Reducing irrational use of antibiotics in children with URIs in rural Guangxi China

Worldwide, irrational use of medicine is a major problem
Medicines are often used incorrectly: around 50% of medicines are prescribed, dispensed or sold inappropriately, while 50% of patients fail to take their medicines appropriate [1]. Inappropriate or excessive antibiotic use results in antibiotic resistance, which is more commonly observed in countries with high rates of antibiotic prescription.
Antibiotic resistance in children
Upper respiratory infections (URIs) are very common in children, but are usually viral and self-limiting. Nevertheless, prescribing antibiotics for a child’s URIs is highly prevalent in community and primary care settings [2].
A cross-sectional study in 10 provinces in rural Western China showed that antibiotics accounted for over half of all prescriptions, predominantly provided for URIs. One-fourth of those receiving antibiotics were children under ten years old [3].
Similarly, a study of children admitted to hospital with pneumonia in rural China found that over 40% of the antibiotics prescribed were unnecessary [4].
Improving the knowledge, attitude and behaviour of healthcare providers and consumers can reduce the irrational use of antibiotics.
Study aims
To reduce the irrational use of antibiotics among children with URIs in rural western China. The study has 3 phases:
Phase 1: understand the current situation of antibiotics use among children in rural Guangxi from the perspectives of policy makers, providers and parents/caregivers. This focuses on measuring the extent of irrational use of antibiotics and exploring the factors which may influence the irrational use of antibiotics among children with URIs.
Phase 2: design a multi-dimensional intervention to reduce the irrational use of antibiotics among children by health providers in township hospitals and parents/caregivers in rural Guangxi.
Phase 3: implement and evaluate a full clustered Randomised Controlled Trial in township hospitals in rural Guangxi.
Phase 1 is complete and phases 2 and 3 are currently underway.
Potential scale up of research findings:
Global Health Research and Development (GHRD), China, will work with the Guangxi Health Bureau and Shandong University to scale up the service delivery model at healthcare facilities where appropriate.
Prof Xiaolin Wei, Guanyang Zou, Jia Yin, Jessica Hu, GHRD; Dr Mei Lin, Guangxi Centre for Disease Control; Dr Sun Qiang, Shandong University
For more information, email Prof Xiaolin Wei:

  1. WHO (2002) Promoting rational use of medicines: core components. WHO Policy Perspectives on Medicines
  2. Andrews T et al. (2012) Interventions to influence consulting and antibiotic use for acute respiratory tract infections in children: a systematic review and meta-analysis. PloSOne, 7(1).
  3. Dong L, Yan H and Wang D (2008) Antibiotic prescribing patterns in village health clinics across 10 provinces of Western China. Journal of Antimicrobial Chemotherapy, 62(2):410-415.
  4. Liang X et al. (2011) Unnecessary use of antibiotics for inpatient children with pneumonia in two counties of rural China. International journal of clinical pharmacy, 33(5):750-754.


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