Effects of restrictive prescribing on antibiotic consumption in primary care in China, 2012–17: an interrupted time-series analysis

Abstract

BackgroundThe overuse of antibiotics is a major public health problem worldwide, especially in low-income and middle-income countries. However, there are few polices specific to antibiotic stewardship in primary care, and their effectiveness is unclear. A restrictive-prescribing stewardship policy was introduced in Hubei province, China, in November, 2014. We aimed to evaluate the effects of this policy on antibiotic consumption in primary care in the region. MethodsMonthly antibiotic consumption data were extracted from the Hubei Medical Procurement Administrative Agency system from Sept 1, 2012, to Aug 31, 2017. An interrupted time-series analysis combined with Anatomical Therapeutic Chemical/Defined Daily Dose methodology and European Surveillance of Antimicrobial Consumption Quality Indictors was performed to evaluate the effects of the restrictive-prescribing stewardship policy on antibiotic consumption in primary care. The Durbin-Watson test was used to check for autocorrelation, and p values and coefficients were estimated by use of the generalised least squares method. FindingsOver the entire study period, a significant reduction (–32·58%, p<0·001) was observed in total antibiotic consumption, which occurred within 1 month after introduction of restrictive prescribing (r=–2·4518, p=0·005) and continued to 2017 (r=–0·1193, p=0·017). Specifically, the use of penicillins (r=–0·0553, p=0·035), cephalosporins (r=–0·0294, p=0·037), and macrolides/lincosamides/streptogramins (r=–0·0182, p=0·003) decreased from before to after the intervention. The restrictive intervention was also associated with an immediate decline in the contribution of β-lactamase-sensitive penicillins to total antibiotic use (r=–2·9126, p=0·001) and a decline from baseline in the use of oral antibiotics (r=–0·0815, p=0·018). However, an immediate increase in the contribution of third-generation and fourth-generation cephalosporins to total antibiotic use (r=5·0352, p=0·005) and an increase from baseline in the contribution of fluoroquinolones to total antibiotic use (r=0·0406, p=0·037) were observed after the intervention. Finally, restrictive prescribing was associated with an immediate increase in the ratio of broad-spectrum to narrow-spectrum antibiotic use (r=1·8747, p=0·001), although use of both types of antibiotics significantly declined from before to after the intervention (broad-spectrum antibiotics: r=–0·0423, p=0·017; narrow-spectrum antibiotics: r=–0·0223, p=0·006). InterpretationRestrictive antibiotic prescribing in primary care in China was effective in reducing total antibiotic consumption, especially use of penicillins, cephalosporins, and macrolides/lincosamides/streptogramins. However, the effects of the intervention on some other antibiotics were mixed. Stronger administrative regulation focusing on specific antibiotics, such as third-generation and fourth-generation cephalosporins, fluoroquinolones, and broad-spectrum antibiotics, is needed in the future. FundingNational Natural Science Foundation of China Youth Fund (grant number 71704058).