title: Trends and patterns of antibiotic consumption in Shanghai municipality, China: a 6 year surveillance with sales records, 2009-14.
abstract: The objective of this study was to identify the trends and patterns of total antibiotic use in Shanghai from 2009 to 2014.
  
  
  
  Sales records were collected from a minimum of 160 hospitals and 241 primary healthcare settings and used as a proxy for consumption. Antibiotic sales expressed in DDD per 1000 inhabitants per day (DID) were calculated. We compared patterns of antibiotic use in the Shanghai municipality, populated by 24 million inhabitants, with European countries using indicators from the European Surveillance of Antimicrobial Consumption (ESAC).
  
  
  
  Total antibiotic use was highest at 25.9 DID in 2010, fell to 17.8 DID in 2012 and remained stable thereafter. The majority of this reduction occurred over 6 months in 2011. In 2014, two-thirds of the antibiotic sales were to hospitals (serving both inpatients and outpatients) and one-third to primary healthcare institutions. Cephalosporins accounted for 50.2% of total DID, followed by macrolides (18.2%), quinolones (16.0%) and penicillins (7.3%). A fifth of all antibiotics were used in parenteral form.
  
  
  
  We have successfully used aggregated sales data to monitor antibiotic usage across a large urban population over a 6 year period. A rapid, substantial and sustained reduction in antibiotic usage across the entire health system occurred. This coincided with several interventions across hierarchies in the health sector, including a national campaign. The patterns of antibiotic use indicate persistent preferences for cephalosporins, macrolides, quinolones and parenteral preparations. Further efforts are needed to investigate and improve the quality of antibiotic use.
authors.affiliation: Department of Health Policy and Management, Innovation Centre for Social Risk Governance in Health (ICSRGH), Fudan University, Shanghai, China Shanghai Health Development Research Centre, Shanghai, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Lin
authors.affiliation: Global Health - Health Systems and Policy (HSP): Medicines, focussing on antibiotics, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Oliver James
authors.initials: OJ
authors.lastname: Dyar
authors.affiliation: Global Health - Health Systems and Policy (HSP): Medicines, focussing on antibiotics, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Senia
authors.initials: S
authors.lastname: Rosales-Klintz
authors.affiliation: Department of Pharmacy, Zhongshan Hospital, affiliated to Fudan University, Shanghai, China.
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Global Health - Health Systems and Policy (HSP), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Tomson
authors.affiliation: Department of Health Policy and Management, Innovation Centre for Social Risk Governance in Health (ICSRGH), Fudan University, Shanghai, China haomo03@fudan.edu.cn.
authors.forename: Mo
authors.initials: M
authors.lastname: Hao
authors.affiliation: Global Health - Health Systems and Policy (HSP): Medicines, focussing on antibiotics, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Stålsby Lundborg
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002681:China; D002947:Cities; D003132:Commerce / Q000706:statistics & numerical data; D004363:Drug Utilization; D006761:Hospitals; D006801:Humans; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents