Way Forward
This document follows on from last year’s report in presenting information on the current status of antimicrobial
resistance in Japan in the areas of human health, animals, agriculture, food and the environment, as well as the volumes of
use (or sales) of human and veterinary antimicrobials. Based on this current report, it is expected that AMR-related
measures will be further advanced by promoting multi-disciplinary cooperation and collaboration. It is also considered
crucial to continue with advanced surveillance activities, in order to take the leadership in global policy in AMR. Part of
this report includes data obtained after Japan’s “National Action Plan on Antimicrobial Resistance (AMR) 2016-2020”
was published. Following on from 2017, figures for 2018 show that the total usage of all antimicrobials and usage of oral
antimicrobials, including oral cephalosporins, oral macrolides, and oral fluoroquinolones, is trending downward compared
with the data for 2013. However, further promotion of measures against AMR will be required to achieve the 2020 targets.
More specifically, it will be necessary to reduce the unnecessary prescription of antimicrobials, particularly in cases of
acute respiratory tract infection, based on the Manual of Antimicrobial Stewardship, among other materials. As the basic
premise underpinning the promotion of antimicrobial stewardship is ensuring that the appropriate antimicrobials can be
used when needed, securing a stable supply of basic antimicrobial agents is crucial. In addition, information about resistant
bacteria in each region and the status of antimicrobial use is being put in place, as it is desirable to select antimicrobials
and promote infection control measures tailored to the situation in each region. Furthermore, it will be necessary to continue
using various techniques for education and awareness activities targeting the public and medical professionals, to achieve
further progress in antimicrobial stewardship.
In animal field, rates of resistance to third-generation cephalosporins and fluoroquinolones in Escherichia coli isolated
from diseased companion animals, surveillance of which began in 2017, were found to be higher than in Escherichia coli
isolated from food-producing animals. This demonstrates the necessity of continuing and enhancing measures to combat
antimicrobial resistance not only via the measures that have been underway for some time in the field of food-producing
animals, but also through the widespread circulation of the guide to prudent use in companion animals launched in 2020.
In food-producing animal field, although the volume of tetracycline sales fell in 2018, rates of tetracycline resistance in
Escherichia coli isolated from healthy food-producing animals—an outcome index for the Action Plan—have not declined.
Accordingly, greater efforts are required to promote prudent use of these antimicrobials, taking into account the reality of
their use among veterinarians and producers.
Following on from 2019, this report makes comparisons between the volume of antimicrobial use (or sales) in the fields
of human medical care, veterinary care, and agriculture. Major progress was thus seen in such areas as the highlighting of
differences in the volume of antimicrobial use in each field by type of antimicrobial, the reporting of antimicrobial
resistance rates in healthy companion animals to accompany existing reporting on rates in diseased companion animals,
and the enhancement of data on trends in antimicrobial-resistant bacteria in food and the environment. Hopes are high that
progress in the surveillance of trends in each field will continue next year and beyond. Furthermore, it is hoped that
initiatives of the kind spotlighted by the National Action Plan on Antimicrobial Resistance, focusing on linking data from
antimicrobial resistance trend surveillance and monitoring in such areas as human health, animals, and food, will contribute
to combating antimicrobial resistance in Japan in the future.
The existing Action Plan covers the five-year period up to 2020. Although some indices are improving, there are still
many that have seen only scant improvement, added to which a number of new issues have emerged, so it is necessary to
continue addressing them in coordination with international trends. As such, industry, academia, and government will work
together to promote frameworks for collaboration between the organizations tasked with handling different fields, while
also examining the promotion of research that enables cross-cutting evaluation of the risks to humans, animals, and the
environment to be conducted.

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