Antibiotic resistance (ABR) has been identified as one of the greatest threats to global population health this century, as well as a major contributor to rising healthcare costs worldwide. The primary cause of ABR is antibiotic misuse, especially the routine inappropriate use of antibiotics for self-limiting illnesses. Therefore, reducing antibiotic misuse has become an urgent priority, especially in low and middle income counties (LMIC) where systems to regulate antibiotic use are weak or non-existent .
China has very high rates of ABR in both hospital and community-acquired infections, following decades of high utilisation of antibiotics. The very large and mobile population also increases the risk of spread of resistance. Around two-thirds of in-patients and 50-60% of out-patients are prescribed antibiotics. As elsewhere, the reasons for overprescribing of antibiotics in China are multifactorial, and therefore demand a multi-facetted response.
The overall aim of the project is to pilot an intervention to reduce inappropriate antibiotic use in children in three townships in Jiangshan County, Zhejiang Province through a controlled community intervention. The methods comprise development of guidelines for management of common self-limiting childhood, training of doctors in the use of the guidelines, institution of a routine surveillance system for antibiotic prescribing of all clinicians, with adherence to prescribing guidelines contributing to performance-related pay, and a community-based health education programme to raise awareness about ABR.
Mid-term evaluation has shown that the project has succeeded in reducing antibiotic prescribing in intervention townships from 59% to 36%. This small project also brought about improvements in management practices, clinician training, use of information systems, prescribing patterns (beyond just antibiotics), hospital and doctors' accountability, doctor-patient communication, and perceived overall quality of care.