Study finds most outpatient antibiotics in China are inappropriate
More than half of outpatient antibiotic prescriptions at Chinese hospitals over a 3.5-year period were inappropriate, Chinese researchers reported yesterday in The Lancet Infectious Diseases.
Using data from the Beijing Data Center for Rational Use of Drugs, a national database that collects prescription data from hospitals from all provincial-level regions in mainland China, the researchers analyzed antibiotic prescriptions linked to visits to outpatient clinics and emergency departments from Oct 1, 2014, through April 30, 2018.
A total of nearly 173 million outpatient visits to 139 secondary and tertiary hospitals were evaluated in the study. ICD-10 diagnostic codes were used to classify outpatient antibiotic prescriptions issued on the same day as diagnosis as appropriate, potentially appropriate, inappropriate, or not linked to any diagnosis for antibiotic use.
Over the study period, 18,848,864 outpatient visits (10.9%) ended with an antibiotic prescription, with prescribing rates of 9.3% for outpatient clinics and 26.9% for emergency departments. Of the antibiotic prescriptions, 51.4% were classified as inappropriate, 28.4% as potentially appropriate, and 15.3% as appropriate, and 4.8% could not be linked to any diagnosis.
Children younger than 6 years had the highest proportion of inappropriate prescriptions, at 71.1%. A substantial amount of antibiotic overuse was driven by respiratory conditions, mainly viral upper respiratory tract infections and bronchitis.
Of the more than 23 million individual antibiotics prescribed, 80% were broad-spectrum. The top four most prescribed antibiotics were third-generation cephalosporins (21.7%), second-generation cephalosporins (16.4%), macrolides (15.3%), and fluoroquinolones (14.1%).
The authors say the findings of the study—the first of its kind conducted in China—suggest China's efforts to curb antibiotic overuse over the past decade have had little effect. Promoting appropriate use of antibiotics and establishing antibiotic stewardship programs in secondary and tertiary hospitals are two of the targets of China's 5-year national action plan (NAP) to contain antimicrobial resistance, which was launched in 2016.
"In conclusion, our findings indicate that inappropriate antibiotic prescribing was highly prevalent nationwide in China," the authors wrote. "More in-depth antibiotic stewardship programmes focusing on optimising antibiotic prescribing need to be implemented in China to achieve the goals set in the NAP."
Jan 27 Lancet Infect Dis abstract
European biotech firms urge support for antibiotic development measures
A coalition of European biotech companies is voicing its support for the European Commission's efforts to boost antibiotic development.
In a statement posted on its website, the BEAM (Biotech companies from Europe innovating in Anti-Microbial resistance research) Alliance said it welcomes the European Commission's Pharmaceutical Strategy, which aims to ensure that Europe has the supply of safe, effective, and affordable medicines to meet its needs. Adopted on Nov 25, 2020, the strategy recognizes the development of novel antibiotics as a prime example of addressing unmet medical needs—one of the strategy's four pillars—and calls for new economic incentives and reimbursement models to boost antibiotic development.
The Alliance also said that while new incentives and reimbursement reforms are needed to maintain a sustainable pipeline of new antibiotics over the long-term, faster solutions are needed. And it argues that innovative approaches to boost antibiotic research and development should embrace a broad definition of antibiotics, including nontraditional approaches, and take into account the needs of small- to medium-sized companies, which are struggling to advance their antibiotic-development programs because of the financial challenges.
"The BEAM Alliance stands ready to provide all necessary input to support the Commission in finding innovative solutions that can be deployed in the short term, and to contribute to the debates on systemic, long-term reforms," the group wrote.
Jan 26 BEAM Alliance statement
