Curbing antibiotic overuse in China will need major reforms - researchers

by Michael Woodhead

China’s new get-tough approach to overuse of antibiotics is having some impact, but there are still huge obstacles  to reversing the tide of antibiotic resistance, researchers from Zhejiang say.

Rates of antibiotic prescribing in hospitals have declined slightly since mandatory curbs and punishments were introduced in 2009, according to a new analysis by Dr Xiao Yonghong and colleagues at the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou.

In a review published in PLOS Medicine, Dr Xiao says antibiotic overuse will continue to be a major problem for China unless further restrictions are introduced on hospitals profiting from antibiotic sales, OTC sales of antibiotics and the use of antibiotics in animal feeds.

The analysis notes that misuse of antibiotics in China has led to high rates of antibiotic resistance. The prevalence of superbugs such as MRSA ranges from 50% to over 71%, the researchers note. This is not surprising given that hospitals derive much of their profits for the sales of medications, of which antibiotics are the most commonly prescribed.

Initial reforms to promote better antibiotic stewardship introduced in 2006 have not been successful because they were voluntary and not complied with, the review found. However, stricter mandatory measures introduced since 2009 have begun to show effect on antibiotic use, figures show.

Hospitals were compelled to draw up antibiotic management strategies and set targets with audits. In some cases, hospital managers were dismissed and clinicians had their prescribing rights withdrawn for failing to address the problem of antibiotic overuse.

After these reforms were implemented,  the percentage of prescriptions for antimicrobials decreased from 68% to 58% for inpatients and from 25% to 15% for outpatients.

This is a significant downturn, says Dr Xiao, but a number of issues still need to be addressed to ensure further improvements in antibiotic use.

Overuse of antibiotics continues through OTC sales and in animal feed, but regulation of these areas is hampered because authority is divided between the State Food and Drug Administration, the Ministry of Agriculture and the ministry of Health.  There is also a need for education of clinicians and the public on the need for antibiotic stewardship, says Dr Xiao.

“Finally, and critically, the government should widen the healthcare reforms and provide financial guarantees to medical institutions to ensure that economic incentives from drug sales are eliminated. This will return healthcare institutions to a not-for-profit status and aid professional standards,” the researchers conclude.

Read the full article at: PLOS Medicine