Skip to main content
SpringerLink
Log in

Is nationwide special campaign on antibiotic stewardship program effective on ameliorating irrational antibiotic use in China? Study on the antibiotic use of specialized hospitals in China in 2011–2012

  • Published:
Journal of Huazhong University of Science and Technology [Medical Sciences] Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Summary

With dwindling number of new antibiotics and inappropriate use of antibiotics, the emergence and spread of antibiotics resistance occurs commonly in healthcare institutions worldwide. In China, antibiotics are commonly overprescribed and misused. This study is to assess the effect of the nationwide special campaign on antibiotic stewardship program (ASP) at specialized hospitals in China by investigating prescription information from 2011 to 2012. Data on the hospital consumption and prescription of systemic antibiotics were obtained from four specialized hospitals, including maternity, children’s, stomatological and cancer hospitals. Systematic random sampling was used to select outpatient prescriptions and inpatient cases. A total of 105 specialized hospitals in 2011 and 121 specialized hospitals in 2012 were analysed. The defined daily doses (DDDs) per 100 inpatient days, the percentage of antibiotic use in outpatient prescriptions, and the percentage of antibiotic use in inpatient cases were used as measurements of antibiotic use. The overall antibiotic use density in the selected hospitals decreased between 2011 and 2012 from 39.37 to 26.54 DDD/100 inpatient days (P<0.001). The percentage of antibiotic use in outpatient prescriptions (range: 24.12%–18.71%, P=0.109) and inpatient cases (64.85%–60.10%, P=0.006) also decreased within the two years. Significant changes were observed among regions and different hospitals within the two years. And antibiotic consumption was correlated with the type and size of specialized hospital in 2012, but not with the regions. This analysis of antibiotic consumption of specialized hospitals allows relevant comparisons for benchmarking and shows that national ASP has improved antibiotic rational use in China. The data will assist policymakers in formulating effective strategies to decrease antibiotic overuse and identify areas that require further work.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Klugman KP, Koornhof HJ. Worldwide increase in pneumococcal antibiotic resistance. Lancet, 1989,2(8660): 444

    Article  CAS  PubMed  Google Scholar 

  2. Hawkey PM. Action against antibiotic resistance: no time to lose. Lancet, 1998,351(9112):1298–1299

    Article  CAS  PubMed  Google Scholar 

  3. Dong L, Yan H, Wang D. Antibiotic prescribing patterns in village health clinics across 10 provinces of Western China. J Antimicrob Chemother, 2008, 62(2):410–415

    Article  CAS  PubMed  Google Scholar 

  4. Ferber D. Antibiotic resistance. Superbugs on the hoof? Science, 2000, 288(5467):792–794

    Article  CAS  PubMed  Google Scholar 

  5. Kmietowicz Z. WHO warns of threat of “superbugs”. BMJ, 2000, 320(7250):1624

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. le Grand A, Hogerzeil HV, Haaijer-Ruskamp FM. Intervention research in rational use of drugs: a review. Health Policy Plan, 1999, 14(2):89–102

    Article  PubMed  Google Scholar 

  7. Phelps CE. Bug/drug resistance. Sometimes less is more. Med Care, 1989, 27(2):194–203

    Article  CAS  PubMed  Google Scholar 

  8. Zhang R, Eggleston K, Rotimi V, et al. Antibiotic resistance as a global threat: evidence from China, Kuwait and the United States. Global Health, 2006, 2:6

    Article  PubMed Central  PubMed  Google Scholar 

  9. World Health Organization. The evolving threat of antimicrobial resistance: Options for action. World Health Organization, 2012

    Google Scholar 

  10. Tang S, Meng Q, Chen L, et al. Tackling the challenges to health equity in China. Lancet, 2008, 372(9648): 1493–1501

    Article  PubMed  Google Scholar 

  11. Meng Q, Xu L, Zhang Y, et al. Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study. Lancet, 2012, 379(9818):805–814

    Article  PubMed  Google Scholar 

  12. Kondro W. Canadian scientists urge government to develop antibiotic plan. Lancet, 2002, 360(9341):1230

    Article  PubMed  Google Scholar 

  13. de Man P, Verhoeven BA, Verbrugh HA, et al. An antibiotic policy to prevent emergence of resistant bacilli. Lancet, 2000, 355(9208):973–978

    Article  PubMed  Google Scholar 

  14. Schito GC, Debbia EA, Marchese A. The evolving threat of antibiotic resistance in Europe: new data from the Alexander Project. J Antimicrob Chemother, 2000, 46(Suppl T1):3–9

    Article  CAS  PubMed  Google Scholar 

  15. WHO, Ministry of Health in China. China-WHO Country Cooperation Strategy 2013-2015. World Health Organization, 2013

    Google Scholar 

  16. Chen W, Tang S, Sun J, et al. Availability and use of essential medicines in China: manufacturing, supply, and prescribing in Shandong and Gansu provinces. BMC Health Serv Res, 2010, 10:211

