiology and health services research at the National Center for Child Health and Development.

In 2015, Japan ranked last among 35 high-income countries in the appropriateness of antibiotic choices for children under 5. That same year, Japanese doctors prescribed antibiotics associated with the lowest risk of resistance only 35% of the time, according to a cross-country comparison. "The clinics are a particular problem," Okubo said regarding sources of problematic antibiotic use.

Problematic antibiotic prescriptions in Japan were frequently administered to children under 3 years old, particularly for upper respiratory tract infections. While antibiotics treat bacterial infections, upper respiratory tract infections are caused by viruses in approximately 90% of cases. Gastroenteritis was another condition frequently subject to antibiotic overprescription in Japan, despite most cases also being caused by a virus. Treating nonbacterial infections with antibiotics can fuel antimicrobial resistance and the rise of superbugs by unnecessarily exposing bacteria to the drugs.

Why It Matters

The Japanese government's incentive program addresses the issue of antibiotic overprescription in a country that historically demonstrated a high rate of inappropriate antibiotic use in pediatric care. By targeting outpatient clinics and specific conditions like upper respiratory tract infections and gastroenteritis, the program seeks to mitigate the development of antimicrobial resistance. The expansion of the program indicates an ongoing effort to broaden its impact on healthcare practices.