Antimicrobial prescribing patterns in a large tertiary hospital in Shanghai, China

Whilst the 'Principles of clinical use of antibiotics' was released by the Ministry of Health of the People's Republic of China in 2004, limited research has been conducted to evaluate the quality of antibiotic use in real-world practice. In this study, we sought to examine antimicrobial prescribing patterns in a large tertiary hospital in Shanghai, China. De-identified outpatient and emergency department pharmacy records containing antimicrobials were extracted from the hospital electronic health records system. Antimicrobial prescribing patterns and out-of-pocket medical costs for antimicrobials were evaluated by patient demographics and the primary diagnosis. Antimicrobial prescriptions stratified by patient age group (<5, 5-17, 18-49, 50-64 and ≥65 years) were also examined. A total of 363 642 antimicrobial prescriptions in 2014 were obtained, corresponding to 197 781 unique patients. Approximately 18% of antimicrobial-containing prescriptions were for acute upper respiratory infection and bronchitis, 15% for fever or cough, 5% for gastritis and duodenitis and non-infective gastroenteritis and colitis, and 7% for other diagnoses without clear indications of bacterial infection. Cephalosporins were the most frequently prescribed antibiotic class (55%). Age-specific antimicrobial prescriptions showed different patterns between children and adults. A total of US$4.6 million were spent as out-of-pocket costs on antimicrobials in 2014, and the median antimicrobial cost per prescription was $9. Unnecessary antibiotic use is still common in real-world clinical practice and remains a public health challenge. Antibiotic-related medical expenditure also presents an important economic burden.