Examining the Effectiveness of Introducing a Notification of Use System for the Appropriate Use of Clarithromycin

Macrolide (ML) antimicrobials are frequently prescribed in outpatient care, and it is difficult to obtain support from an Antimicrobial Stewardship Team (AST). Therefore, appropriate use of ML antimicrobials must be promoted in outpatient care. Several medical facilities have introduced a system for the notification of antimicrobial use, and electronic medical records display the notification form during prescribing. A system for notification of the use of clarithromycin (CAM), an ML antimicrobial, was introduced, and a physician has to select the purpose for prescribing it. The notification form states that CAM is not recommended for upper respiratory tract infections, which are mostly viral, and it lists other antimicrobials recommended by the AST. The notification of use system was introduced after COVID-19 was downgraded to a class 5 infectious disease (under the Infectious Diseases Control Act). Comparison of the period before COVID-19 and the H1NI influenza pandemic indicated that inappropriate use of CAM in outpatient settings tended to decrease and that the system helped to prevent its inappropriate use. CAM is sometimes prescribed as low-dose long-term therapy, and evaluating its appropriate use based on the duration of its prescription or its dose compared with other antimicrobials is difficult. A notification system would allow the purpose for prescribing an antimicrobial to be determined from electronic medical records, potentially reducing the workload of the AST in evaluating appropriate antimicrobial use. ML antimicrobials are frequently prescribed in outpatient settings, and numerous medical facilities should consider a notification of use system to promote their appropriate use.