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. 2022 Feb 14:13:813213.
doi: 10.3389/fphar.2022.813213. eCollection 2022.

Antibiotic Use in China's Public Healthcare Institutions During the COVID-19 Pandemic: An Analysis of Nationwide Procurement Data, 2018-2020

Ying Yang  1   2 , Xin Geng  1   2 , Xiaojun Liu  3 , Xiaotong Wen  1   2 , Ruonan Wu  1   2 , Dan Cui  1   2 , Zongfu Mao  1   2   4
Affiliations

Antibiotic Use in China's Public Healthcare Institutions During the COVID-19 Pandemic: An Analysis of Nationwide Procurement Data, 2018-2020

Ying Yang et al. Front Pharmacol. .

Abstract

Background: The overuse of antibiotics is a serious public health problem and a major challenge in China, and China lacks up-to-date evidence on the nationwide antibiotic use in different healthcare settings. The changes of China's antibiotic use under the COVID-19 pandemic are still unknown. Objective: This study aimed to investigate the use of antibiotics in China's public medical institutions based on a three-year nationwide surveillance and to examine the impact of the COVID-19 pandemic on China's antibiotic consumption. Methods: This study used nationwide drug procurement data from the China Drug Supply Information Platform (CDSIP). We retrospectively analyzed antibiotic procurement data of 9,176 hospitals and 39,029 primary healthcare centers (PHCs) from 31 provinces in mainland China from January 2018 to December 2020. Antibiotic utilization was measured by defined daily doses (DDDs) and DDD per 1,000 inhabitants per day (DID). Generalized linear regression models were established to quantify the impact of the COVID-19 pandemic on antibiotic use. Results: The total antibiotic consumption among all healthcare settings increased from 12.94 DID in 2018 to 14.45 DID in 2019, and then dropped to 10.51 DID in 2020. More than half of antibiotics were consumed in PHCs, especially in central regions (59%-68%). The use of penicillins (J01C) and cephalosporins (J01D) accounted for 32.02% and 28.86% of total antibiotic consumption in 2020. During 2018-2020, parenteral antibiotics accounted for 31%-36% of total antibiotic consumption; the proportion is more prominent in central and western regions and the setting of hospitals. Access category antibiotics comprised 40%-42% of the total utilization. Affected by COVID-19, the antibiotic consumption was significantly dropped both in hospitals (β = -.11, p < .001) and PHCs (β = -.17, p < .001), as well as in total (β = -.14, p < .001). Significant increments were observed in the proportion of total antibiotics (β = .02, p = .024) consumed in hospitals (against the consumption in all healthcare settings), as well as parenteral antibiotics (β = 1.73, p = .001). Conclusion: The consistent preferred use of penicillin and cephalosporin, as well as injections, among China's public healthcare institutions should draw concern. China's antibiotic consumption significantly declined during the COVID-19 pandemic, which brings opportunities for antibiotic use management in China.

Keywords: COVID-19; China; antibiotic consumption; antimicrobial resistance; rational drug use.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Antibiotic consumption (expressed in DID) in China’s public medical institutions in 2019. Note: Data of 31 provinces were involved. DID, defined daily doses per 1,000 inhabitants per day.
FIGURE 2
FIGURE 2
Proportional consumption (%) of antibiotics used in medical institutions by AWaRe categorization in China, 2018–2020. (A) Overall, (B) eastern China, (C) central China, and(D) western China. Note: Data of 24 provinces were involved.
FIGURE 3
FIGURE 3
Proportional consumption (%) of antibiotics utilized in different medical institutions in China, 2018–2020. (A) Overall, (B) eastern China, (C) central China, and(D) western China. Note: Data of 24 provinces were involved.
FIGURE 4
FIGURE 4
Utilization proportion of parenteral antibiotics in different medical institutions in China, 2018–2020. (A) Overall, (B) eastern China, (C) central China, and(D) western China. Note: Data of 24 provinces were involved. PHCs, primary healthcare centers.
FIGURE 5
FIGURE 5
Proportional consumption (%) of antibiotics by AWaRe categorization in different medical institutions in China, 2018–2020. (A) Tertiary hospitals, (B) secondary hospitals, and(C) PHCs. Note: Data of 24 provinces were involved. PHCs, primary healthcare centers.
FIGURE 6
FIGURE 6
Monthly trend of antibiotic consumption, clinical visits, and number of COVID-19 cases under treatment between January 2018 and December 2020. Note: Data of 24 provinces were involved. DDD, defined daily doses.
FIGURE 7
FIGURE 7
Influencing factors and their interaction relation of antibiotics use in China’s public medical institutions under the COVID-19 pandemic. Note: PHCs, primary healthcare centers; and NPIs, non-pharmaceutical interventions.
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