Study Finds Antibiotics Traces in 80% of Shanghai Schoolchildren Tested – Implications for Hospital Management in China

A recent study by Fudan University confirmed an alarming issue that has been around for some time but usually ends up being filed away in the consciousness of hospital administrators as one of those cultural issues that you can do very little about. I’m referring to the propensity of Chinese physicians to use antibiotics unnecessarily and inappropriately and Chinese patients to demand them.

The overuse of antibiotics is believed to be more severe in China than in any other country. Physicians routinely prescribe multiple doses of antibiotics for even minor conditions like sore throats and common colds. One study estimated that a total of 10.4 billion bottles of medicines in intravenous infusions – 8 bottles per person ‐ were used in China compared to 2.5 to 3.3 bottles per person per year worldwide. Antibiotics are used in as high as 80% of hospitalized patients, 75% of patients with colds and 95% of surgeries. The study estimates that 80% of the antibiotic usage was unnecessary.

In a study testing for 21 common antibiotics, Fudan University researchers found traces of at least one variety in 80% of 505 schoolchildren tested in Shanghai. Some individual antibiotics, including those normally used in farming, were detected in nearly one‐third of the children tested. A report by the World Health Organization in November, 2015 found that nearly two thirds of Chinese mistakenly believed antibiotics should be used to treat colds and flu, with doctors in China prescribing them to half of all outpatients.

The health risk associated with the widespread use of antibiotics is the creation of antibiotics‐resistant bacteria and a high‐level of antibiotic resistance among the patients who unnecessarily receive them. The challenge for hospitals in China that aspire to international standards is that the Chinese public places blind faith in antibiotics and will stubbornly request them even for minor colds or fever whatever the physician might say about their effectiveness. Adding to the problem is the fact that antibiotics can be easily purchased without a prescription. Another study showed that 75.4% of Chinese habitually stock antibiotics at home and most people have taken antibiotics without a physician’s guidance.

Efforts by the government to control this problem have had very limited effect on changing attitudes and prescribing patterns.

So, this is a horrible situation. But what can you do about it if you are operating a hospital in China? Unfortunately your choices are limited. Certainly a strongly – supported patient education program of posters, educational seminars and physician talks can be of some benefit. But the reality is that the only real way to control this problem is through medical leadership. Your senior medical leadership, from the CMO to department chairs, must strongly support your program of reducing antibiotic usage. It needs to be reinforced and monitored on a regular basis. A good approach is for the quality assurance committee to monitor individual physician’s prescribing patterns and counsel individuals with excessive utilization of antibiotics.

Whatever approach you use will only be effective with constant attention and focus. Hospital administration must make this a priority on a long‐term basis.

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