よむ、つかう、まなぶ。
【参考資料３】【英版R4.1.17】Nippon AMR One Health Report (NAOR) 2020 (81 ページ)
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| 出典情報 | 国際的に脅威となる感染症対策関係閣僚会議 薬剤耐性ワンヘルス動向調査検討会（第9回 1／17）《厚生労働省》 |
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[Information updated in FY2020]
Teratani et al. used JMDC’s database to study the relationship between the use of rapid antigen detection tests to identify
GAS and the prescription of antimicrobials for tonsillitis during the period January 2013 to December 2015. 15 Analysis
of 1.27 million consultations revealed that 5.6% of patients underwent a rapid antigen detection test to identify GAS.
Antimicrobials were prescribed at 59.3% of all consultations, with penicillins accounting for 10.8% of all antimicrobials
prescribed. The antimicrobial prescription rate in the group of patients who underwent rapid antigen detection tests was
75.0%, which was higher than in the group who did not (58.4%). On the other hand, the proportion prescribed penicillin
was higher among the group who underwent rapid antigen detection tests (25.4% vs 9.7%, odds ratio 1.55 [1.50-1.60])
(Table 89).
Table 89 Factors associated with the use of rapid antigen detection test (RADT) to identify Group A betahemolytic Streptococcus, using multilevel logistic regression analysis
Diagnostic code
Acute pharyngitis,
unspecified
Acute pharyngitisdue to
other specified
Streptococcal
pharyngitis
Total
Visits with
pharyngitis
(%)
1,234,915
(97.5)
2365
(0.2)
29,300
(2.3)
1,266,580
(100.0)
without RADT, %
(95% confidence
interval)
with RADT, %
(95% confidence
interval)
Proportion prescribed penicillins/visits
with an antimicrobial
without RADT, %
With RADT, %
(95% confidence
(95% confidence
interval)
interval)
3.6
58.4 (58.3-58.5)
63.1 (62.6-63.5)
9.6 (9.6-9.7)
14.8 (14.4-15.2)
17.7
10.0 (8.7-11.4)
16.5 (12.9-20.0)
10.3 (6.0-14.5)
24.6 (14.5-34.8)
88.2
82.7 (81.4-84.0)
96.2 (96.0-96.5)
39.6 (37.8-41.4)
37.3 (36.7-37.9)
5.6
58.4 (58.3-58.5)
75.0 (74.6-75.3)
9.7 (9.7-9.8)
25.4 (25.0-25.8)
Proportion of visits prescribed an antimicrobial
Proportion used
RADT, %
[Summary]
GAS infections are one of the most common infections in which the administration of antimicrobials is justified.
Appropriate testing and selection of therapeutic drugs are required in the case of GAS infections and these studies showed
that they are being carried out appropriately. In particular, given that the use of testing is not yet prevalent, efforts to
promote the proper use of testing are required. While cystitis is another infection in which the administration of
antimicrobials is justified, there is a tendency to favor third-generation cephalosporins and fluoroquinolones when
selecting antimicrobials, due in part to the fact that the antimicrobials available in Japan to treat uncomplicated cystitis
are limited (antimicrobials commonly used overseas such as nitrofurantoin, trimethoprim, and pivmecillinam cannot be
used in Japan). Accurate diagnosis and efforts to ascertain regional antimicrobial susceptibility are required.
80
Teratani et al. used JMDC’s database to study the relationship between the use of rapid antigen detection tests to identify
GAS and the prescription of antimicrobials for tonsillitis during the period January 2013 to December 2015. 15 Analysis
of 1.27 million consultations revealed that 5.6% of patients underwent a rapid antigen detection test to identify GAS.
Antimicrobials were prescribed at 59.3% of all consultations, with penicillins accounting for 10.8% of all antimicrobials
prescribed. The antimicrobial prescription rate in the group of patients who underwent rapid antigen detection tests was
75.0%, which was higher than in the group who did not (58.4%). On the other hand, the proportion prescribed penicillin
was higher among the group who underwent rapid antigen detection tests (25.4% vs 9.7%, odds ratio 1.55 [1.50-1.60])
(Table 89).
Table 89 Factors associated with the use of rapid antigen detection test (RADT) to identify Group A betahemolytic Streptococcus, using multilevel logistic regression analysis
Diagnostic code
Acute pharyngitis,
unspecified
Acute pharyngitisdue to
other specified
Streptococcal
pharyngitis
Total
Visits with
pharyngitis
(%)
1,234,915
(97.5)
2365
(0.2)
29,300
(2.3)
1,266,580
(100.0)
without RADT, %
(95% confidence
interval)
with RADT, %
(95% confidence
interval)
Proportion prescribed penicillins/visits
with an antimicrobial
without RADT, %
With RADT, %
(95% confidence
(95% confidence
interval)
interval)
3.6
58.4 (58.3-58.5)
63.1 (62.6-63.5)
9.6 (9.6-9.7)
14.8 (14.4-15.2)
17.7
10.0 (8.7-11.4)
16.5 (12.9-20.0)
10.3 (6.0-14.5)
24.6 (14.5-34.8)
88.2
82.7 (81.4-84.0)
96.2 (96.0-96.5)
39.6 (37.8-41.4)
37.3 (36.7-37.9)
5.6
58.4 (58.3-58.5)
75.0 (74.6-75.3)
9.7 (9.7-9.8)
25.4 (25.0-25.8)
Proportion of visits prescribed an antimicrobial
Proportion used
RADT, %
[Summary]
GAS infections are one of the most common infections in which the administration of antimicrobials is justified.
Appropriate testing and selection of therapeutic drugs are required in the case of GAS infections and these studies showed
that they are being carried out appropriately. In particular, given that the use of testing is not yet prevalent, efforts to
promote the proper use of testing are required. While cystitis is another infection in which the administration of
antimicrobials is justified, there is a tendency to favor third-generation cephalosporins and fluoroquinolones when
selecting antimicrobials, due in part to the fact that the antimicrobials available in Japan to treat uncomplicated cystitis
are limited (antimicrobials commonly used overseas such as nitrofurantoin, trimethoprim, and pivmecillinam cannot be
used in Japan). Accurate diagnosis and efforts to ascertain regional antimicrobial susceptibility are required.
80