J Korean Med Sci.  2020 Dec;35(47):e390. 10.3346/jkms.2020.35.e390.

Trend of Antibiotic Usage for Hospitalized Community-acquired Pneumonia Cases in Korea Based on the 2010–2015 National Health Insurance Data

• Kim B
• Myung R
• Lee Mj
• Kim J
• Pai H

• KMID: 2509442
• DOI: http://doi.org/10.3346/jkms.2020.35.e390

Abstract

Background
This study is to describe the changes in prescribing practices of antibiotics to treat community-acquired pneumonia (CAP) in Korea during 2010–2015.
Methods
The claim database of the Health Insurance Review and Assessment Service in Korea was used to select adult patients (≥ 18 years of age) admitted between 2010 and 2015, with the International Classification of Diseases, Tenth Revision codes relevant to all-cause pneumonia for the first or second priority discharge diagnosis. The episodes with hospital-acquired or healthcare-associated pneumonia were excluded. Consumption of each antibiotic was converted to defined daily dose (DDD) per episode. The amount of antibiotic consumption was compared between patients with CAP aged < 65 years and those aged ≥ 65 years.
Results
The average amount of antibiotic consumption per episode was 15.5 DDD, which remained stable throughout the study period (P = 0.635). Patients aged ≥ 65 years received more antibiotics than those aged < 65 years (15.7 vs. 15.3 DDD). Third-generation cephalosporin (4.9 DDD/episode, 31.4%) was the most commonly prescribed, followed by macrolide (2.7 DDD/episode, 17.1%) and beta-lactam/beta-lactamase inhibitor (BL/BLI) (2.1 DDD/episode, 13.6%). The consumption amount of fourth-generation cephalosporin (4th CEP) (P = 0.001), BL/BLI (P = 0.003) and carbapenem (P = 0.002) increased each year during the study period. The consumption of 4th CEP and carbapenem was doubled during 2010–2015.
Conclusion
The prescription of broad-spectrum antibiotics such as 4th CEP and carbapenem to treat CAP increased in Korea during 2010–2015.

Keyword

Antibiotics; Pneumonia; Resistance; Stewardship; Korea

Figure

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  Fig. 1 Flow diagram showing the process of selecting episodes with community-acquired pneumonia based on the National Health Insurance claims data.HIV = human immunodeficiency virus.

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  Fig. 2 Average antibiotic consumption per hospitalized community-acquired pneumonia episode by age group during 2010–2015.

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  Fig. 3 Proportion of antibiotic classes used for the treatment of community-acquired pneumonia during 2010–2015.(A) Total, (B) Patients aged < 65 years, (C) Patients aged ≥ 65 years.1st CEP = first-generation cephalosporin, 2nd CEP = second-generation cephalosporin, 3rd CEP = third-generation cephalosporin, 4th CEP = fourth-generation cephalosporin, AG = aminoglycoside, BL/BLI = beta-lactam/beta-lactamase inhibitor, FQ = fluoroquinolone, SXT = trimethoprim/sulfamethoxazole.

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