    Article  PubMed Central  PubMed  Google Scholar 

  17. Xiang X, Yang C, Wang D, et al. Effects of China’s national essential medicines policy on the use of injection in primary health facilities. J Huazhong Univ Sci Technolog Med Sci, 2012, 32(4):626–629

    Article  PubMed  Google Scholar 

  18. Heddini A, Cars O, Qiang S, et al. Antibiotic resistance in China—a major future challenge. Lancet, 2009, 373(9657):30

    Article  PubMed  Google Scholar 

  19. Jing L. China faces great risk due to overuse of antibiotics. 2013. http://www.nationmultimedia.com/opinion/China-faces-great-risk-due-to-overuse-of-antibioti-30207488.html

    Google Scholar 

  20. Reynolds L, McKee M. Factors influencing antibiotic prescribing in China: an exploratory analysis. Health Policy, 2009, 90(1):32–36

    Article  PubMed  Google Scholar 

  21. Bi P, Tong S, Parton KA. Family self-medication and antibiotics abuse for children and juveniles in a Chinese city. Soc Sci Med, 2000, 50(10):1445–1450

    Article  CAS  PubMed  Google Scholar 

  22. Ramanan Laxminarayan AMDH. Extending the cure: policy responses to the growing threat of antibiotic resistance. Washington, DC 20036-1400 USA: 2007

    Google Scholar 

  23. Ministry of Health in China. Interim provisions on the administration of hospital pharmacy. 2002. http://www.moh.gov.cn/mohyzs/s3577/200804/18787.shtml (Chinese)

    Google Scholar 

  24. Xiao Y, Li L. Legislation of clinical antibiotic use in China. Lancet Infect Dis, 2013, 13(3):189–191

    Article  PubMed  Google Scholar 

  25. Yang L, Liu C, Ferrier JA, et al. The impact of the National Essential Medicines Policy on prescribing behaviours in primary care facilities in Hubei province of China. Health Policy Plan, 2012

    Google Scholar 

  26. Ministry of Health in China. Notification for the special campaign of antibiotics rational use in hospitals. 2012. http://www.moh.gov.cn/mohyzs/s3586/201203/54251.shtml (Chinese)

    Google Scholar 

  27. Regev-Yochay G, Raz M, Dagan R, et al. Reduction in antibiotic use following a cluster randomized controlled multifaceted intervention: the Israeli judicious antibiotic prescription study. Clin Infect Dis, 2011, 53(1):33–41

    Article  PubMed  Google Scholar 

  28. Kern WV, de With K, Nink K, et al. Regional variation in outpatient antibiotic prescribing in Germany. Infection, 2006, 34(5):269–273

    Article  CAS  PubMed  Google Scholar 

  29. Filippini M, Masiero G, Moschetti K. Socioeconomic determinants of regional differences in outpatient antibiotic consumption: evidence from Switzerland. Health Policy, 2006, 78(1):77–92

    Article  PubMed  Google Scholar 

  30. National Bureau of Statistics in China. The Divide of Regions According to Economic Development in China. 2012. http://www.stats.gov.cn/tjzs/t20110613_402731597.htm. (Chinese)

    Google Scholar 

  31. National Bureau of Statistics in China. Division Method of Regions. 2011. http://www.stats.gov.cn/tjzs/t20110613_402731597.htm. (Chinese)

    Google Scholar 

  32. Antachopoulos C, Dotis J, Pentsioglou V. Development of a paediatric daily defined dose system for the measurement of antibiotic consumption in paediatric units. 14th European Congress of Clinical Microbiology and Infectious Diseases. Prague, Czech Republic: 2004

    Google Scholar 

  33. Kern WV, de With K, Steib-Bauert M, et al. Antibiotic use in non-university regional acute care general hospitals in southwestern Germany, 2001–2002. Infection, 2005, 33(5–6):333–339

    Article  CAS  PubMed  Google Scholar 

  34. De WK, Steib-Bauert M, Straach P, et al. Is there significant regional variation in hospital antibiotic consumption in Germany? Infection, 2006, 34(5):274–277

    Article  Google Scholar 

  35. Piovani D, Clavenna A, Cartabia M, et al. The regional profile of antibiotic prescriptions in Italian outpatient children. Eur J Clin Pharmacol, 2012, 68(6):997–1005

    Article  PubMed  Google Scholar 

  36. Zhang W, Shen X, Bergman U, et al. Drug utilisation 90% (DU90%) profiles of antibiotics in five Chinese children’s hospitals (2002–2006). Int J Antimicrob Agents, 2008, 32(3):250–255

    Article  CAS  PubMed  Google Scholar 

  37. Ceyhan M, Yildirim I, Ecevit C, et al. Inappropriate antimicrobial use in Turkish pediatric hospitals: a multicenter point prevalence survey. Int J Infect Dis, 2010, 14(1): e55–e61

    Article  CAS  PubMed  Google Scholar 

  38. Ashiru-Oredope D, Sharland M, Charani E, et al. Improving the quality of antibiotic prescribing in the NHS by developing a new Antimicrobial Stewardship Programme: Start Smart—Then Focus. J Antimicrob Chemother, 2012, 67(Suppl 1):i51–i63

