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Project Summary听
Antibiotic resistance (ABR) has been identified as one of the听greatest threats to global population health this century, as听well as a major contributor to rising healthcare costs听worldwide. The primary cause of ABR is antibiotic misuse,听especially the routine inappropriate use of antibiotics for self-limiting illnesses. Therefore, reducing antibiotic misuse has听become an urgent priority, especially in low and middle income听counties (LMIC) where systems to regulate antibiotic use are听weak or non-existent .听
China has very high rates of ABR in both hospital and听community-acquired infections, following decades of high听utilisation of antibiotics. The very large and mobile population听also increases the risk of spread of resistance. 听Around two-thirds of in-patients and 50-60% of out-patients are prescribed听antibiotics. 听As elsewhere, the reasons for overprescribing of听antibiotics in China are multifactorial, and therefore demand a听multi-facetted response. 听
The overall aim of the project is to pilot an intervention to听reduce inappropriate antibiotic use in children in three听townships in Jiangshan County, Zhejiang Province through a听controlled community intervention. The methods comprise听development of guidelines for management of common self-limiting childhood, training of doctors in the use of the听guidelines, institution of a routine surveillance system for听antibiotic prescribing of all clinicians, with adherence to听prescribing guidelines contributing to performance-related听pay, and a community-based health education programme to听raise awareness about ABR.
Mid-term evaluation has shown听that the project has succeeded in reducing antibiotic听prescribing in intervention townships from 59% to 36%. This听small project also brought about improvements in听management practices, clinician training, use of information听systems, prescribing patterns (beyond just antibiotics), hospital听and doctors' accountability, doctor-patient communication, and听perceived overall quality of care.
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