Abstract
Background: The overuse of antibiotics is a serious public health problem and a major challenge in China, and China lacks up-to-date evidence on the nationwide antibiotic use in different healthcare settings. The changes of China’s antibiotic use under the COVID-19 pandemic are still unknown. Objective: This study aimed to investigate the use of antibiotics in China’s public medical institutions based on a three-year nationwide surveillance and to examine the impact of the COVID-19 pandemic on China’s antibiotic consumption. Methods: This study used nationwide drug procurement data from the China Drug Supply Information Platform (CDSIP). We retrospectively analyzed antibiotic procurement data of 9,176 hospitals and 39,029 primary healthcare centers (PHCs) from 31 provinces in mainland China from January 2018 to December 2020. Antibiotic utilization was measured by defined daily doses (DDDs) and DDD per 1,000 inhabitants per day (DID). Generalized linear regression models were established to quantify the impact of the COVID-19 pandemic on antibiotic use. Results: The total antibiotic consumption among all healthcare settings increased from 12.94 DID in 2018 to 14.45 DID in 2019, and then dropped to 10.51 DID in 2020. More than half of antibiotics were consumed in PHCs, especially in central regions (59%–68%). The use of penicillins (J01C) and cephalosporins (J01D) accounted for 32.02% and 28.86% of total antibiotic consumption in 2020. During 2018–2020, parenteral antibiotics accounted for 31%–36% of total antibiotic consumption; the proportion is more prominent in central and western regions and the setting of hospitals. Access category antibiotics comprised 40%–42% of the total utilization. Affected by COVID-19, the antibiotic consumption was significantly dropped both in hospitals (β = −.11, p < .001) and PHCs (β = −.17, p < .001), as well as in total (β = −.14, p < .001). Significant increments were observed in the proportion of total antibiotics (β = .02, p = .024) consumed in hospitals (against the consumption in all healthcare settings), as well as parenteral antibiotics (β = 1.73, p = .001). Conclusion: The consistent preferred use of penicillin and cephalosporin, as well as injections, among China’s public healthcare institutions should draw concern. China’s antibiotic consumption significantly declined during the COVID-19 pandemic, which brings opportunities for antibiotic use management in China.
Highlights
Antimicrobial resistance (AMR) has been increasingly concerned as a major public health problem worldwide, which affects all areas of health and incurs high economic costs to society (WHO, 2016)
This study showed that parenteral antibiotics accounted for 1/ 3 of the total antibiotic consumption in China’s public medical institutions, which is much higher than the proportion in most European countries reported by previous studies (Coenen et al, 2009; Robertson et al, 2021), and the proportion was more prominent in central and western regions than that in eastern regions
We explored the impact of the COVID-19 pandemic on antibiotic consumption in China’s public medical institutions, by taking medical services decline as the main intervention factor related to the pandemic
Summary
Antimicrobial resistance (AMR) has been increasingly concerned as a major public health problem worldwide, which affects all areas of health and incurs high economic costs to society (WHO, 2016). China is one of the countries that consume the most antibiotics and have one of the highest prevalence of AMR in the world, and the average antibiotic consumption of China in 2013 was six times higher than that of the United States and Europe (Zhang et al, 2015) To address this issue, the Chinese government had taken many measures to strengthen antimicrobial management, for example, the introduction of guidance for clinical use of antibiotics, the establishment of national surveillance networks for both antibiotic use and resistance, and the implementation of “Special Rectification Activities of Clinical Use of Antibacterial” (Xiao et al, 2013; Liu et al, 2019; Yin et al, 2019). The changes of China’s antibiotic use under the COVID-19 pandemic are still unknown
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