Abstract
Objectives: This study aimed to identify the trends in antibiotics utilization and patients costs, evaluating the effect of the policy and exploring factors associated with the irrational use of antibiotics. Methods: Based on the Cooperation Project Database of Hospital Prescriptions, data were collected from 89 tertiary hospitals in nine cities in China during 2016–2019. The study sample consisted of prescription records with antibiotics for 3,422,710 outpatient and emergency visits and 26, 118, 436 inpatient hospitalizations. Results: For outpatients, the proportion of treated with antibiotics declined from 14.72 to 13.92% significantly (p < 0.01). The proportion of antibiotic costs for outpatients decreased from 5.79 to 4.45% significantly (p < 0.01). For emergency patients, the proportion of treated with antibiotics increased from 39.31 to 43.45% significantly (p < 0.01). The proportion of antibiotic costs for emergency patients decreased from 36.44 to 34.69%, with no significant change (p = 0.87). For inpatients, the proportion of treated with antibiotics increased from 23.82 to 27.25% significantly (p < 0.01). The proportion of antibiotic costs for outpatients decreased from 18.09 to 17.19% with no statistical significance (p = 0.89). Other β-lactam antibacterials (1,663.03 ten thousand DDD) far exceeded other antibiotics categories. Stablely ranked first, followed by Macrolides, lincosamide and streptogramins (965.74 ten thousand DDD), Quinolone antibacterials (710.42 ten thousand DDD), and β-lactam antibacterials, penicillins (497.01 ten thousand DDD). Conclusions: The proportion of treated with antibiotics for outpatients and inpatients meet the WHO standards. The antibiotics use varied by different survey areas, clinical departments, patient gender, patient age and antibiotics categories. More efforts should focus on improving the appropriateness of antibiotics use at the individual level.
Highlights
Antibiotics are medicinal products that kill or inhibit the growth of living microorganisms (European Centre for Disease Prevention and Control, 2018)
We focused on identifying the trends in antibiotics utilization and patients costs, evaluating the effect of the policy and exploring factors associated with the irrational use of antibiotics
Information pertaining to the use of antibiotics, including sample city, patient characteristic, visit time, type of care (Outpatient/ Emergency/Inpatient), clinical department, the number of all Outpatient/Emergency prescriptions or inpatient records with antibiotics, prescribed antibiotics and additional information was gathered from the Cooperation Project Database of Hospital Prescriptions (CPDHP)
Summary
Antibiotics are medicinal products that kill or inhibit the growth of living microorganisms (European Centre for Disease Prevention and Control, 2018). As one of the most important discoveries in pharmaceuticals, antibiotics have saved millions of lives worldwide. When antibiotics are used the emergence of antimicrobial resistance (AMR) is inevitable. As well as the emergence of AMR, prolonged hospitalization, more substantial social and economic burden, increased human suffering, and more premature deaths are the results of inappropriate antibiotics (Gandra et al, 2014; Li et al, 2019). According to a review chaired by the English Economist JIM O’NEILL, if AMR is not curtailed, 10 million people will die of drug-resistant bacterial infection every year by 2050 worldwide, with cumulative economic loss up to 100 trillion USD in total (Jim, 2015). In 2015, the WHO Global Action Plan on AMR was adopted by the member states at the 68th World Health Assembly, which aimed to promote the use of antibiotics (World Health Organization, 2016)
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