Japan has an extensive track record in addressing antimicrobial resistance with initiatives such as their ‘area network for infection control’ which involves advanced hospitals and small hospitals, clinics and nursing care facilities which share best practices and educate each other through mutual site visits to promote infection control. Another initiative, the Directly Observed Treatment Short-course (DOTS) prevent development of drug resistant tuberculosis. Due to the comprehensive DOTS program, the proportion of multi-drug resistant TB cases remains quite low at 0.7% among culture-positive cases in Japan.
In the Japanese national fee schedule, incentives are given to promote prudent use of antibiotics. Also, many professional societies have their own certification programmes which contribute to antimicrobial stewardship and human resource development. In fact, Japan has dedicated the last decade to human resource development to promote antimicrobial stewardship. It is characterised by its inter-professional approach: good collaboration between health professionals is a key to its successful implementation. Japan is embracing the One Health approach which is demonstrated by their guidelines of responsible and prudent use of antimicrobials in the livestock sector. As a complimentary action, the country has the Japanese Veterinary Antimicrobial Resistance Monitoring System (JVARM) to monitor the occurrence of antimicrobial resistance in bacteria in food-producing animals, and to monitor the quantities of antimicrobials used in animal. JVARM allows the efficacy of antimicrobials in food-producing animals to be determined, prudent use of such antimicrobials to be encouraged, and the effect on public health to be ascertained.