Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time s
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(2020) 9:159
RESEARCH
Open Access
Effects of restrictive-prescribing stewardship on antibiotic consumption in primary care in China: an interrupted time series analysis, 2012–2017 Xuemei Wang1, Yuqing Tang1, Chenxi Liu1, Junjie Liu2, Youwen Cui1 and Xinping Zhang1*
Abstract Background: The overuse of antibiotics has been a major public health problem worldwide, especially in low- and middle- income countries (LMIC). However, there are few policies specific to antibiotic stewardship in primary care and their effectiveness are still unclear. A restrictive-prescribing stewardship targeting antibiotic use in primary care has been implemented since December 2014 in Hubei Province, China. This study aimed to evaluate the effects of the restrictive-prescribing stewardship on antibiotic consumption in primary care so as to provide evidence-based suggestions for prudent use of antibiotics. Methods: Monthly antibiotic consumption data were extracted from Hubei Medical Procurement Administrative Agency (HMPA) system from Sept 1, 2012, to Aug 31, 2017. Quality Indictors of European Surveillance of Antimicrobial Consumption (ESAC QIs) combined with Anatomical Therapeutic Chemical (ATC) classification codes and DDD per 1000 inhabitants per day (DID) methodology were applied to measure antibiotic consumption. An interrupted time series analysis was performed to evaluate the effects of restrictive-prescribing stewardship on antibiotic consumption. Results: Over the entire study period, a significant reduction (32.58% decrease) was observed in total antibiotic consumption, which declined immediately after intervention (coefficient = − 2.4518, P = 0.005) and showed a downward trend (coefficient = − 0.1193, P = 0.017). Specifically, the use of penicillins, cephalosporins and macrolides/ lincosamides/streptogramins showed declined trends after intervention (coefficient = − 0.0553, P = 0.035; coefficient = − 0.0294, P = 0.037; coefficient = − 0.0182, P = 0.003, respectively). An immediate decline was also found in the contribution of β-lactamase-sensitive penicillins to total antibiotic use (coefficient = − 2.9126, P = 0.001). However, an immediate increase in the contribution of third and fourth-generation cephalosporins (coefficient = 5.0352, P = 0.005) and an ascending trend in the contribution of fluoroquinolones (coefficient = 0.0406, P = 0.037) were observed after intervention. The stewardship led to an immediate increase in the ratio between broad- and narrow-spectrum antibiotic use (coefficient = 1.8747, P = 0.001) though they both had a significant downward trend (coefficient = − 0.0423, P = 0.017; coefficient = − 0.0223, P = 0.006, respectively). An immediate decline (coefficient = − 1.9292, P = 0.002) (Continued on next page)
* Correspondence: [email protected] 1 School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This arti
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