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J Int Med Res. 2017 Dec;45(6):1768-1778. doi: 10.1177/0300060516686230. Epub 2017 Jan 30.

Use of and microbial resistance to antibiotics in China: a path to reducing antimicrobial resistance.

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1 School of Public Health, Global Health Institute, Wuhan University, China.
2 School of Biosciences, School of Immunity and Infection, University of Birmingham, Birmingham, UK.
3 School of Public Health, Chinese Academy of Medical Sciences, Peking Union Medical College, China.


We analyzed China's current use of and microbial resistance to antibiotics, and possible means of reducing antimicrobial resistance. Interventions like executive orders within clinical settings and educational approach with vertical approaches rather than an integrated strategy to curb the use of antimicrobials remain limited. An underlying problem is the system of incentives that has resulted in the intensification of inappropriate use by health professionals and patients. There is an urgent need to explore the relationship between financial and non-financial incentives for providers and patients, to eliminate inappropriate incentives. China's national health reforms have created an opportunity to contain inappropriate use of antibiotics through more comprehensive and integrated strategies. Containment of microbial resistance may be achieved by strengthening surveillance at national, regional and hospital levels; eliminating detrimental incentives within the health system; and changing prescribing behaviors to a wider health systems approach, to achieve long-term, equitable and sustainable results and coordinate stakeholders' actions through transparent sharing of information.


Antimicrobial resistance; appropriate use; containment

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