Infect Chemother.  2019 Sep;51(3):295-304. 10.3947/ic.2019.51.3.295.

Prescription of Antibiotics for Adults with Acute Infectious Diarrhea in Korea: A Population-based Study

• Lee HJ
• Park KH
• Park DA
• Park J
• Bang BW
• Lee SS
• Lee EJ
• Kim YJ
• Hong SK
• Kim YR

• KMID: 2459045
• DOI: http://doi.org/10.3947/ic.2019.51.3.295

Abstract

BACKGROUND
Acute infectious diarrhea (AID) is a commonly observed condition globally. Several studies recommend against the use of empiric antibiotic therapy for AID, except in some cases of travelers' diarrhea. However, many physicians prescribe antimicrobial agents for AID. We aimed to determine the rate of antibiotic use and the associated prescription patterns among adults with AID.
MATERIALS AND METHODS
This population-based, retrospective epidemiological study was performed using Korean National Health Insurance claims data from 2016 to 2017. The study population comprised adults (age ≥18 years) who had visited clinics with AID-related complaints. Exclusion criteria were the presence of Crohn's disease, ulcerative colitis, irritable bowel syndrome, and other non-infectious forms of colitis. Patients who underwent surgery during admission were also excluded.
RESULTS
The study population comprised 1,613,057 adult patients with AID (767,606 [47.6%] men). Young patients (age 18 - 39 years) accounted for 870,239 (54.0%) of the study population. Overall, 752,536 (46.7%) cases received antibiotic prescriptions. The rate of antibiotic administration tended to be higher among elderly patients (age ≥65 years) than among younger patients (49.5% vs. 46.4%, P <0.001). The antibiotics most frequently prescribed in both monotherapy and combination regimens were fluoroquinolones (29.8%), rifaximin (26.8%), second-generation cephalosporins (9.2%), third-generation cephalosporins (7.3%), trimethoprim/sulfamethoxazole (5.5%), and β-lactam/β-lactamase inhibitors (5.3%). Patients who visited tertiary care hospitals had lower rates of antibiotic therapy (n = 14,131, 41.8%) than did those visiting private clinics (n = 532,951, 47.1%). In total, 56,275 (62.3%) admitted patients received antibiotic therapy, whereas outpatients had lower rates of antibiotic prescription (n = 694,204, 46.0%).
CONCLUSION
This study revealed differences between the antibiotics used to treat AID in Korea and those recommended by the guidelines for AID treatment. Multifaceted efforts are necessary to strengthen physicians' adherence to published guidelines.

Keyword

Dysentery; Anti-bacterial agents; Epidemiology; Diarrhea; Gastroenteritis

MeSH Terms

Adult*
Aged
Anti-Bacterial Agents*
Anti-Infective Agents
Cephalosporins
Colitis
Colitis, Ulcerative
Crohn Disease
Diarrhea*
Dysentery
Epidemiologic Studies
Epidemiology
Fluoroquinolones
Gastroenteritis
Humans
Irritable Bowel Syndrome
Korea*
National Health Programs
Outpatients
Prescriptions*
Retrospective Studies
Tertiary Healthcare
Anti-Bacterial Agents
Anti-Infective Agents
Cephalosporins
Fluoroquinolones

Figure

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  Figure 1 Distribution of adult patients with infectious diarrhea, according to age group and sex.

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  Figure 2 Frequency of antibiotic prescription for patients with infectious diarrhea, according to medical facility type.

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  Figure 3 Use of antimicrobial agents among adults with infectious diarrhea, by region.

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