A 2018 Japanese policy offering financial incentives for not prescribing antibiotics to children aged 3 and younger with viral infections aimed to address Japan's high rates of inappropriate antibiotic use, as highlighted by a 2015 global survey.

The study, following over 165,000 children, reported:

• 44.9% reduction in antibiotic prescriptions within the first month, with a sustained 19.5% decrease over 48 months.

• Broad-spectrum antibiotic use dropped by 24.4%.

• Physicians were incentivized with ¥800 per case to avoid unnecessary antibiotics, coupled with educating caregivers on viral infections.

• The policy did not result in higher healthcare costs or adverse outcomes.

This evidence supports incentive-based strategies as effective tools for reducing unnecessary antibiotic use while empowering healthcare providers and educating the public.