Analysis of Antibiotic Use Patterns and Trends Based on Procurement Data of Healthcare Institutions in Shaanxi Province, Western China, 2015–2018

Abstract

Overuse of antibiotics has caused a series of global problems, especially in the underdeveloped western regions where healthcare systems are fragile. We used antibiotic procurement data of all healthcare institutions to analyze the total amount, patterns and trends of antibiotic use in Shaanxi Province, western China between 2015 and 2018. Antibiotic utilization was quantified using the standard Anatomical Therapeutic Chemical (ATC)/Defined daily dose (DDD) methodology. The World Health Organization’s “Access, Watch and Reserve” (AWaRe) classification and European Surveillance of Antimicrobial Consumption (ESAC) drug-specific quality indicators were also adopted to evaluate the appropriateness and quality of antibiotic utilization. Overall, antibiotic consumption decreased from 11.20 DID in 2015 to 10.13 DID (DDDs per 1000 inhabitants per day) in 2016, then increased to 12.99 DID in 2018. The top three antibiotic categories consumed in 2018 were J01C (penicillins) 33.58%, J01D (cephalosporins) 29.76%, and J01F (macrolides) 19.14%. Parenteral antibiotics accounted for 27.41% of the total consumption. The largest proportion of antibiotic use was observed in primary healthcare institutions in rural areas, which accounts for 51.67% of total use. Consumption of the Access group, the Watch group, the Reserve group of antibiotics was 40.31%, 42.28% and 0.11%, respectively. Concurrently, the consumption of J01D and the percentage of J01 (DD + DE) (third and fourth generation cephalosporins) were at a poor level according to the evaluation of ESAC quality indicators. The total antibiotic consumption in Shaanxi Province had been on an upward trend, and the patterns of antibiotic use were not justified enough to conclude that it was rational. This is partly because there was high preference for the third and fourth generation cephalosporins and for the Watch group antibiotics.

Analysis of Antibiotic Consumption by AWaRe Classification in Shandong Province, China, 2012–2019: A Panel Data Analysis

“…The national antibiotic stewardship strategies appear to play a role in reducing antibiotic use at health care institutions in Shandong Province, as well as in Hubei Province and Shanghai Municipality ( Lin et al, 2016 ; Zhang et al, 2019 ). However, other studies indicate that China’s national antibiotic stewardship strategies have had no significant effect on antibiotic consumption in Shanxi Province where the volumes of antibiotic consumption kept increasing between 2016 and 2018 ( Xu et al, 2020 ).…”

“…The current published studies conducted in China often focus on the patterns of clinical use of antibiotics in selected tertiary hospitals with findings that indicate a decline in antibiotic prescribing rates ( Bao et al, 2015 ; Wushouer et al, 2017 ; Chen et al, 2018 ). Few studies analyzed the changes of antibiotic consumption using data collected from all the health care institutions in a provincial area ( Lin et al, 2016 ; Yin et al, 2018 ; Xu et al, 2020 ). In context of China’s 10-years national antibiotic stewardship program, this study analyzed the changes in trends and patterns of antibiotic consumption in health care institutions in the second-largest population province of China, by WHO AWaRe Classification.…”

Knowledge, Attitude, and Prescription Practice on Antimicrobials Use Among Physicians: A Cross-Sectional Study in Eastern China

“…3,4 . The prescription of antimicrobials has risen steadily in some provinces, 5,6 and is a major risk factor of AMR development. The antimicrobial prescription rate (APR) in China is twice as that recommended by the World Health Organization, 7 with 52% to 78% of the prescriptions for inpatients including at least 1 antibiotic 8,9 compared to 30% in some developed countries.…”

Knowledge, Attitude and Prescription Practice on Antimicrobials Use among Physicians: A Cross-sectional Study in Zhejiang, China

“…As the second largest consumer of antibacterial drugs in the world, the problem of antimicrobial misuse and overuse is particularly severe in China [3,4]. The prescription of antimicrobials has risen steadily in some provinces [5,6], and is a major risk factor of AMR development. The antimicrobial prescription rate (APR) in China is twice as that recommended by the World Health Organization [5,6], with 52% to 78% of the prescriptions for inpatients including at least one antibiotic [8,9] compared to 30% in some developed countries [10].…”

“…The prescription of antimicrobials has risen steadily in some provinces [5,6], and is a major risk factor of AMR development. The antimicrobial prescription rate (APR) in China is twice as that recommended by the World Health Organization [5,6], with 52% to 78% of the prescriptions for inpatients including at least one antibiotic [8,9] compared to 30% in some developed countries [10]. In addition, there is empirical evidence showing higher frequency of antimicrobial prescription in the rural areas of China compared to the urban and economically more prosperous regions [9,11].…”