Antibiotic prescription patterns in China may contribute to resistance

1. A significant proportion of antibiotics given at Chinese primary health care clinics were not appropriate prescriptions.

2. Judicious use of antibiotics is essential to preventing propagation of resistant organisms.

Evidence Rating Level: 4 (Below Average)

Study Rundown: Increased use of antibiotics worldwide has undoubtedly improved morbidity and mortality from infectious diseases. However, inappropriate use of antibiotics results in the selection of drug-resistant organisms, presenting a major public health issue. This study sought to assess the appropriateness of antibiotic prescriptions given at community hospitals or clinics in China. Of the 39 primary health care facilities included in the survey, only 39.4% of outpatient and 28.2% of inpatient antibiotic prescriptions were deemed appropriate.

The study hypothesizes that inadequate training of prescribers, in conjunction with financial pressures, may be contributing factors to this issue. Government subsidization of these facilities forces them to rely on drug sales, and therefore over-prescription, to remain financially solvent. Though the findings of this paper shed light on the extent of antibiotic misuse in such settings, several limitations exist. Western regions of China were not considered for study due to difficulties in data acquisition, and such difficulties also precluded measurement of daily doses of antibiotics given to patients. As antibiotics are the most commonly used medicine in Chinese health care, maintaining proper standards for antibiotic use is essential to prevent antimicrobial resistance.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Origins and Evolution of Antibiotic Resistance

In-Depth [retrospective case series]: Data was acquired via survey of 48 primary health care facilities, 39 of which were ultimately included in analysis. A total of 10,199 quality-controlled prescriptions were evaluated. Most staff at these facilities had less than a college degree. Antibiotics accounted for a median of 22.8% drugs sales. The most commonly used antibiotics were cephalosporins, fluoroquinolones, penicillins, and nitroimidazoles. Appropriateness was defined as using the gold standard antibiotic for a given clinical infection or prophylaxis. Partial appropriateness was defined as justified use of antibiotics, but with an improper agent or for an ineffective duration.

Of the 7,311 outpatient prescriptions studied, 52.9% of them were antibiotics and 39.4% were appropriate. Of the 2,888 inpatient prescriptions, 77.5% were antibiotics and 24.6% were appropriate. Of 1,931 surgical patient prescriptions, 98.0% were antibiotics and 18.0% were appropriate. The most outpatient antibiotic prescriptions were in Jilin, and the lowest were in Beijing. More penicillins and fluoroquinolones were used in Shandong and Jilin than in other areas studied.

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