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

  • 1Division of Infectious Diseases, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 2Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea.
  • 3Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.
  • 4Department of Laboratory Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 5Division of Gastroenterology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
  • 6Division of Infectious Diseases, Department of Internal Medicine, Hallym University, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
  • 7Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
  • 8Division of Infectious Diseases, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 9Division of Infectious Diseases, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Sungnam, Korea.


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.
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.
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%).
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.


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

MeSH Terms

Anti-Bacterial Agents*
Anti-Infective Agents
Colitis, Ulcerative
Crohn Disease
Epidemiologic Studies
Irritable Bowel Syndrome
National Health Programs
Retrospective Studies
Tertiary Healthcare
Anti-Bacterial Agents
Anti-Infective Agents


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

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

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


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