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.
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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
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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)