Changes in Chinese Policies to Promote the Rational Use of Antibiotics

PLoS Medicine, Nov 2013

Xonghong Xiao and colleagues analyze the challenge of antimicrobial resistance in China. A government strategy to promote rational use of antimicrobials in health care reduced antibiotic sales and percentage of prescriptions for antimicrobials for both hospitalized patients and outpatients, and offers insights to shape future initiatives. Please see later in the article for the Editors' Summary

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Changes in Chinese Policies to Promote the Rational Use of Antibiotics

et al. (2013) Changes in Chinese Policies to Promote the Rational Use of Antibiotics. PLoS Med 10(11): e1001556. doi:10.1371/journal.pmed.1001556 Changes in Chinese Policies to Promote the Rational Use of Antibiotics Yonghong Xiao 0 1 Jing Zhang 0 1 Beiwen Zheng 0 1 Lina Zhao 0 1 Sujuan Li 0 1 Lanjuan Li 0 1 0 Abbreviations: AMR, antimicrobial resistance; MOH, Ministry of Health; Mohcas, Chinese Ministry of Health Center for Antibacterial Surveillance; Mohnarin, Chinese Ministry of Health National Antimicrobial Resistance Investigation Net; MRSA , methicillin-resistant Staphylococcus aureus 1 Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou , China Antimicrobial resistance (AMR) is a serious public health challenge and containment of AMR is a global priority. On World Health Day in April 2011, the World Health Organization appealed to all member countries to ''combat drug resistance: no action today, no cure tomorrow'' [1]. The implementation of new Chinese policies over the past 2 years for the rational use of antimicrobials and AMR containment is a promising response to this appeal. - The prevalence of AMR is relatively high in China; the morbidity and mortality from infections caused by multidrugresistant or pan-drug-resistant pathogens are higher in China than in other countries [2]. Data reported by the Chinese Ministry of Health (MOH) National Antimicrobial Resistance Investigation Net (Mohnarin) indicates that AMR is rising steadily. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum b-lactamase-producing Escherichia coli, imipenem-resistant Pseudomonas aeruginosa, and imipenem-resistant Acinetobacter baumanniithe so-called superbugs in nosocomial infections was 50.5%, 71.2%, 23.4%, and 56.8% in 2010, respectively (Figure 1). The overall prevalence of erythromycin-resistant Streptococcus pneumonia and ciprofloxacin-resistant E. coli was 94.7% and 65.7% in community settings, respectively [3,4]. Irrational use of antimicrobial agents is the main cause of increased AMR. In China, antibiotics are considered to be a panacea by the general public and some healthcare practitioners. Over-the-counter purchase and over-reliance on antibiotics The Health in Action section is a forum for individuals or organizations to highlight their innovative approaches to a particular health problem. sation provided to healthcare institutions for drug sales. The Chinese healthcare system consists of a government-led system with characteristics of free market financing and lower service pricing. The governments contribution to hospital budgets is less than 20% of hospital expenditure. Healthcare institutions can receive financial compensation by selling healthcare services and drugs. The governments acquiescence to the situation has stimulated, and to some extent encouraged, excessive examinations, unnecessary treatment, and overuse of medicines by routine healthcare services. Drug sales constitute about half of institutional income and most of the profit, with more than 25% being sales of antimicrobial agents [6]. At the same time, the overuse of antimicrobial agents in animal husbandry and farming has contributed to the occurrence and spread of antibiotic-resistant microbes in the environment [7,8]. The Limited Effect of Professional Strategies for the Rational Use of Antibiotics To control AMR, the Chinese health administrative authorities have taken a series of actions over the past 10 years, including the development of technical specifications and policies. These included the issue of guidance about antibiotic use and infection control. Mohnarin and the Chinese MOH Center for Antibacterial Surveillance (Mohcas) were established in 2006. Hospitals were required to set up a drug therapeutics committee to facilitate the rational use of drugs, and medical practitioners were required to prescribe antibiotics in a rational manner. Furthermore, nosocomial infection control measures were emphasized, such as hand hygiene and contact precautions for AMR infections (although compliance is often unsatisfactory because of heavy staff workloads and large patient populations). In addition, nationwide continuing medical education programs focusing on rational drug use and AMR control, were conducted repeatedly. All of the measures were established as part of a technical support system to promote the rational use of antibiotics, as recommended by the World Health Organization [9,10]. However, due to strained resources, insufficient enforcement, absence of supervision and inspection, and inefficient implementation plans, these policies and strategies were not successful. Indeed, during the past decade, antimicrobials have remained the most prescribed institutional medicine, and AMR has continued to in (...truncated)


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Yonghong Xiao, Jing Zhang, Beiwen Zheng, Lina Zhao, Sujuan Li, Lanjuan Li. Changes in Chinese Policies to Promote the Rational Use of Antibiotics, PLoS Medicine, 2013, Volume 10, Issue 11, DOI: 10.1371/journal.pmed.1001556