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Doctor Lu Ankang talks with patients with respiratory problems caused by smoking at Ruijin Hospital in Shanghai April 27, 2011. China will ban smoking at all indoor public venues from May 1, in an effort to shield the world's most populous nation, and its largest cigarette producer, from the harmful effects of the habit, the health ministry said. China, which has more than 300 million smokers, will require businesses to display prominent no-smoking signs, forbid vending machines from selling cigarettes and ensure that designated outdoor smoking zones not affect pedestrian traffic. Although nearly 1.2 million Chinese people die from smoking-related diseases each year, the habit is deeply entrenched in public life. Picture taken April 27, 2011. REUTERS/Carlos Barria
Reuters/Carlos Barria
“The honest truth? I have no idea.”
COMMENTARY

China has a plan to stem the rise of antibiotic resistance, and it’s working

By Gwynn Guilford in China

The rise of “suberbugs,” lethal germs that can’t be zapped by most antibiotics, owes particular thanks to China, where antibiotics are handed out like throat lozenges because hospitals depend on overprescribing them to make money. That’s part of why some scientists think deaths from infection could soon hit levels not seen since the early 20th century.

What saves the world from that fate could be this: In 2011, China’s ministry of health started cracking down on antibiotics overprescription, applauding hospitals that complied, and publicly shaming those that flouted its new protocols. Now there’s evidence the plan is working. A new study (pdf) by doctors at Zhejiang University reports that the percentage of hospitalized patients who were prescribed antibiotics fell from 68% in 2011 to 58% by the end of 2012. For outpatients, that proportion dropped from 25% to 15%.

Data on hospital drug sales reflect this trend as well. Antibiotics procurement in Tianjin, for example, was 200 million yuan ($32 million) less in 2011 than in 2010, despite upticks in both hospitalizations and outpatients. This chart from IMS research showing how the value of antibiotics (antimicrobials) sold, as a proportion of overall drug sales, has changed:

"Changes in Chinese Policies to Promote the Rational Use of Antibiotics," Xiao et al.

We’re not out of the woods yet, though. The authors of the Zhejiang University study note that most Chinese medical students aren’t taught the relationship between antibiotics use and superbugs. And since the government only provides 20% of their funding, hospitals are still dependent on drug sales for profits. Plus, a big cause of antibiotic resistance is the drugs’ over-use not just on people, but on millions of farm animals. And that’s an area over which the health ministry has no say.