China's progress in antibiotic guidance trumpeted

Chinese scientists have made advances in antibiotic stewardship research for primary health care, providing a replicable and scalable "China PHC Management Program" to address the challenge of implementing scientific antimicrobial stewardship in primary healthcare facilities.

A medical research team has published their study entitled "Effects of a comprehensive antibiotic stewardship program on antibiotic prescribing for acute respiratory infections in rural facilities: a cluster randomized trial" in the top international journal Nature Medicine.

The study not only provides a practical policy guidance framework for promoting scientific antimicrobial stewardship and improving the quality of medical services in China's primary healthcare facilities, but also offers a Chinese approach for primary antimicrobial stewardship in other regions, especially low- and middle-income countries, bearing significant public health implications.

The study has been led by Zhong Nanshan, an academician with the Chinese Academy of Engineering and a renowned respiratory expert, and Zhuo Chao, director of the infectious disease department at the First Affiliated Hospital of Guangzhou Medical University, in collaboration with Professor Wei Xiaolin's team from the University of Toronto, Canada, and Chief Pharmacist Zheng Jinkun from Yuebei People's Hospital in the northern Guangdong city of Shaoguan.

The seven-year study has been conducted in 34 township hospitals across two rural county-level cities in South China's Guangdong Province.

It found that the intervention program successfully reduced the antimicrobial prescribing rate for acute respiratory infections from a baseline of 83 percent to 26 percent at the end of the study, without increasing risks to patient safety.

Zhong said the inappropriate antibiotic use in China stands at 70 percent, and the issue is even worse in rural areas.

"Overuse causes bacteria to develop resistance, which is evolving faster than new antibiotics can be developed," said Zhong at a news conference in Guangzhou on Saturday.

He said that some patients can recover completely without needing antibiotics.

To verify the effectiveness of the program, the research team conducted a 12-month cluster randomized controlled trial in 34 township hospitals, with more than 100,000 patients having participated, he added.

Among them, 17 hospitals were assigned to the intervention group, where the comprehensive stewardship program was implemented, and the other 17 to the control group, which maintained routine clinical practice.

A total of 97,239 eligible clinical data records of acute respiratory infections (ARI) were collected through the hospital electronic information systems.

The study focused on analyzing changes in antimicrobial prescribing rates, and tracked the hospitalization rate for aggravated respiratory symptoms or severe disease within 30 days of the first consultation across the entire Shaoguan city to assess safety. It also analyzed secondary outcomes including the types of antimicrobials used and medical costs.

The research finding provides scientific evidence and practical experience from China for the rational use of antimicrobials and the containment of bacterial resistance worldwide, and offers an important evidence-based medical solution to the issue of rational antimicrobial use in primary health care in other countries.

Wen Peilin contributed to this story.