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Prevalence and risk factors for antibiotic utilization in Chinese children
Shasha Guo1,2, Qiang Sun1,2, Xinyang Zhao3
1Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
Insights
Antibiotic use in Chinese children is high, with 63.8% of outpatients and 81.3% of inpatients receiving them. Lack of knowledge among physicians and caregivers contributes to this irrational antibiotic utilization.
Area of Science:
- Pediatrics
- Public Health
- Infectious Diseases
Background:
- Antibiotic resistance is a global public health crisis, driven by irrational antibiotic use.
- Children are vulnerable to infections, yet antibiotics are frequently prescribed despite viral etiologies.
- High antibiotic use in children raises concerns about prescribing appropriateness.
Purpose of the Study:
- To measure the prevalence of antibiotic utilization in children in China.
- To identify risk factors associated with antibiotic use in Chinese children.
Main Methods:
- Systematic review and meta-analysis of studies published between 2010 and July 2020.
- Searched English and Chinese databases for studies on antibiotic utilization in children (0-18 years).
- Qualitative analysis was used to explore risk factors.
Main Results:
- Included 98 studies, with 79 reporting prevalence and 42 reporting risk factors.
- Overall prevalence of antibiotic use was 63.8% in outpatients and 81.3% in inpatients.
- Caregiver self-medication prevalence was 37.8%; key risk factors included lack of knowledge and caregiver pressure.
Conclusions:
- High prevalence of antibiotic use exists in Chinese children, both in hospitals and at home.
- Addressing irrational antibiotic use requires effective government strategies, particularly in rural areas.
- Improving physician and caregiver knowledge is crucial to combat antibiotic resistance.
Background:
Antibiotic resistance poses a significant threat to public health globally. Irrational utilization of antibiotics being one of the main reasons of antibiotic resistant. Children as a special group, there's more chance of getting infected. Although most of the infection is viral in etiology, antibiotics still are the most frequently prescribed medications for children. Therefore, high use of antibiotics among children raises concern about the appropriateness of antibiotic prescribing. This systematic review aims to measuring prevalence and risk factors for antibiotic utilization in children in China.
Methods:
English and Chinese databases were searched to identify relevant studies evaluating the prevalence and risk factors for antibiotic utilization in Chinese children (0-18 years), which were published between 2010 and July 2020. A Meta-analysis of prevalence was performed using random effect model. The Agency for Healthcare Research and Quality (AHRQ) and modified Jadad score was used to assess risk of bias of studies. In addition, we explored the risk factors of antibiotic utilization in Chinese children using qualitative analysis.
Results:
Of 10,075 studies identified, 98 eligible studies were included after excluded duplicated studies. A total of 79 studies reported prevalence and 42 studies reported risk factors for antibiotic utilization in children. The overall prevalence of antibiotic utilization among outpatients and inpatients were 63.8% (35 studies, 95% confidence interval (CI): 55.1-72.4%), and 81.3% (41 studies, 95% CI: 77.3-85.2%), respectively. In addition, the overall prevalence of caregiver's self-medicating of antibiotics for children at home was 37.8% (4 studies, 95% CI: 7.9-67.6%). The high prevalence of antibiotics was associated with multiple factors, while lacking of skills and knowledge in both physicians and caregivers was the most recognized risk factor, caregivers put pressure on physicians to get antibiotics and self-medicating with antibiotics at home for children also were the main factors attributed to this issue.
Conclusion:
The prevalence of antibiotic utilization in Chinese children is heavy both in hospitals and home. It is important for government to develop more effective strategies to improve the irrational use of antibiotic, especially in rural setting.
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