Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions
Open accessAbstract
BACKGROUND: Overuse of antibiotics contributes to the development of antimicrobial resistance. OBJECTIVE: This study aims to assess the condition of antibiotic use at health facilities at county, township and village levels in rural Guangxi, China. METHODS: We conducted a cross-sectional study of outpatient antibiotic prescriptions in 2014 for children aged 2-14 years with upper respiratory infections (URI). Twenty health facilities were randomly selected, including four county hospitals, eight township hospitals and eight village clinics. Prescriptions were extracted from the electronic records in the county hospitals and paper copies in the township hospitals and village clinics. RESULTS: The antibiotic prescription rate was higher in township hospitals (593/877, 68%) compared to county hospitals (2736/8166, 34%) and village clinics (96/297, 32%) (p < 0.001). Among prescriptions containing antibiotics, county hospitals were found to have the highest use rate of broad-spectrum antibiotics (82 vs 57% [township], vs 54% [village], p < 0.001), injectable antibiotics (65 vs 43% [township], vs 33% [village], p < 0.001) and multiple antibiotics (47 vs 15% [township], vs 0% [village], p < 0.001). Logistic regression showed that the likelihood of prescribing an antibiotic was significantly associated with patients being 6-14 years old compared with being 2-5 years old (adjusted odds ratio [aOR] = 1.3, 95% CI 1.2-1.5), and receiving care at township hospitals compared with county hospitals (aOR = 5.0, 95% CI 4.1-6.0). Prescriptions with insurance copayment appeared to lower the risk of prescribing antibiotics compared with those without (aOR = 0.8, 95% CI 0.7-0.9). CONCLUSIONS: Inappropriate use of antibiotics was high for outpatient childhood URI in the four counties of Guangxi, China, with the highest rate found in township hospitals. A significant high proportion of prescriptions containing antibiotics were broad-spectrum, by intravenous infusion or with multiple antibiotics, especially at county hospitals. Urgent attention is needed to address this challenge.
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Zhang et al. indicated that increased interaction time with patients led to a higher likelihood of pharmacies dispensing antibiotics in China.
“This finding aligns with research by Zhang et al in China, which indicated that increased interaction time with patients led to a higher likelihood of pharmacies dispensing antibiotics. 21”
From Evaluation of antibiotic dispensing without prescription by community pharmacies: a simulated patient study (2025) · cites this paper as [21]
The Methods describe a study of outpatient prescriptions in hospitals and village clinics, while the Discussion addresses antibiotic prescribing and clinician–patient communication. Searches for interaction or consultation time and pharmacy dispensing found no passage linking longer patient interactions to a higher likelihood of dispensing antibiotics. (LLM, conf=0.76)
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Self-citation
- Authors
- Zhang, Z., Hu, Y., Zou, G., Lin, M., Zeng, J., Deng, S., Zachariah, R., Walley, J., Tucker, J. D., & Wei, X.
- Affiliations
- China Global Health Research and Development, Shenzhen, China
- Chinese University of Hong Kong (HK)
- Sun Yat-sen University (CN)
- Guangxi Center for Disease Prevention and Control (CN)
- Médecins Sans Frontières (GB)
- University of Leeds (GB)
- University of North Carolina at Chapel Hill (US)
- University of Toronto (CA)
- Corresponding author
- Wei, Xiaolin
- ORCID
- Venue
- Global Health Action
- Publisher
- Informa UK Limited
- Published
- 2017-01
- Volume
- 10
- Issue
- 1
- Pages
- 1287334-1287334
- ISSN
- 1654-9716 (ISSN-L)
- 1654-9880
- PMC
- PMC5496075
- OpenAlex
- W2611591534
- Cited by
- 74
- References
- 36
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 6 · 2023: 8 · 2022: 7 · 2021: 14 · 2020: 12 · 2019: 7 · 2018: 4 · 2017: 2 · 2016: 1
- FWCI
- 5.16
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Global Health Action (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Medecins Sans Frontieres Field Research (Medecins Sans Frontieres) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Funders
- Department for International Development, UK Government (MD10740)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Keywords
- antibiotic prescribing, upper respiratory tract infection, children, rural health facilities, antimicrobial resistance, broad-spectrum antibiotics, injectable antibiotics, township health centers, village clinics, Guangxi
- MeSH terms
- Prescription Drug Overuse, Adolescent, Anti-Bacterial Agents, Child, Child, Preschool, China, Cross-Sectional Studies, Drug Utilization, Female, Humans, Male, Outpatients, Practice Patterns, Physicians', Residence Characteristics, Respiratory Tract Infections, Rural Population
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