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Antimicrob Resist Infect Control. 2018 Apr 25;7:56. doi: 10.1186/s13756-018-0347-8. eCollection 2018.

Temporal relationship between antibiotic use and respiratory virus activities in the Republic of Korea: a time-series analysis.

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Division of Infectious Disease Control, Gyeonggi Provincial Government, Suwon, Republic of Korea.
2Department of Epidemiology and Health Informatics, Graduate School of Public Health, Korea University, Seoul, Republic of Korea.
3Department of Insurance Benefit, National Health Insurance Service, Seoul, Republic of Korea.
4Center for Disease Dynamics, Economics & Policy, Washington D.C., USA.
5Department of Emergency Medicine, Johns Hopkins University, Baltimore, USA.
6Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
7Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea.



Inappropriate use of antibiotics increases resistance and reduces their effectiveness. Despite evidence-based guidelines, antibiotics are still commonly used to treat infections likely caused by respiratory viruses. In this study, we examined the temporal relationships between antibiotic usage and respiratory infections in the Republic of Korea.


The number of monthly antibiotic prescriptions and the incidence of acute respiratory tract infections between 2010 and 2015 at all primary care clinics were obtained from the Korean Health Insurance Review and Assessment Service. The monthly detection rates of respiratory viruses, including adenovirus, respiratory syncytial virus, influenza virus, human coronavirus, and human rhinovirus, were collected from Korea Centers for Disease Control and Prevention. Cross-correlation analysis was conducted to quantify the temporal relationship between antibiotic use and respiratory virus activities as well as respiratory infections in primary clinics.


The monthly use of different classes of antibiotic, including penicillins, other beta-lactam antibacterials, macrolides and quinolones, was significantly correlated with influenza virus activity. These correlations peaked at the 0-month lag with cross-correlation coefficients of 0.45 (p < 0.01), 0.46 (p < 0.01), 0.40 (p < 0.01), and 0.35 (< 0.01), respectively. Furthermore, a significant correlation was found between acute bronchitis and antibiotics, including penicillin (0.73, p < 0.01), macrolides (0.74, p < 0.01), and quinolones (0.45, p < 0.01), at the 0-month lag.


Our findings suggest that there is a significant temporal relationship between influenza virus activity and antibiotic use in primary clinics. This relationship indicates that interventions aimed at reducing influenza cases in addition to effort to discourage the prescription of antibiotics by physicians may help to decrease unnecessary antibiotic consumption.


Antibiotic use; Influenza; Korea; Respiratory virus; Time-series analysis

Conflict of interest statement

This study was exempted from ethical approval by the Institutional Review Board designated by Korean Ministry of Health and Welfare (P01-201711-21-017).The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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