1. Antimicrobial Resistance Japan
2. Antimicrobial Use Japan
3. Antimicrobial Stewardship
4. Japan Antibiotic Consumption
5. Regional Variation Antimicrobial Use

In Japan, a country renowned for its cutting-edge healthcare system, a silent threat looms large: the rise of antimicrobial resistance (AMR). This has prompted the government and health officials to take decisive action with the National Action Plan on Antimicrobial Resistance, aiming for a substantial reduction in the usage of critical antimicrobial agents. A study published in the Japanese Journal of Infectious Diseases meticulously analyzed this national predicament, navigating through a plethora of data and uncovering trends in antimicrobial consumption across Japan’s diverse regions from 2013 to 2016.

DOI: 10.7883/yoken.JJID.2018.417

The Study: A Window into Japan’s Antimicrobial Usage

Carried out by an astute team of researchers from the AMR Clinical Reference Center at the National Center for Global Health and Medicine, the study presents an intricate mosaic of Japanese antimicrobial use (AMU), utilizing national sales data as its cornerstone. The analysis offered a granular examination by scrutinizing the defined daily dose (DDD) of antimicrobials per 1,000 inhabitants per day (DID), a WHO-endorsed metric for gauging drug consumption. This study, a concerted effort helmed by authors such including Yoshiki Kusama, Masahiro Ishikane, and Norio Ohmagari, pierces through the complex layer of regional variations and posits important implications on the efficacy of AMR countermeasures.

Antimicrobial Consumption: Trends and Patterns

The findings present a mixed tableau: AMU demonstrated a subtle decline from 14.9 DID in 2013 to 14.6 DID in 2016. This national average, however, masks the disparity among the prefectures. A substantial majority (34 out of 47) witnessed decreasing trends, whilst 13 saw a rise in antimicrobial use. Broad-spectrum oral antimicrobials—specifically cephalosporins, macrolides, and quinolones—were under the microscope due to their linkage to the proliferation of drug-resistant bacteria.

The standout revelations of regional divergences illustrate a complex web of consumption practices. For instance, the eastern region boasted a significantly lower mean usage of oral macrolides compared to the central and western regions. On the flip side, the western region’s affinity for oral quinolones surpassed that of the eastern and central precincts. Such findings underscore the necessity to delve deeper into the whys and wherefores of these discrepancies.

The Conundrum of Appropriate Targeting

While the research has rolled out a foundational understanding of AMU patterns, it elucidates the challenge of crafting tailored antimicrobial stewardship interventions. To effectively stymie the tide of resistance, it becomes imperative to investigate the root causes of regional variations. Such findings delineate the pressing need for a comprehensive analysis of prescriber behaviors, patient demands, and the healthcare infrastructure that underpins them.

The Tipping Point: Implications for Antimicrobial Stewardship

This study is a clarion call for nuanced antimicrobial stewardship—a concerted, interdisciplinary approach to foster prudent antimicrobial use. The insight it provides acts as a keystone in Japan’s struggle against the harbinger of multidrug-resistant organisms that threaten not just national health security but the fabric of global healthcare.


1. Kusama, Y., Ishikane, M., Tanaka, C., Kimura, Y., Yumura, E., Hayakawa, K., Muraki, Y., Yamasaki, D., Tanabe, M., & Ohmagari, N. (2019). Regional Variation of Antimicrobial Use in Japan from 2013-2016, as Estimated by the Sales Data. Japanese Journal of Infectious Diseases, 72(5), 326-329. doi: 10.7883/yoken.JJID.2018.417
2. World Health Organization. (2019). WHO report on surveillance of antibiotic consumption: 2016-2018 early implementation. Retrieved from
3. Antimicrobial Resistance Division, Ministry of Health, Labour, and Welfare (Japan). (2016). National Action Plan on Antimicrobial Resistance (AMR) 2016-2020. Retrieved from
4. O’Neill, J. (2016). Tackling drug-resistant infections globally: final report and recommendations. Review on Antimicrobial Resistance. Retrieved from
5. World Health Organization. (2017). Global action plan on antimicrobial resistance. Retrieved from

Despite the comprehensive report, the unceasing evolution of bacteria and the continuous tug-of-war between antimicrobial development and bacterial adaptation remains a critical challenge. Japan, with its robust healthcare system and technological prowess, is poised to make significant strides in its battle against AMR. However, unified global efforts and shared knowledge will ultimately dictate the pace of winning this war. As seen in Japan, the rigor of local research can substantially aid in understanding and addressing the nuances of antimicrobial resistance, a feat crucial for public health strategies worldwide. The diligence with which Japan tackles this issue today sets a benchmark for other nations in their pursuit of a future unmarred by the dire consequences of unchecked antimicrobial resistance.