Abstract
ObjectivesTo identify the patterns of antibiotic use and irrational antibiotic prescriptions in primary healthcare institutions (PHIs) in Dongcheng District of Beijing, China.Materials and methodsAll primary healthcare institutions (7 community healthcare centres and 59 community healthcare stations in total) in Dongcheng District were included in the study. Prescription data from January 2015 to December 2018 was derived from the Beijing Prescription Reviewing System of Primary healthcare institutions and analysed retrospectively. The antibiotic prescription rate was calculated and cases of irrational antibiotic prescriptions were identified.ResultsWe extracted 11,166,905 prescriptions from the database. Only 189,962 prescriptions were included in the study, among which 9167 (4.8%) contained antibiotics. The antibiotic prescription rate fell from 5.2% in 2015 to 4.1% in 2018 while irrational antibiotic prescription rate increased from 10.4 to 11.8%. Acute Bronchitis was the most prevalent diagnosis (17.6%) for antibiotic prescriptions, followed by Unspecified Acute Respiratory Tract Infection (14.4%), Acute Tonsillitis (9.9%), and Urinary Tract Infection (6.4%). Around 10% of the prescriptions for the top 7 diagnoses identified were rated as irrational. Cephalosporins, fluoroquinolones, and macrolides were the most prescribed antibiotics, which accounted for 89.3% of all antibiotic prescriptions. Of all the antibiotic prescriptions, 7531 were reviewed, among which 939 (12.5%) were rated as irrational because of antibiotic use. Among all the irrational prescriptions, prescriptions with inappropriate antibiotic use and dosage accounted for the majority (54.4%).ConclusionAlthough a relatively low level of antibiotic utilization was found in PHIs in Dongcheng District of Beijing, the utilization patterns differed considerably from developed countries and irrational prescriptions remained. Considering the imbalanced allocation of medical resources between primary healthcare setting and secondary and tertiary hospitals, there need to be more efforts invested in regions with different levels of economic development.
Highlights
Antibiotic use is one of the major drives for antimicrobial resistance (AMR), a significant challenge to public health for all countries alike
Conclusion: a relatively low level of antibiotic utilization was found in primary healthcare institutions (PHIs) in Dongcheng District of Beijing, the utilization patterns differed considerably from developed countries and irrational prescriptions remained
The characteristics of the sample prescriptions were described in Table 1. 28,217 (14.9%) and 161,745 (85.1%) of the total prescriptions were from community healthcare centres (CHCs) and community healthcare stations (CHSs) respectively
Summary
Antibiotic use is one of the major drives for antimicrobial resistance (AMR), a significant challenge to public health for all countries alike. There was no direct evidence drawing correlation between antibiotic use in the community with the prevalence of antibiotic resistance observed in hospitals, antibiotic use in primary health care was proved to affect AMR [3]. Studies have investigated antibiotic use in secondary and tertiary hospitals with various drug management programs to promote appropriate use of antibiotics [4,5,6]. These studies significantly increased after the implementation of the Zero Mark-up Policy, which remarkably reduced incentives for hospitals to rely on prescriptions for financial gains. Primary healthcare institutions did not proportionately benefit from the policies
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