Massive misuse of antibiotics by university students in all regions of China: implications for national policy

Abstract

Antimicrobial resistance (AMR) is one of the greatest threats to global health this century. The primary cause of AMR is antibiotic misuse, especially routine use of antibiotics for self-limiting illnesses. This study aimed to explore behaviours related to antibiotic use in university students across China. An electronic questionnaire was distributed at a major university in each of the six regions. A cluster random sampling method was adopted. The χ test and logistic regression were used to assess the relationship between knowledge and behaviour. A total of 11,192 students completed the questionnaire. In the past month, 3337 students (29.8%) reported a self-limiting illness, of whom 913 (27.3%) saw a doctor, 600 (65.7%) of whom were prescribed antibiotics [190 (31.7%) by infusion]; 136 students (22.7%) asked for and received antibiotics. Of the 1711 students (51.3%) who treated themselves, 507 (29.6%) self-medicated with antibiotics. In the past year, 23.0% of students had used antibiotics as prophylaxis, 63.1% kept a personal stock of antibiotics and 56.0% had bought antibiotics at a drugstore (two-thirds without a prescription). Students with lower knowledge scores about antibiotics were significantly more likely to see a doctor, be prescribed with antibiotics, self-medicate with antibiotics, and use antibiotics prophylactically. This massive misuse of antibiotics for self-limiting illnesses by well-educated young adults is a serious concern. A national campaign is urgently required to address rational prescribing of antibiotics by doctors, enforce existing restrictions on over-the-counter sale of antibiotics, and educate the general public about antibiotics and the management of self-limiting illnesses.

Antibiotic misuse among university students in developed and less developed regions of China: a cross-sectional survey

“…Permission was initially obtained from authorities at each university to conduct the survey. The aim was to achieve a sample size of roughly 1800 students across a range of disciplines, including science, social science/the humanities, and medicine, at each university [17]. The class timetable on the main campus was obtained at each university the day before the survey was administered.…”

The Drivers of Antibiotic Use and Misuse: The Development and Investigation of a Theory Driven Community Measure

“…Existing literature highlights consumer or patient demand and behaviour, as a driving force behind antibiotic misuse (18)(19)(20). Understanding the extent of global trends in consumer demand for, and knowledge about, antibiotics is therefore an important component in the battle to curtail the growth of AMR and has precipitated multinational surveys.…”

Trends, Epidemiology, and Management of Multi-Drug Resistant Gram-Negative Bacterial Infections in the Hospitalized Setting

“…A cross-sectional study of university students throughout six major regions of China found that only 38.7% of students understood that antibiotics did not work for viral illnesses, and 41.0% believed antibiotics sped influenza recovery. These students were also twice as likely as U.S. college students to request antibiotics for self-limited illnesses [70]. A similar study estimated that 75% of patients with suspected flu were treated with antibiotics yearly in China [71].…”