Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions

Zhitong Zhang; Yanhong Hu; Guanyang Zou; Mei Lin; Jun Zeng; Simin Deng; Rony Zachariah; John Walley; Joseph D Tucker; Xiaolin Wei

doi:10.1080/16549716.2017.1287334

Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions

Glob Health Action. 2017;10(1):1287334. doi: 10.1080/16549716.2017.1287334.

Authors

Zhitong Zhang¹, Yanhong Hu², Guanyang Zou³, Mei Lin⁴, Jun Zeng⁴, Simin Deng¹, Rony Zachariah⁵, John Walley⁶, Joseph D Tucker⁷, Xiaolin Wei⁸

Affiliations

¹ a China Global Health Research and Development , Shenzhen , China.
² b School of Public Health and Primary Care , Chinese University of Hong Kong , Hong Kong , China.
³ c School of Public Health , Sun Yat-sen University , Guangzhou , China.
⁴ d Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control , Nanning , China.
⁵ e Medical Department, Operational Research Unit, Médecins sans Frontières , Brussels Operational Center , Luxembourg City , Luxembourg.
⁶ f Nuffield Centre for International Health and Development , University of Leeds , Leeds , UK.
⁷ g Institute for Global Health and Infectious Diseases , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
⁸ h Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada.

Abstract

Background: Overuse of antibiotics contributes to the development of antimicrobial resistance.

Objective: This study aims to assess the condition of antibiotic use at health facilities at county, township and village levels in rural Guangxi, China.

Methods: We conducted a cross-sectional study of outpatient antibiotic prescriptions in 2014 for children aged 2-14 years with upper respiratory infections (URI). Twenty health facilities were randomly selected, including four county hospitals, eight township hospitals and eight village clinics. Prescriptions were extracted from the electronic records in the county hospitals and paper copies in the township hospitals and village clinics.

Results: The antibiotic prescription rate was higher in township hospitals (593/877, 68%) compared to county hospitals (2736/8166, 34%) and village clinics (96/297, 32%) (p < 0.001). Among prescriptions containing antibiotics, county hospitals were found to have the highest use rate of broad-spectrum antibiotics (82 vs 57% [township], vs 54% [village], p < 0.001), injectable antibiotics (65 vs 43% [township], vs 33% [village], p < 0.001) and multiple antibiotics (47 vs 15% [township], vs 0% [village], p < 0.001). Logistic regression showed that the likelihood of prescribing an antibiotic was significantly associated with patients being 6-14 years old compared with being 2-5 years old (adjusted odds ratio [aOR] = 1.3, 95% CI 1.2-1.5), and receiving care at township hospitals compared with county hospitals (aOR = 5.0, 95% CI 4.1-6.0). Prescriptions with insurance copayment appeared to lower the risk of prescribing antibiotics compared with those without (aOR = 0.8, 95% CI 0.7-0.9).

Conclusions: Inappropriate use of antibiotics was high for outpatient childhood URI in the four counties of Guangxi, China, with the highest rate found in township hospitals. A significant high proportion of prescriptions containing antibiotics were broad-spectrum, by intravenous infusion or with multiple antibiotics, especially at county hospitals. Urgent attention is needed to address this challenge.

Keywords: Antibiotics prescribing behavior; broad-spectrum antibiotics; injectable antibiotics; multiple use of antibiotics; township hospital.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Anti-Bacterial Agents / administration & dosage
Anti-Bacterial Agents / therapeutic use*
Child
Child, Preschool
China
Cross-Sectional Studies
Drug Utilization / statistics & numerical data*
Female
Humans
Male
Outpatients
Practice Patterns, Physicians' / statistics & numerical data
Prescription Drug Overuse / statistics & numerical data
Residence Characteristics
Respiratory Tract Infections / drug therapy*
Rural Population*

Substances

Anti-Bacterial Agents

Grants and funding

This work was supported by the Department for International Development, U.K. Government [Grant No. MD10740], and the Dalla Lana School of Public Health, University of Toronto [Grant No. 208606].