Physician control of pediatric antimicrobial use in Beijing, China, and its rural environs

Background. Antibiotic resistance is recognized as an increasing problem in China. It is widely believed that because antibiotics are available withou t a prescription, changing physician prescribing behaviors will not decreas e inappropriate usage. This study identified the sources of antibiotics and the important influence that physicians have on antibiotic use by children in one region of China. Methods. Trained medical professionals surveyed parents of children attendi ng several kindergartens in urban Beijing and rural Gu'An, Hebei County. Pa rents completed a questionnaire concerning the children's recent illnesses, care-seeking patterns and antibiotic use. The team also observed hospital- and non-hospital-based pharmacy purchases of antibiotics for children, ass essed the proportion accompanied by a prescription and then interviewed par ents about factors influencing those purchases. Results. Of 241 urban and 143 rural kindergarten parents, 76 to 82% usually obtained children's antibiotics from a hospital pharmacy (with a prescript ion). For 84% the first source of care was usually a physician (primarily w estern medicine, sometimes traditional Chinese medicine). Only 5% of antibi otics were obtained from independent vendors without prior physician consul tation. Among 229 observed antibiotic purchases 72% occurred at hospital-ba sed facilities, even after longer observation times at nonhospital pharmaci es. Prescriptions accompanied all hospital-based antibiotic purchases, cont rasting with 18% of nonhospital transactions (P < 0.001), Together 86% of p arents self-reported that the observed purchase stemmed from a doctor's rec ommendation. Conclusions. Doctors directly and indirectly controlled the majority of ant ibiotic usage for childhood illnesses in Beijing and Gu'An (Hebei County). Physician education and implementation of treatment guidelines might substa ntially reduce inappropriate antimicrobial usage and help prevent antimicro bial resistance in this region.