Factors influencing inappropriate use of antibiotics in outpatient and community settings in China: a mixed-methods systematic review

Abstract

BackgroundFor decades, antibiotics have been excessively consumed around the world, contributing to increased antimicrobial resistance (AMR) and negatively impacting health outcomes and expenditures. Antibiotic use in China accounts for half of worldwide antibiotic consumption, which mainly takes place in outpatient and community settings, and often unnecessarily for self-limiting community-acquired infections. This study aimed to identify and assess factors of inappropriate use of antibiotics in the Chinese context to inform the development of interventions to mitigate inappropriate consumption in the absence of clinical indications.MethodsWe conducted a mixed-methods systematic review and included empirical studies with original data conducted in mainland China, Hong Kong and Taiwan that investigated factors of antibiotic use in the community including outpatient care among patients, caregivers and prescribers. We searched MEDLINE, EMBASE, the Cochrane Library, PsycINFO, Google Scholar and one Chinese database CNKI (China Knowledge Resource Integrated Database), using a combination of the key terms ‘antibiotic’, ‘antimicrobial’, ‘use’, ‘consumption’, ‘behaviour’, ‘prescribe’ and related syntax for all peer-reviewed publications published before June 2020. Health Belief Model was employed for data synthesis.FindingsFifty-four studies were included in the full-text review: 44 quantitative, 5 qualitative and 5 mixed-methods studies. Despite a high AMR awareness, public perception/misconception of antibiotic efficacy and easy access to antibiotics for self-limiting conditions drive inappropriate demand and use in the community including primary care setting. Providers’ prescribing behaviours are influenced by financial incentives, lack of diagnostic capacity and concerns over complications.ConclusionsInappropriate outpatient and community antibiotic use is influenced by non-biomedical factors at the individual, community, health system and societal levels in mainland China, contributing to a high antibiotic use rate. This study calls for context-tailored One Health interventions, restrictive antibiotic drug policy and multifaceted antibiotic stewardship programmes that simultaneously address drivers of inappropriate use from both the supply-side and demand-side within and beyond clinical settings.PROSPERO registration numberCRD42019139591.

Vaccine Hesitancy: COVID-19 and Influenza Vaccine Willingness among Parents in Wuxi, China—A Cross-Sectional Study

“…Government and health authorities should build a transparent, robust, and reasonable immunization process for COVID-19 vaccines with context-tailored vaccine communication that addresses public concerns. Behavioral-change theories (e.g., the health-belief model and social marketing [ 38 , 39 ]), which have been effectively adapted to improve individual medical use, should be used in developing strategies to improve the acceptance and uptake of COVID-19 vaccinations. Effective communication for COVID-19 vaccines should target those with graduate degrees.…”

The General Population’s Inappropriate Behaviors and Misunderstanding of Antibiotic Use in China: A Systematic Review and Meta-Analysis

“…Results from these studies showed high degrees of variability of findings, settings, participants, and other study characteristics. Though one recent study has qualitatively synthesized the factors influencing the general population’s irrational use of antibiotics [ 31 ], it is still unclear what the prevalence of the general population’s irrational use of antibiotic behaviors is, as well as the prevalence of potential factors contributing to it.…”

Outpatient prescribing pattern for acute bronchitis in primary healthcare settings in China

“…A Cochrane review suggested that antibiotics were minimally effective for acute bronchitis, with a half-day reduction in cough and no reduction in functional impairment compared to placebo, as well as increasing rates of adverse events 3 . Public perception/misconception of antibiotic efficacy drove inappropriate demand for utilizing antibiotics in the primary outpatient setting in China 24 . Surveys showed that 60% of the population believed that antibiotics were effective for the treatment of acute bronchitis 25 , a belief that varied by educational level 26 .…”