P-1652. Geographical factors associated with antibiotic use for non-bacterial upper respiratory infections using nationwide Japanese data

Abstract Background The large number of antibiotic prescriptions for non-bacterial upper respiratory infections has been reported globally. The reduction of unnecessary antibiotic use for non-bacterial upper respiratory infections is critical. Elucidating geographical factors associated with antibiotic use for non-bacterial upper respiratory infections using nationwide data may guide national policy regarding antibiotic stewardship. Methods This study evaluated geographical factors regarding antibiotic use for patients with sole diagnosis of upper respiratory infections using health insurance claims data across all Japanese prefectures. A multivariable negative binomial regression analysis was implemented for the outcome of the defined daily doses per 1,000 habitants per day by prefecture with patient- and physician-level variables. Total and sub-class antibiotic use were analyzed. Results In 2019, 116,174,509 defined daily doses of antibiotic use for non-bacterial upper respiratory infections were included from all 47 prefectures. The annual number of diagnoses related with upper respiratory infections per 1,000 inhabitants per day (adjusted rate ratio [aRR] 1.001, [95% confidence interval 1.000-1.001], p=0.001) were significantly correlated with total antibiotic use. The mean age of physician (aRR 1.059 [1.009-1.113], p=0.019) for third generation cephalosporins and aRR 1.065 [1.011-1.122], p=0.016) for fluoroquinolones and the proportion of children age under 15 years (aRR 0.920 [0.876-0.966], p< 0.001) for third generation cephalosporins and aRR 0.926 [0.879-0.977], p=0.002 for fluoroquinolones) was also associated with the consumption of third generation cephalosporins and fluoroquinolones. Conclusion This ecological study demonstrated that the proportion of children and the mean age of physicians were associated with the use of third generation cephalosporins and quinolones for non-bacterial upper respiratory infections. The results may contribute to the further development of the national stewardship strategies to reduce unnecessary antibiotic use for upper respiratory infections. Disclosures All Authors: No reported disclosures