Study indicates a high proportion of inappropriate use of antibiotics for treatment of simple acute cough in China, despite a series of antimicrobial stewardship guidelines released in China since 2011

Pump priming funding from NAMRIP led to an NIHR-funded online survey on the use of antibiotics and other treatments in Chinese adults with acute coughs. The study recruited 25,583 Chinese participants with acute coughs, and was conducted between 25th January and 11th February 2019.

The participants were drawn from members of public, across all 34 province-level regions in China, mostly from North and East China. The study suggested that there is still likely a high proportion of inappropriate use of antibiotics for treatment of simple acute cough, despite a series of antimicrobial stewardship decrees released in China since 2011. These included:

• All hospitals in China are required to set up an antimicrobial agents administrative group or to identify a point person to take control of antimicrobial stewardship;
• Infectious diseases departments and clinical microbial laboratories are required to be set up in all tertiary and secondary hospitals;
• Antibacterial agents are classified according to safety, efficacy, bacterial resistance, price and other factors;
• Prescribers have accredited prescription rights for different categories of antimicrobials, depending on their levels of seniority;
• The establishment of compulsory standardised training on the clinical use of antimicrobials as a requirement for all doctors.

The study found that when the recruited Chinese participants became concerned about cough symptoms, they used a wide variety of different treatments and perceived similar relief in symptom severity after using them. The study also found that the use of Chinese herbal medicine was associated with the relief of cough symptoms (median 4 on a 1-5 Likert scale). Participants who smoked (χ2 = 16.950, P < 0.01), were aged 65 or older (χ2 =12.317, P= 0.002), with severe cough (χ2 = 113.535, P < 0.01), with presumed upper respiratory tract infections (URTIs) (χ2 = 9.385, P = 0.002), and underlying lung conditions (χ2 = 145.196, P < 0.01) were the most likely to take antibiotics after taking Chinese Herbal Medicines at 16.8%, 15.6%, 20.5%, 15.2%, and 23.8% respectively. This presents an important opportunity for antibiotic stewardship in China.

The researchers also identified several Chinese herbal medicines products merited further research on their clinical effectiveness, cost-effectiveness and safety. The establishment of a collaboration with the Beijing University of Chinese Medicine through this work, was an important outcome.

This work is published as Open Access at https://www.sciencedirect.com/science/article/pii/S2213422022000877 ('Use of antibiotics and other treatments in Chinese adults with acute cough: An online survey', Integrative Medicine Research, 12(1), 2023, https://doi.org/10.1016/j.imr.2022.100920)

The Global Network for Anti-Microbial Resistance and Infection Prevention (Global-NAMRIP) awarded pump-priming funding to support this research through the EPSRC (Grant EP/MO27260/1). XYH was funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR). MLW was funded by the National Institute of Health Research (NIHR), (Grant CL-2016-26-005). This article was written by Dr Xiao-Yang (Mio) Hu and Dr Merlin Willcox on behalf of the research team

The research team (Xiao-Yang Hu, Ru-Yu Xia, Michael Moore, Beth Stuart, Ling-Zi Wen, Bertrand Graz, Lily Lai, Jian-Ping Liu, Yu-Tong Fei and Merlin Willcox) represent a collaboration between:

• Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
• Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
• Pragmatic Trial Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
• Antenna Foundation, Geneva, Switzerland.