Optimizing Antimicrobial Use in Japan: Strategies for Dosage, Combination Therapy, De-Escalation, Oral Switching, Duration, and Guideline Adherence

Antimicrobial stewardship has gained momentum in Japan, prompting the adoption of various strategies to optimize antimicrobial use. Key recommendations include individualized dosing, dosing intervals, and treatment regimens tailored to the patient's condition, causative pathogens, and affected organs. Combination therapy is advised for empiric treatment of severe infections and suspected multidrug-resistant organisms. Early initiation of antimicrobial therapy followed by de-escalation may enhance clinical outcomes and reduce resistance development. Additionally, while clear criteria for intravenous-to-oral switch therapy remain undefined, its implementation could play a crucial role in optimizing antimicrobial administration. The duration of therapy should be guided by disease pathophysiology rather than isolated inflammatory markers, including C-reactive protein, with adherence to established guidelines and clinical recommendations. These strategies have been incorporated at the bedside, and optimized antibiotics use are now advanced in Japan.