Trends in Antimicrobial Prescription for Inpatients in Changsha, China, 2003 to 2014
-
Yinhua ZHANG
,
Qun YUAN
,
Xia YI
,
Honghua LIU
,
Xiaoyan PAN
,
Jingwei LIU
,
Yi XU
,
Yang CHEN
,
Guoping HE
Abstract
Background: China had implemented policies to limit antimicrobials prescription since 2004; we conducted this study to reflect the effect of these national policies by analyzing antimicrobial prescription trends of medical insurance in patients from 2003 to 2014 in Changsha city, China.
Methods: The participants were inpatients of the medical insurance of urban workers (UEBMI). Data were extracted from medical insurance information system of Changsha Medical Insurance Institution, which directly connects with hospitals information systems.
Results: Trend analysis showed great changes in antimicrobial prescription and inpatients’ cost on antimicrobials over the study period. Antimicrobial prescription rates gradually declined over the study period from 79.0% in 2003 to 43.5% in 2014 (adjusted OR0.205; 95%CI 0.198 to 0.213). There was a quicker decline from 2011 to 2014 (with implementing national antimicrobial stewardship action plan) than the period from 2003 to 2010 (with implementing antimicrobials use education and self-management strategies). The proportion of inpatients used one antimicrobial increased significantly from 25.6% in 2003 to 46.7% in 2014, while the proportion of inpatients used three or more antimicrobials gradually decreased. Bacterial culture rate increased from 20.4% in 2003 to 36.6% in 2014 (adjusted OR 2.248; 95% CI 2.149 to 2.352). The average costs on antimicrobials decreased significantly, from 277.43 US Dollar in 2003 to 91.05 US Dollar in 2014.
Conclusion: National efforts to promote rational use of antimicrobials in clinical practice have had a positive effect over the past decade in China.
Kumar R, Indira K, Rizvi A, et al (2008). Antibiotic prescribing practices in primary and secondary health care facilities in Uttar Pradesh, India. J Clin Pharm Ther, 33(6):625-34.
Nissinen A， Seppala H， Huovinen P (1997).The Effect of Changes in the Consumption of Macrolide Antibiotics on Erythromycin Resistance in Group A Streptococci in Finland. N Engl J Med, 337(7): 441-6.
EMV Bijnen，CDD Heijer，WJ Paget，et al (2011). The appropriateness of prescribing antibiotics in the community in Europe: study design. BMC Infect Dis,11:293.
Zhang R, Eggleston K, Rotimi V, Zeckhauser RJ (2006). Antimicrobial resistance as a global threat: evidence from China, Kuwait and the United States. Global Health, 2:6.
Worldwide country situation analysis: response to antimicrobial resistance. (2015). http://www.who.int/drugresistance/documents/situationanalysis/en/
Yin X1, Song F,Gong Y, et al (2013). A systematic review of antibiotic utilization in China. J Antimicrob Chemother, 68(11):2445-52.
Wang JF, Chou KC (2013). Metallo-beta-lactamases: structural features, antimicrobial recognition, inhibition, and inhibitor design. Curr Top Med Chem, 13(10): 1242-1253.
WHO global strategy for containment of antimicrobial resistance. http://www.who.int/drugresistance/WHO_Global_Strategy_English.pdf
The Notification of National Governance Campaign of Clinical Antimicrobial Application. The Health and Family Planning Commission of P.R.China; 2011.
The Notification of Deepening National Governance Campaign of Clinical Antimicrobial Application. The Health and Family Planning Commission of P.R.China; 2012.
The Notification of Further Launching National Governance Campaign of Clinical Antimicrobial Application. The Health and Family Planning Commission of P.R.China; 2013.
WHO. Using Indicators to Measure Country Pharmaceutical Situations. http://apps.who.int/medicinedocs/index/assoc/s14101e/s14101e.pdf
Li C, Ren N, Wen X, et al (2013). Changes in Antimicrobial Use Prevalence in China: Results from Five Point Prevalence Studies. PLoS One, 8(12): e82785.
Bao L, Peng R, Wang Y, et al (2015). Significant Reduction of Antibiotic Consumption and Patients’ Costs after an Action Plan in China, 2010–2014. PLoS One, 10(3): e0118868.
Ashiru-Oredope D, Sharland M, Charani E, et al (2012). Improving the quality of antibiotic prescribing in the NHS by developing a new Antimicrobial Stewardship Programme: Start Smart-Then Focus. J Antimicrob Chemother, 67 Suppl 1:i51-63.
Low M, Nitzan O, Bitterman H, et al (2013). Trends in outpatient antibiotic use in Israel during the years 2000–2010: setting targets for an intervention. Infection, 41(2):401-7.
Caims KA, Jenney AW, Abbott IJ, et al (2013). Prescribing trends before and after implementation of an antimicrobial stewardship program. Med J Aust,198(5):262-6
Dumartin D, Rogues AM, Amadeo B, et al (2011). Antibiotic stewardship programmes: legal framework and structure and process indicator in Southwestern French hospitals, 2005-2008. J Hosp Infect, 77(2):123-128.
Zou XX, Fang Z, Min R, et al (2014). Is nationwide special campaign on antibiotic stewardship program effective on ameliorating irrational antibiotic use in China? Study on the antibiotic use of specialized hospitals in China in 2011-2012. J Huazhong Univ Sci Technolog Med Sci, 34(3):456-63.
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| Issue | Vol 46 No 9 (2017) | |
| Section | Original Article(s) | |
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| Antimicrobial Prescription Inpatient China | ||
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