Abstract
BackgroundThe overuse of antibiotics is a serious public health problem in China, causing a high rate of antimicrobial resistance. This study identified the trends of antibiotic consumption in China to provide evidence for further intervention.MethodThe six-year surveillance data on antibiotic sales from 2012 to 2017, which served as a proxy for consumption, were collected from 39 public health care facilities in Shandong province, including three tertiary hospitals, six secondary hospitals, and 30 primary health centers. Based on the Anatomical Therapeutic Chemical (ATC)/DDD methodology, antibiotic consumption was formulated in defined daily doses (DDD) per 1,000 inhabitants per day (DID).ResultsThe total antibiotic consumption among all health care settings increased from 16.07 DID in 2012 to a peak of 17.44 DID in 2015 and then decreased to 11.35 DID in 2017 with a 34.90% reduction. J01C (beta-lactam antimicrobials, penicillin), the most frequently used antibiotic class, accounted for 36.32% of the total DID. Consumption of carbapenems increased from 0.029 DID in 2012 to 0.08 DID in 2017. Parenteral antibiotics accounted for nearly 40% of the total consumption. Compared with the 2012 figures, the 2017 consumption showed a small increase in hospital sector that was compensated by the decrease in community care.ConclusionA substantial reduction in total antibiotic consumption was observed in China from 2012 to 2017. However, the extensive consumption of broad-spectrum antimicrobials, high proportion of parenteral antibiotic use, and increased use of last-resort antibiotics attracted public health concerns.
Highlights
Antimicrobial resistance (AMR) driven by antibiotic consumption is a growing threat to global public health (Song, 2018; Zhang et al, 2019)
China was estimated to be the second largest consumer of antibiotics in the world in 2010 in terms of the volume of antibiotics sold for human use in retail and hospital pharmacies (Van Boeckel et al, 2014).Antibiotics accounted for nearly 20% of total drug sales in health care facilities (Xiao et al, 2013)
The percentage of prescriptions that include an antibiotic in China was 41%-60%, which is above the recommended threshold of 30% by the World Health Organization (WHO) (Yin et al, 2013; Wang et al, 2014; Ren et al, 2016)
Summary
Antimicrobial resistance (AMR) driven by antibiotic consumption is a growing threat to global public health (Song, 2018; Zhang et al, 2019). The main factors affecting misuse of antibiotics lie in physicians’ lack of sufficient knowledge about appropriate use and pressure from patients who believe that antibiotics can quickly alleviate the symptoms of a disease (Xiao et al, 2013) Another widely believed influence factor is the provision of financial compensation for drug sales to medical institutions (Song et al, 2014b). In China, public hospitals can charge 15% on top of wholesale price of medicines This drug mark-up was originally designed to compensate health care institutions that provide services at below-cost prices. This approach can result in serious health hazards as physicians tend to over-prescribe unnecessary medicines, including antibiotics. This study identified the trends of antibiotic consumption in China to provide evidence for further intervention
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