Antibiotic overuse in China: call for consolidated efforts to develop antibiotic stewardship programmes

Abstract

On the basis of large-scale prescription data, Houyu Zhao and colleagues1Zhao H Wei L Li H et al.Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study.Lancet Infect Dis. 2021; (published online Jan 27.)https://doi.org/10.1016/s1473-3099(20)30596-xSummary Full Text Full Text PDF Scopus (16) Google Scholar reported the first nationally representative investigation of antibiotic prescribing in China. We note the high rate of antibiotic prescription (40% for outpatient visits) for viral upper respiratory tract infections, which is inappropriate. The authors recommended a hospital antibiotic stewardship programme. We did a systematic review and meta-analysis of interventions for upper respiratory tract infections and developed an antibiotic stewardship programme, with a clinical guide, training, and prescription reviews embedded into routine trainings,2Wei X Zhang Z Walley JD et al.Effect of a training and educational intervention for physicians and caregivers on antibiotic prescribing for upper respiratory tract infections in children at primary care facilities in rural China: a cluster-randomised controlled trial.Lancet Glob Health. 2017; 5: e1258-e1267Summary Full Text Full Text PDF PubMed Scopus (55) Google Scholar as the authors recommended. We also included leaflets and patient education videos in waiting rooms. The effectiveness of this programme was evaluated through a cluster randomised controlled trial in 25 rural primary care facilities in southwest China. After 6 months, primary care facilities in the intervention group successfully reduced antibiotic prescription rates by 40% for childhood upper respiratory tract infections, leading to a 29% risk reduction compared with primary care facilities in the control group. The process evaluation, using implementation science theories, indicated that our clinical guide and training for doctors and information for caregivers were essential for the behaviour change, while the prescription review meeting helped to drive changes in primary care doctors’ practice.3Wei X Deng S Haldane V et al.Understanding factors influencing antibiotic prescribing behaviour in rural China: a qualitative process evaluation of a cluster randomized controlled trial.J Health Serv Res Policy. 2020; 25: 94-103Crossref PubMed Scopus (7) Google Scholar A follow-up study 12 months after the trial ended showed sustained benefits in the intervention group, and leadership at the facility level had an important role in adopting the antibiotic stewardship programme into routine practice.4Wei X Zhang Z Hicks JP et al.Long-term outcomes of an educational intervention to reduce antibiotic prescribing for childhood upper respiratory tract infections in rural China: follow-up of a cluster-randomised controlled trial.PLoS Med. 2019; 16e1002733Crossref PubMed Scopus (27) Google Scholar We further designed an antibiotic stewardship programme5Zhuo C Wei X Zhang Z et al.An antibiotic stewardship programme to reduce inappropriate antibiotic prescribing for acute respiratory infections in rural Chinese primary care facilities: study protocol for a clustered randomised controlled trial.Trials. 2020; 21: 394Crossref PubMed Scopus (2) Google Scholar for rural primary care facilities for a range of respiratory conditions, including upper respiratory tract infections and bronchitis. In collaboration with the China National Health Commission and the National Centre for Respiratory Diseases in Guangzhou, we designed the stewardship programme to use mobile technology and enhanced electronic medical records systems to facilitate the review of, and decision making in, antibiotic prescription. Our results will inform the development of China's first national antibiotic stewardship programme for primary care facilities. We call for consolidated efforts to build up antibiotic stewardship programmes for different types of hospitals in low-income and middle-income countries. Implementation science frameworks will be helpful in designing health interventions to inform how antibiotic stewardship programmes can be adapted to national policies under different contexts. The monitoring and surveillance system, as reported by Zhao and colleagues,1Zhao H Wei L Li H et al.Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study.Lancet Infect Dis. 2021; (published online Jan 27.)https://doi.org/10.1016/s1473-3099(20)30596-xSummary Full Text Full Text PDF Scopus (16) Google Scholar should be established at the country level to assess the population and long-term effects when these programmes are scaled-up as national policies. We declare no competing interests. Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database studyInappropriate antibiotic prescribing was highly prevalent nationwide in China. Over half of the antibiotic prescriptions were inappropriate in secondary-level and tertiary-level hospitals, suggesting an urgent need for outpatient antibiotic stewardship aimed at optimising antibiotic prescribing to achieve the goals set in China's 2016 national action plan to contain antimicrobial resistance. Full-Text PDF