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Why are Japanese doctors prescribing far more antibiotics to young women than men?

Cephalosporin, an antibiotic, is seen in this image. (Mainichi/Toshiyasu Kawachi)

TOKYO -- A recent survey by Japan's National Center for Global Health and Medicine has shown that women in their 20s and 30s are prescribed far higher amounts of antibiotics by medical institutions than men of the same age are.

    The finding comes amid worldwide concerns that overuse of antibiotics is causing germs to develop antimicrobial resistance (AMR). Some have projected that AMR could be responsible for 10 million deaths 30 years from now, but why are higher levels of antibiotics being given out to young women in Japan? The lifestyles of women in this age bracket give us a glimpse as to the reasons why.

    The national center analyzed a Ministry of Health, Labor and Welfare database of medical prescriptions to determine the amounts of antibiotics prescribed across the country between 2013 and 2019. In 2019, per 1,000 people in the population, women in their 20s received 50% more prescribed antibiotics each day than men in the same age group, and among people in their 30s, women received 40% more. Women in their 40s and 50s also received more, but only at a rate of about 20% more.

    Yoshiki Kusama, chief of pharmacoepidemiology at the AMR Clinical Reference Center explained, "Women of this age range probably have more opportunities to be seen at medical institutions than men do." The same health ministry database has statistics on initial consulting fees, which provide evidence of how often medical institutions are used. They show that in fiscal 2017, 50% more women in their 20s and 30s than men in the same age bracket visited such facilities.

    Yoshiki Kusama, chief of pharmacoepidemiology at the AMR Clinical Reference Center is seen in this photo. (Mainichi)

    Women of this age range have children who are still young, which provides ample opportunities for them to go to see medical professionals when their children develop fevers or hurt themselves. Kusama speculated, "They might have medical complaints they would ordinarily just put up with, but because they're at the doctor's with their children, if they take the opportunity to mention their own ailments, they can probably as a result more easily get antibiotic prescriptions."

    Antibiotics are used to treat infectious bacterial diseases, and they are not effective against colds, which are caused by viral infections. Research reports have shown that some 60% of antibiotics prescribed in Japan are given for infections that do not require them. If people unnecessarily consume antibiotics or if they stop taking them halfway through the period they have been instructed to, it becomes easier for AMR to develop. It can make antibiotics ineffective, or render treatment more difficult.

    The center is calling on patients to take all of the antibiotics they have been given as doctors have instructed them to do, to not store them for later, and to not give or receive the drugs from other people, among other measures. It is also urging people to carry out thorough infection measures, such as washing their hands and wearing masks, to reduce the number of occasions in which they require consultations at medical institutions. Kusama said, "It's not just about having patients refrain from asking for antibiotics; medical professionals must also heighten their sense of awareness and not prescribe them unnecessarily."

    If prevention measures are not devised to stop the rise in AMR, it is predicted to cause some 10 million deaths worldwide by 2050. It's estimated that in Japan alone, at least 8,000 people died in fiscal 2017 due to bacterial resistance to antibiotics. By comparison, the new coronavirus currently spreading across the world has as of Oct. 27 caused around 1.15 million deaths worldwide and some 1,700 in Japan. Although measures against the pandemic are getting a lot of attention, there is also a need to maintain initiatives to stop microbial resistance.

    (Japanese original by Eri Misono, Lifestyle and Medical News Department)

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