Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012–2017

Abstract

Background The overuse of antibiotics has been a major public health problem worldwide, especially in low- and middle- income countries (LMIC). However, there are few policies specific to antibiotic stewardship in primary care and their effectiveness are still unclear. A restrictive-prescribing stewardship targeting antibiotic use in primary care has been implemented since December 2014 in Hubei Province, China. This study aimed to evaluate the effects of the restrictive-prescribing stewardship on antibiotic consumption in primary care so as to provide evidence-based suggestions for prudent use of antibiotics. Methods Monthly antibiotic consumption data were extracted from Hubei Medical Procurement Administrative Agency (HMPA) system from Sept 1, 2012, to Aug 31, 2017. Quality Indictors of European Surveillance of Antimicrobial Consumption (ESAC QIs) combined with Anatomical Therapeutic Chemical (ATC) classification codes and DDD per 1000 inhabitants per day (DID) methodology were applied to measure antibiotic consumption. An interrupted time series analysis was performed to evaluate the effects of restrictive-prescribing stewardship on antibiotic consumption. Results Over the entire study period, a significant reduction (32.58% decrease) was observed in total antibiotic consumption, which declined immediately after intervention (coefficient = − 2.4518, P = 0.005) and showed a downward trend (coefficient = − 0.1193, P = 0.017). Specifically, the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins showed declined trends after intervention (coefficient = − 0.0553, P = 0.035; coefficient = − 0.0294, P = 0.037; coefficient = − 0.0182, P = 0.003, respectively). An immediate decline was also found in the contribution of β-lactamase-sensitive penicillins to total antibiotic use (coefficient = − 2.9126, P = 0.001). However, an immediate increase in the contribution of third and fourth-generation cephalosporins (coefficient = 5.0352, P = 0.005) and an ascending trend in the contribution of fluoroquinolones (coefficient = 0.0406, P = 0.037) were observed after intervention. The stewardship led to an immediate increase in the ratio between broad- and narrow-spectrum antibiotic use (coefficient = 1.8747, P = 0.001) though they both had a significant downward trend (coefficient = − 0.0423, P = 0.017; coefficient = − 0.0223, P = 0.006, respectively). An immediate decline (coefficient = − 1.9292, P = 0.002) and a downward trend (coefficient = − 0.0815, P = 0.018) were also found in the oral antibiotic use after intervention, but no significant changes were observed in the parenteral antibiotic use. Conclusions Restrictive-prescribing stewardship in primary care was effective in reducing total antibiotic consumption, especially the use of penicillins, cephalosporins and macrolides/lincosamides/streptogramins. However, the intervention effects were limited regarding the use of combinations of penicillins with ß-lactamase inhibitors, the third and fourth-generation cephalosporins, fluoroquinolones and parenteral antibiotics. Stronger administrative regulations focusing on specific targeted antibiotics, especially the use of broad-spectrum antibiotics and parenteral antibiotics, are in urgent need in the future.

Antibiotic use in township hospitals during the COVID-19 pandemic in Shandong, China

“…In China, more than 50% of outpatients have been prescribed antibiotics over the past decade [ 8 ], far above the level recommended by WHO (less than 30%) [ 9 ]. Therefore, it is necessary to optimize antibiotic use in PHSs for containing bacterial resistance [ 4 , 6 , 10 ].…”

Effects of Regulation on Carbapenem Prescription in a Large Teaching Hospital in China: An Interrupted Time Series Analysis, 2016–2018

“… 35 , 36 It is worth noting that previous antibiotic policies in China have targeted all antibiotics and lacked regulation of specific antibiotics, with limited intervention effects on the use of carbapenems. 37 , 38 In many Asian hospitals, carbapenem-focused interventions for prevalent carbapenem-resistant A. baumannii may be more practical than widespread prescription restrictions. 21 Therefore, compared to previous antibiotic stewardship policies, the interventions in this study are more targeted and represent a solid attempt to manage a single type of antibiotic.…”

Point Prevalence Survey of Antimicrobial Use and Resistance during the COVID-19 Era among Hospitals in Saudi Arabia and the Implications

“…In the case of children, this may include prevalence rates broken down by specific age groups; generally though, this is not the case as seen in the global PPS study and studies among children in Pakistan, as well as the management of children with COVID-19 admitted to hospitals in Bangladesh and India [36,38,39,41,42]. PPS studies are also not time-series analyses, which typically investigate specific policies or activities over time, including policies to limit the utilization of antibiotics, or alternatively, the impact of events such as COVID-19 on the utilization of antimicrobials in ambulatory care [43][44][45].…”