Antibiotic Sales in Primary Care in Hubei Province, China: An Analysis of 2012–2017 Procurement Records

Abstract

The over-use of antibiotics has been identified as a major global challenge, where there is insufficient knowledge about the use of antibiotics in primary healthcare settings, especially at a population level. This study aims to investigate the trends and patterns of antibiotic sales in primary care in Hubei, China over a six-year period from 2012 to 2017. Antibiotic sales were expressed with Defined Daily Doses per 1000 inhabitants per day (DIDs) and compared with European countries using the 12 quality indicators proposed by the scientific advisory board of the European Surveillance of Antimicrobial Consumption (ESAC) project. Antibiotic sales increased from 12.8 DID in 2012 to 15.3 DID in 2013, and then declined afterwards. The most commonly used antibiotics, J01C (beta-lactam antimicrobials, penicillins), accounted for 40.5% of total antibiotic sales. Parenteral administration of antibiotics accounted for over 50% of total antibiotic sales. Total antibiotic sales were almost on a par with the 31 European countries monitored by the ESAC project, but cephalosporin sales were higher than at least three quarters of the compared countries, resulting in a significant higher proportion of third-generation cephalosporin consumption (13.8–19.43%). The relative consumption of Fluoroquinolone (9.26–9.89%) was also higher than at least half of the compared countries. There is a lack of robust evidence to show that antibiotic consumption in primary care is lower in Hubei compared with other countries. The preference of clinicians in China to use broad-spectrum and parenteral antibiotics deserves further study and policy attention.

Antibiotic Consumption Trends in China: Evidence From Six-Year Surveillance Sales Records in Shandong Province

“…These changes coincided with the multiple interventions that regulate the use of antibiotics in China, including the 2012 Administrative Rules for the Clinical Use of Antibiotics issued by the Ministry of Health. This administration intervention appeared to work better according to the findings of this study and others (Zhang et al, 2019). In addition to persuasive guidelines, penalties for violating these administrative rules and measures, such as downgraded accreditation and service fee levels and dismissal of managers, were applied.…”

“…Antimicrobial resistance (AMR) driven by antibiotic consumption is a growing threat to global public health (Song, 2018;Zhang et al, 2019). China is among the world's largest producers and consumers of antibiotics, which are widely used for disease treatment in humans and livestock, as well as prophylaxis and growth promoters for the latter (Qiao et al, 2018).…”

Identifying antibiotic prescribing patterns through multi-level latent profile analyses: a cross-sectional survey of primary care physicians in Hubei of China

“…In addition, the high prevalence of parenteral administration of antibiotics has attracted increasing safety concerns in China. Studies showed that 36% to 60% of antibiotics were administered through parenteral injections in primary care settings in China [29][30][31].…”

“…The domination of broad-spectrum antibiotics in antibiotic prescribing in Hubei of China is comparable to ndings of other studies. A study monitoring antibiotic sales in primary cares in Hubei showed that broad-spectrum antibiotics were increasingly used in recent years, rising from 74.87% as a proportion of antibiotic sales in 2012 to 85.69% in 2017 [31]. This is not unique to China.…”

Identifying antibiotic prescribing patterns through multi-level latent profile analyses: a cross-sectional survey of primary care physicians in Hubei of China

“…In addition, the high prevalence of parenteral administration of antibiotics has attracted increasing safety concerns in China. Studies showed that 36-60% of antibiotics were administered through parenteral injections in primary care settings in China [29][30][31].…”