    Article  CAS  PubMed  Google Scholar 

  39. Low M, Nitzan O, Bitterman H, et al. Trends in outpatient antibiotic use in Israel during the years 2000–2010: setting targets for an intervention. Infection, 2013, 41(2): 401–407

    Article  CAS  PubMed  Google Scholar 

  40. Cairns KA, Jenney AW, Abbott IJ, et al. Prescribing trends before and after implementation of an antimicrobial stewardship program. Med J Aust, 2013, 198(5): 262–266

    Article  PubMed  Google Scholar 

  41. Dumartin C, Rogues AM, Amadeo B, et al. Antibiotic stewardship programmes: legal framework and structure and process indicator in Southwestern French hospitals, 2005–2008. J Hosp Infect, 2011, 77(2):123–128

    Article  CAS  PubMed  Google Scholar 

  42. Hadi U, Keuter M, van Asten H, et al. Optimizing antibiotic usage in adults admitted with fever by a multifaceted intervention in an Indonesian governmental hospital. Trop Med Int Health, 2008, 13(7):888–899

    Article  PubMed  Google Scholar 

  43. Wilf-Miron R, Ron N, Ishai S, et al. Reducing the volume of antibiotic prescriptions: a peer group intervention among physicians serving a community with special ethnic characteristics. J Manag Care Pharm, 2012, 18(4): 324–328

    PubMed  Google Scholar 

  44. Elseviers MM, Ferech M, Vander SR, et al. Antibiotic use in ambulatory care in Europe (ESAC data 1997–2002): trends, regional differences and seasonal fluctuations. Pharmacoepidemiol Drug Saf, 2007, 16(1):115–123

    Article  PubMed  Google Scholar 

  45. Dumartin C, L’Heriteau F, Pefau M, et al. Antibiotic use in 530 French hospitals: results from a surveillance network at hospital and ward levels in 2007. J Antimicrob Chemother, 2010, 65(9):2028–2036

    Article  CAS  PubMed  Google Scholar 

  46. Grau S, Fondevilla E, Mojal S, et al. Antibiotic consumption at 46 VINCat hospitals from 2007 to 2009, stratified by hospital size and clinical services. Enferm Infecc Microbiol Clin, 2012, 30(Suppl 3):43–51

    Article  PubMed  Google Scholar 

  47. D’Alerte R. Surveillance de la consommation des antibiotiques. Institut de veille sanitaire, 2010

    Google Scholar 

  48. Sumpradit N, Chongtrakul P, Anuwong K, et al. Antibiotics Smart Use: a workable model for promoting the rational use of medicines in Thailand. Bull World Health Organ, 2012, 90(12):905–913

    PubMed Central  PubMed  Google Scholar 

  49. Stockley JM. European Antibiotic Awareness Day 2012: getting smart about antibiotics, a public-professional partnership. J Infect, 2012, 65(5):377–379

    Article  CAS  PubMed  Google Scholar 

  50. Currie J, Lin W, Zhang W. Patient knowledge and antibiotic abuse: Evidence from an audit study in China. J Health Econ, 2011, 30(5):933–949

    Article  PubMed  Google Scholar 

  51. Goossens H, Ferech M, Vander SR, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet, 2005, 365(9459): 579–587

    Article  PubMed  Google Scholar 

  52. Kuster SP, Ruef C, Bollinger AK, et al. Correlation between case mix index and antibiotic use in hospitals. J Antimicrob Chemother, 2008, 62(4):837–842

    Article  CAS  PubMed  Google Scholar 

  53. Sabath LD, Notto DA. Analysis of factors influencing antibiotic usage in hospitals. Prog Clin Biol Res, 1979, 35:65–74

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Xiao-xu Zou  (邹晓旭), Rui Min  (闵 锐), Xue Bai  (白 雪) & Peng-qian Fang  (方鹏骞)

  2. School of Foreign Languages and Literature, Wuhan University, Wuhan, 430072, China

    Zi Fang  (方 子)

  3. School of Business, University of Aberdeen, Aberdeen, AB24 3FX, UK

    Zi Fang  (方 子)

  4. Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Yang Zhang  (张 杨)

  5. Management Research Institute, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Dong Xu  (许 栋)

Authors
  1. Xiao-xu Zou  (邹晓旭)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zi Fang  (方 子)
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rui Min  (闵 锐)
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xue Bai  (白 雪)
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yang Zhang  (张 杨)
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dong Xu  (许 栋)
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peng-qian Fang  (方鹏骞)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peng-qian Fang  (方鹏骞).

Additional information

This study was supported by grants from the General Program of National Natural Science Foundation of China (No. 71073062) and Major Project in Philosophy and Social Science of Ministry of Education in China (No. 10JZD0027).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zou, Xx., Fang, Z., Min, R. et al. Is nationwide special campaign on antibiotic stewardship program effective on ameliorating irrational antibiotic use in China? Study on the antibiotic use of specialized hospitals in China in 2011–2012. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 34, 456–463 (2014). https://doi.org/10.1007/s11596-014-1300-6

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11596-014-1300-6

Key words

Search

Navigation