title: Overuse of antibiotics for the common cold - attitudes and behaviors among doctors in rural areas of Shandong Province, China.
abstract: BACKGROUND
  Irrational antibiotic use is common in rural areas of China, despite the growing recognition of the importance of appropriate prescribing to contain antibiotic resistance. The aim of this study was to analyze doctors' attitudes and prescribing practices related to antibiotics in rural areas of Shandong province, focusing on patients with the common cold.
  
  
  METHODS
  A survey was conducted with doctors working at thirty health facilities (village clinics, township health centers and county general hospitals) in three counties within Shandong province. Questions were included on knowledge and attitudes towards antibiotic prescribing. Separately, a random selection of prescriptions for patients with the common cold was collected from the healthcare institutions at which the doctors worked, to investigate actual prescribing behaviors.
  
  
  RESULTS
  A total of 188 doctors completed the survey. Most doctors (83%, 149/180) had attended training on antibiotic use since the beginning of their medical practice as a doctor, irrespective of the academic level of their undergraduate training. Of those that had training, most had attended it within the past three years (97%, 112/116). Very few doctors (2%, 3/187) said they would give antibiotics to a patient with symptoms of a common cold, and the majority (87%, 156/179) would refuse to prescribe an antibiotic even if patients were insistent on getting them. Doctors who had attended training were less likely to give antibiotics in this circumstance (29% vs. 14%, p < 0.001). A diagnosis of common cold was the only diagnosis reported on 1590 out of 8400 prescriptions. Over half (55%, 869/1590) of them included an antibiotic. Prescriptions from village clinics were more likely to contain an antibiotic than those from other healthcare institutions (71% vs. 44% [township] vs. 47% [county], p < 0.001).
  
  
  CONCLUSIONS
  Most doctors have recently attended training on antibiotic use and report they would not prescribe antibiotics for patients with a common cold, even when placed under pressure by patients. However, more than half of the prescriptions from these healthcare institutions for patients with the common cold included an antibiotic. Exploring and addressing gaps between knowledge and practice is critical to improving antibiotic use in rural China.
authors.affiliation: Center for Health Management and Policy, Key Lab of Health Economics and Policy Research of Ministry of Health, Shandong University, 250012, Jinan, Shandong, China. qiangs@sdu.edu.cn.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Medical Education Centre, North Devon District Hospital, Raleigh Park, Barnstaple, Devon, EX31 4JB, UK. oliver.dyar@ki.se.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Dyar
authors.affiliation: Center for Health Management and Policy, Key Lab of Health Economics and Policy Research of Ministry of Health, Shandong University, 250012, Jinan, Shandong, China. zlb_0619@126.com.
authors.forename: Lingbo
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Public Health Sciences, Department of Learning, Informatics, Management, Tomtebodavägen 18 A; Medical Management Centre (MMC), Ethics Karolinska Institutet, 171 77, Stockholm, Sweden. Goran.Tomson@ki.se.
authors.forename: Göran
authors.initials: G
authors.lastname: Tomson
authors.affiliation: Department of Clinical and Experimental Medicine, Clinical Microbiology, Faculty of Health Sciences, Linköping University, 581 85, Linköping, Sweden. lennart.e.nilsson@liu.se.
authors.forename: Lennart E
authors.initials: LE
authors.lastname: Nilsson
authors.affiliation: Antibiotics and Infection Control Unit, Public Health Agency of Sweden, 17182, Solna, Sweden. malin.grape@folkhalsomyndigheten.se.
authors.forename: Malin
authors.initials: M
authors.lastname: Grape
authors.affiliation: School of Public Health, Shandong University, Jinan, Shandong, 250012, China. yysong@sdu.edu.cn.
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Song
authors.affiliation: Jinan Central Hospital, Jinan, Shandong, 250013, China. yinxiao@medmail.com.cn.
authors.forename: Ling
authors.initials: L
authors.lastname: Yan
authors.affiliation: Department of Public Health Sciences, Global Health (IHCAR), Tomtebodavägen 18 A, Karolinska Institutet, 1771 77, Stockholm, Sweden. Cecilia.Stalsby.Lundborg@ki.se.
authors.forename: Cecilia Stålsby
authors.initials: CS
authors.lastname: Lundborg
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002681:China; D003139:Common Cold / Q000188:drug therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D000067490:Prescription Drug Overuse / Q000523:psychology* / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*
chemical_list: D000900:Anti-Bacterial Agents