Abstract

Using point-prevalence methodology and the World Health Organization (WHO) Access, Watch, and Reserve Classification, we measured antibiotic use in 5 hospitals in Okinawa, Japan, on October 1, 2020. Overall, 29% of patients were prescribed an antibiotic on the survey date and the 3 most used antibiotics in the “Watch” category were cefazolin, ampicillin-sulbactam, and ampicillin. Recently, a nationwide push in Japan has spurred action against antimicrobial resistance, including establishment of a national action plan.^{Reference Kusama, Tsuzuki, Muraki, Koizumi, Ishikane and Ohmagari1}Although the prevalence of antibiotic stewardship programs (ASPs) has increased in Japan, published data on the uptake of ASPs in the country are limited. To better inform nationwide efforts on antibiotic use, we sought to understand inpatient antibiotic use in the prefecture of Okinawa, Japan, where there has been little published in the realm of antimicrobial stewardship.^{Reference Taniguchi, Tsuha, Shiiki and Narita2}Point-prevalence studies of antibiotic use have been used internationally to provide regional data on antibiotic use.^{Reference Thu, Rahman, Coffin, Harun-Or-Rashid, Sakamoto and Hung3–Reference Morioka, Iguchi and Tetsuka5}The World Health Organization (WHO) Access, Watch and Reserve (AWaRe) Classification is a tool developed in 2019 that can compare antibiotic use from different geographic regions. The AWaRe criteria were intended to improve international antibiotic monitoring and use, with an emphasis on potential for antimicrobial resistance. “Access” antibiotics are common frontline antibiotics, “Watch” antibiotics are high-priority antibiotics with toxicity or resistance concerns, and “Reserve” antibiotics are last-line treatments for multidrug-resistant infections. We hypothesized that Access and Watch antibiotics would comprise most antibiotics used in this group of hospitals.

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