Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study

Abstract

There were only two studies that described the appropriateness of outpatient antibiotic prescriptions in multiple provinces of China. One study estimated that in primary health care settings in China, more than 60% of antibiotic prescriptions were inappropriate by using a sample of only 7311 outpatient visits from six provinces. The other study reported the appropriateness of antibiotic prescriptions in tertiary-level hospitals in 25 provinces of Mainland China, with 0•45 million prescriptions. Both studies were conducted through manual prescription review, of which the review scheme was not clearly described and validated. No study investigated the antibiotic prescription rates for various diagnoses at the national level in China. Added value of this studyWe analyzed a prescription data of 173 million outpatient visits from 28 provinces collected during October 2014 and April 2018 in China. Using a well established and validated approach, we established the baseline of outpatient antibiotic prescription rates for various diagnoses and the proportion of inappropriate antibiotic prescribing, and our results suggested that over 50% of outpatient antibiotic prescribing in China was inappropriate. To the best of our knowledge, no previous studies analyzed such a big prescription data to investigate antibiotic prescribing in China. This study provides the most recent and comprehensive evaluation of the appropriateness of outpatient antibiotic prescriptions in China, which can be benchmark for future studies to assess the progress of China curbing antibiotic misuse and overuse. Implications of all the available evidenceAlthough years of efforts to curb antibiotic use have significantly reduced antibiotic prescription rate, the inappropriate antibiotic prescribing is still prevalent in China. Our findings inform policy makers in China, as well as other countries with high prevalence of inappropriate antibiotic prescribing, carrying out more in-depth antibiotic stewardship programs focusing on reducing inappropriate antibiotic prescribing to achieve the goals of optimizing antibiotic use and curbing antimicrobial resistance. This study also provides a precedent for the use of large-scale prescription data and a wellestablished methodological framework to evaluate the appropriateness of antibiotic prescriptions in China. Future studies focusing on antibiotic use in China can apply our methods to evaluate the appropriateness of antibiotic prescribing by using big electric medical records or administrative data. Summary BackgroundInappropriate antibiotic use greatly accelerates antimicrobial resistance. The appropriateness of antibiotic prescriptions is well evaluated, using big observational data, in some high-income countries (HICs), whereas the evidence of this appropriateness is very limited in China. We aimed to assess the appropriateness of antibiotic prescriptions in China ambulatory care settings. MethodsWe used a data from the Beijing Data Center for Rational Use of Drugs, which was a national database designed for...

Emergence of Ceftazidime- and Avibactam-Resistant Klebsiella pneumoniae Carbapenemase-Producing Pseudomonas aeruginosa in China

“…The emergence of the predominant ST463 clone is worrisome. It is possible that capturing the KPC-encoding plasmid allows it to survive in clinical environments where the antibiotic pressure is high ( 25 ). Such specific associations between plasmid types and bacterial clones have been observed in previous studies ( 26 ).…”

Molecular Characterization Based on Whole-Genome Sequencing of Streptococcus pneumoniae in Children Living in Southwest China During 2017-2019

“…In this study, erm ( B ) and mef ( A ) were detected in 98.4% and 41.4% of the strains, respectively, which may be responsible for the heavy ERY resistance burden in this region. Although 14 ministries of China jointly issued a 5-year national action plan to control antimicrobial resistance (NAP) in 2016, 51.4% of prescriptions related to antibiotics, including the use of macrolides, remain inappropriate ( Zhao et al, 2021 ). Similar to the results from other reports ( Li et al, 2019 ; Wang et al, 2020b ), the isolates were highly resistant to CLI in this work, thus, CLI may be not suitable for the treatment of S. pneumoniae infections.…”

Outpatient Antibiotic Prescribing Patterns and Appropriateness for Children in Primary Healthcare Settings in Beijing City, China, 2017–2019

“…The selection pressure of antibiotics, driven by inappropriate antibiotic prescribing, generates antimicrobial resistance [1,2]. The development of antimicrobial resistance (AMR) is further accelerated by inappropriate antibiotic use and has become a growing public health threat worldwide, particularly for children [3,4]. An estimate from the China Antimicrobial Resistance Surveillance System (CARSS) showed that the proportions of third-generation cephalosporin-resistant Escherichia coli in China (CTX/CRO-R ECO) isolated from children and newborns in 2019 were 38.8% and 10.1%, respectively, which were higher than those from adults (28.8%) [5].…”