An analysis of outpatient antibiotic prescriptions from primary healthcare facilities (PHFs) in six Chinese provinces found that more than 70% were inappropriate, Chinese researchers reported last week in Clinical Microbiology and Infection.
In the nationwide survey of outpatient antibiotic prescriptions ordered from Chinese primary care facilities, researchers at Peking University collected data on all outpatient-visit prescriptions from 269 Chinese PHFs in 31 cities in six provinces from 2017 to 2019. They randomly selected 100 outpatient antibiotic prescriptions from each facility, then classified them as appropriate, potentially appropriate, and inappropriate based on the diagnosis for which they were prescribed. They also analyzed the type of antibiotics prescribed and the costs associated with inappropriate prescribing.
Of the 641,732 prescriptions analyzed, 209,662 (32.7%) included at least one antibiotic. Of those antibiotic prescriptions, 4.8% were classified as appropriate, 20.6% as potentially appropriate, and 70.5% as inappropriate. Upper respiratory tract infections, acute bronchitis, and non-infectious gastroenteritis were responsible for 68.9% of inappropriately antibiotic prescriptions. A total of 256,474 individual antibiotics were prescribed, of which 82.2% were broad-spectrum antibiotics, with second-generation cephalosporins (15.1%) and third-generation cephalosporins (14.6%) being the most commonly prescribed subgroups.
Higher inappropriate antibiotic prescribing rates were observed in children aged 0 to 5 years (78.5%) and patients living in economically undeveloped areas (77.5%). Cumulative spending on inappropriate antibiotics accounted for 66.8% of the total cost of antibiotics.
The study authors say antibiotic stewardship efforts should target certain conditions (i.e., upper respiratory tract infections, acute bronchitis, and non-infectious gastroenteritis) and on clinicians and children in cities of lower economic status.
"Real-world evidence is increasingly appreciated as fundamental to the development of antibiotic stewardship and interventions aiming at modifying antibiotic prescribing and improving patients' health," they wrote. "Tailored training and continuous education for primary clinicians that promote accurate diagnosis and evidence-based treatment based on clinical guidelines are urgently needed."