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

Abstract

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.

Keywords

specialized hospital / antibiotic usage / antibiotic prescription / national antibiotic stewardship program, China

References

[1] KlugmanKP, KoornhofHJ. Worldwide increase in pneumococcal antibiotic resistance. Lancet, 1989, 2(8660): 444

[2] HawkeyPM. Action against antibiotic resistance: no time to lose. Lancet, 1998, 351(9112): 1298-1299

[3] DongL, YanH, WangD. Antibiotic prescribing patterns in village health clinics across 10 provinces of Western China. J Antimicrob Chemother, 2008, 62(2): 410-415

[4] FerberD. Antibiotic resistance. Superbugs on the hoof?. Science, 2000, 288(5467): 792-794

[5] KmietowiczZ. WHO warns of threat of “superbugs”. BMJ, 2000, 320(7250): 1624

[6] le GrandA, HogerzeilHV, Haaijer-RuskampFM. Intervention research in rational use of drugs: a review. Health Policy Plan, 1999, 14(2): 89-102

[7] PhelpsCE. Bug/drug resistance. Sometimes less is more. Med Care, 1989, 27(2): 194-203

[8] ZhangR, EgglestonK, RotimiV, et al.. Antibiotic resistance as a global threat: evidence from China, Kuwait and the United States. Global Health, 2006, 2: 6

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

[10] TangS, MengQ, ChenL, et al.. Tackling the challenges to health equity in China. Lancet, 2008, 372(9648): 1493-1501

[11] MengQ, XuL, ZhangY, 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

[12] KondroW. Canadian scientists urge government to develop antibiotic plan. Lancet, 2002, 360(9341): 1230

[13] de ManP, VerhoevenBA, VerbrughHA, et al.. An antibiotic policy to prevent emergence of resistant bacilli. Lancet, 2000, 355(9208): 973-978

[14] SchitoGC, DebbiaEA, MarcheseA. The evolving threat of antibiotic resistance in Europe: new data from the Alexander Project. J Antimicrob Chemother, 2000, 46(SupplT1): 3-9

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

[16] ChenW, TangS, SunJ, 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

[17] XiangX, YangC, WangD, 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

[18] HeddiniA, CarsO, QiangS, et al.. Antibiotic resistance in China—a major future challenge. Lancet, 2009, 373(9657): 30

[19] JingL. . China faces great risk due to overuse of antibiotics, 2013

[20] ReynoldsL, McKeeM. Factors influencing antibiotic prescribing in China: an exploratory analysis. Health Policy, 2009, 90(1): 32-36

[21] BiP, TongS, PartonKA. Family self-medication and antibiotics abuse for children and juveniles in a Chinese city. Soc Sci Med, 2000, 50(10): 1445-1450

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

[23] Ministry of Health in China.. . Interim provisions on the administration of hospital pharmacy, 2002

[24] XiaoY, LiL. Legislation of clinical antibiotic use in China. Lancet Infect Dis, 2013, 13(3): 189-191

[25] YangL, LiuC, FerrierJA, 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

[26] Ministry of Health in China.. . Notification for the special campaign of antibiotics rational use in hospitals, 2012

[27] Regev-YochayG, RazM, DaganR, 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

[28] KernWV, de WithK, NinkK, et al.. Regional variation in outpatient antibiotic prescribing in Germany. Infection, 2006, 34(5): 269-273

[29] FilippiniM, MasieroG, MoschettiK. Socioeconomic determinants of regional differences in outpatient antibiotic consumption: evidence from Switzerland. Health Policy, 2006, 78(1): 77-92

[30] National Bureau of Statistics in China.. . The Divide of Regions According to Economic Development in China, 2012

[31] National Bureau of Statistics in China.. . Division Method of Regions, 2011

[32] AntachopoulosC, DotisJ, PentsioglouV. 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

[33] KernWV, de WithK, Steib-BauertM, et al.. Antibiotic use in non-university regional acute care general hospitals in southwestern Germany, 2001–2002. Infection, 2005, 33(5–6): 333-339

[34] DeWK, Steib-BauertM, StraachP, et al.. Is there significant regional variation in hospital antibiotic consumption in Germany?. Infection, 2006, 34(5): 274-277

[35] PiovaniD, ClavennaA, CartabiaM, et al.. The regional profile of antibiotic prescriptions in Italian outpatient children. Eur J Clin Pharmacol, 2012, 68(6): 997-1005

[36] ZhangW, ShenX, BergmanU, 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

[37] CeyhanM, YildirimI, EcevitC, et al.. Inappropriate antimicrobial use in Turkish pediatric hospitals: a multicenter point prevalence survey. Int J Infect Dis, 2010, 14(1): e55-e61

[38] Ashiru-OredopeD, SharlandM, CharaniE, 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(Suppl1): i51-i63

[39] LowM, NitzanO, BittermanH, 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

[40] CairnsKA, JenneyAW, AbbottIJ, et al.. Prescribing trends before and after implementation of an antimicrobial stewardship program. Med J Aust, 2013, 198(5): 262-266

[41] DumartinC, RoguesAM, AmadeoB, 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

[42] HadiU, KeuterM, van AstenH, 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

[43] Wilf-MironR, RonN, IshaiS, 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

[44] ElseviersMM, FerechM, VanderSR, 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

[45] DumartinC, L’HeriteauF, PefauM, 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

[46] GrauS, FondevillaE, MojalS, 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(Suppl3): 43-51

[47] D’AlerteR. Surveillance de la consommation des antibiotiques. Institut de veille sanitaire, 2010

[48] SumpraditN, ChongtrakulP, AnuwongK, 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

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

[50] CurrieJ, LinW, ZhangW. Patient knowledge and antibiotic abuse: Evidence from an audit study in China. J Health Econ, 2011, 30(5): 933-949

[51] GoossensH, FerechM, VanderSR, et al.. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet, 2005, 365(9459): 579-587

[52] KusterSP, RuefC, BollingerAK, et al.. Correlation between case mix index and antibiotic use in hospitals. J Antimicrob Chemother, 2008, 62(4): 837-842

[53] SabathLD, NottoDA. Analysis of factors influencing antibiotic usage in hospitals. Prog Clin Biol Res, 1979, 35: 65-74