E-DRUG: Rational antibiotic use in China: lessons learnt through introducing
surgeons to Australian guidelines
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Rational antibiotic use in China: lessons learnt through introducing surgeons to Australian guidelines
Yan Zhang and Ken J Harvey
Australia and New Zealand Health Policy 2006, 3:5
http://www.anzhealthpolicy.com/content/3/1/5
Published: 30 May 2006
Abstract
Background
World-wide concern about increasing antibiotic resistance has focused
attention on strategies to improve antibiotic use. This research adapted
Australian best-practice guidelines on the prophylactic use of
antibiotics in surgery to a Beijing teaching hospital; then used them as
a quality assessment and improvement tool, supplemented by educational
interventions. Qualitative data about factors influencing antibiotic use
was also obtained.
Methods
Australian and international guideline materials were amalgamated with
the help of Chinese experts. Antibiotics prescribed for surgical
prophylaxis in 60 consecutive patients undergoing clean or
clean-contaminated surgery (120 in total) were then compared with
guideline recommendations in three phases; a pre-intervention period
from June to August, 2002, an intervention period from June to August
2003 and post-intervention period from September to November 2003 (360
patients in all). During the intervention phase, prescriptions not in
accord with the guidelines were discussed with around 25 prescribers
every two weeks. In addition, local factors influencing antibiotic use
were explored with 13 junior surgeons and 8 high level informants.
Results
While agreement was reached on key principles of antibiotic surgical
prophylaxis there was no consensus on detail. Of 180 patients undergoing
clean surgery throughout all phases of the study, antibiotic prophylaxis
was administered to 78% compared to 98% of the 180 patients undergoing
clean-contaminated surgery. Second and third generation cephalosporin
antibiotics predominated in both low-risk clean and clean-contaminated
operations. The timing of prophylaxis was correct in virtually all
patients. The duration of prophylaxis was less than 24 hours in 96% of
patients undergoing clean surgery compared to only 62% of patients
undergoing clean-contaminated surgery. The intervention produced no
improvement in the duration of prophylaxis nor the overuse and
inappropriate choice of unnecessary broad-spectrum and expensive drugs.
Interviews and focus groups revealed that an important explanation for
the latter problem was Chinese government policy which expected
hospitals to support themselves largely through the sale of drugs.
Conclusions
Improving antibiotic use in China requires hospital funding reform,
health insurance system improvement, more authoritative best-practice
guidelines, hospital authorities embracing quality improvement and
greater international collaboration.
Ken Harvey
k.harvey@medreach.com.au