This news story was first published on the University of Leeds health news pages. It describes our work at COMDIS-HSD to combat the inappropriate use of antibiotics – a major global risk factor in the development of drug-resistant ‘superbugs’.

A collaboration between scientists has helped reduce the prescription of unneeded antibiotics to children in rural China.

Young people in some areas of the country are being given antibiotics, often intravenously, to treat a cold, ear or throat infections – but the drugs are not effective against virus-based illnesses.

The inappropriate use of antibiotics is a major risk factor in the development of drug-resistant “superbugs”.

Antibiotic use halved

The collaboration brought together rural hospitals in two counties in rural China, Chinese health officials and academics at the University of Leeds (COMDIS-HSD) and the University of Toronto.
The aim was to devise and evaluate a system of ‘anti-microbial stewardship’ that could be used in other parts of the Chinese health system and would give doctors the confidence to say no to requests for inappropriate antibiotic treatment.
The stewardship programme was rolled out to a group of primary care hospitals in Guangxi province in Southern China.
Much of the demand for antibiotics in the Chinese primary care sector comes from parents and grandparents who have children with upper respiratory tract infections such as a sore throat or earache.

Doctors working in the primary care hospitals come under considerable pressure from parents to prescribe antibiotics to children who have upper respiratory tract infections

John Walley, Professor of International Public Health at the University of Leeds, said:
“Doctors working in the primary care hospitals come under considerable pressure from parents to prescribe antibiotics to children who have upper respiratory tract infections.
“They can feel that if they don’t give the antibiotic, the parents will just go elsewhere and get it.
“These are difficult decisions for the doctor. They may have a very ill child in front of them – and they do not have a battery of tests results to rely on. They are having to make a clinical judgement about the risks involved in not giving antibiotics.”

New guidelines for doctors

University academics and Chinese experts drew up clinical guidelines based on those produced by the UK’s National Institute for Health and Care Excellence to help doctors decide when it would be appropriate to prescribe antibiotics and alert them to the warning signs of more serious illness.
Two groups of primary-care hospitals in Guangxi were selected for the evaluation. Baseline data was collected about the prescribing practices for children attending with upper respiratory tract infections.
In the first group, containing 12 hospitals, doctors received training in how to explain to parents why antibiotics are not necessary. Medical managers also conducted monthly prescription reviews to monitor doctors’ compliance with the guidelines.
In the second group, made up of 13 hospitals, medical staff continued to prescribe in the usual way.

The results showed that in the group that had received stewardship training, the antibiotic prescription rate had dropped from 82 per cent to 40 per cent

Six months later, several thousand prescriptions were selected at random from the two groups and compared with the baseline findings. The results showed that in the group that had received stewardship training, the antibiotic prescription rate had dropped from 82 per cent to 40 per cent. In the business-as-usual group, the rate went from 75 per cent to 70 per cent.
The findings were reported in Lancet Global Health.
Taking account of statistical issues, the researchers say the stewardship programme resulted in a 48 per cent reduction in the prescribing rate of antibiotics for children with upper respiratory tract infections.
Professor Walley said: “There have been other approaches that have tried to change the behaviour of doctors and patients – but none has delivered the scale of change that we have seen.”
Typically in successful trials the change is between five and 25 per cent.
The Chinese Health Ministry has policies to reduce antibiotic use but the challenge is to get that aim delivered in primary care clinics and hospitals, Professor Walley said.
He said the key to success was to “embed” stewardship programmes within the health system, giving doctors the skills and encouragement to give antibiotics when there is a real clinical need – and to refuse them when their use would be inappropriate.
The problem of the overuse of antibiotics exists in many low and middle income countries, and existed in the UK – although healthcare policies in recent decades have resulted in more careful use of antibiotics.
Read more:

• See our full research findings: Wei X, Zhang Z, Walley J, Hicks J P, Zeng J, Deng S, et al. (2017) Effect of a training and educational intervention for physicians and caregivers on antibiotic prescribing for upper respiratory tract infections in children at primary care facilities in rural China: a cluster randomised controlled trial. The Lancet Global Health. DOI
• Read our policy brief for a summary of our findings and key recommendations and see our research brief for further details on our study methods.