China

How China Tackled the Risky Overprescription of Antibiotics


Beijing has lately enjoyed an uncharacteristic stretch of clear blue skies, a respite from the smog, but I’ve still been feeling under the weather. So, after a few weeks of coughing and persistent sniffles, I finally paid a visit to the Beijing SOS International Health Clinic today. The Dutch doctor took my temperature, listened to my breathing through a stethoscope (“You have mucus in your lungs”), examined my tonsils, and asked several questions about how long symptoms had persisted before prescribing a weeklong course of antibiotics. Like many internationally trained doctors, he was duly cautious about writing a prescription too quickly.

In recent years, international medical researchers have spotlighted the dangers of overprescribing antibiotics, which can give rise to drug-resistant bacteria, or “superbugs,” a significant public health threat. Last month the Journal of the American Medical Association published an analysis by Harvard researchers of two extensive sets of U.S. national medical records from 1997 to 2010. While bacterial infections cause only 10 percent of cases of acute bronchitis, the researchers found American doctors prescribed antibiotics roughly 70 percent of the time. For the 90 percent of acute bronchitis cases caused by viral infections, antibiotics have no impact, at best.

At worst, the impact can be counterproductive. “When bacteria are exposed to antibiotics, they start learning how to outsmart the drugs,” explains the U.S. Centers for Disease Control and Prevention on its website. “At least 2 million people [in the U.S.] become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year as a direct result of these infections.” The U.S. CDC has launched a public-awareness campaign to reduce inappropriate drug prescriptions.

The situation in China is even thornier. Last year the Ministry of Health released data showing that, due to rampant overprescription, people in China consume on average 10 times the amount of antibiotics annually as Americans. This happens, in part, because Chinese patients frequently request antibiotics and hospitals depend on revenue from drug sales. According to a study by researchers at Zhejiang University published last month in the peer-reviewed journal PLOS Medicine, government funding covers just 20 percent of hospital costs. Drug sales make up most of the funding gap, and antibiotics sales account for about 25 percent of all drug sales.

The same study, however, also contained a glimmer of hope. Chinese health authorities launched a campaign in 2011 to discourage overprescription of antibiotics, and their efforts appear to be having an effect. The Zhejiang University researchers found that prescriptions of antibiotics to hospital patients in China (admitted for a spectrum of ailments, not only bronchitis symptoms) declined 15 percent over two years. To spread new protocols, “excellent hospitals were recognized, and failures were criticized in public. Several hospital presidents were dismissed and some clinicians were published with economic sanctions,” the researchers write. In other words, the jobs of hospital administrators and doctors were put on the line.

To be sure, the misuse of antibiotics isn’t confined to hospitals. In China, about half of all antibiotics administered are given to livestock; a similar risk of drug misuse giving rise to drug-resistant bacteria strains exists on farms. But China’s agricultural sector is much less stringently monitored than its hospitals, so progress there may be much slower. Let’s hope change comes before more superbugs do.

Larson is a Bloomberg Businessweek contributor.

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