Antibiotic misuse among children with diarrhea in China: results from a national survey.
BACKGROUND
Antibiotic resistance is one of the world's biggest public health issues, and the situation in China is particularly grave. The objective of this study is to investigate the antibiotics usage pattern among Chinese children and provide further insight in developing strategies for promoting public health education.


METHODS
This is a cross-sectional study, in the study, participants are from 53,665 guardians of children aged 0-6 years, who were recruited with multistage stratified random cluster sampling in 2013/2014 from 46 community health centers in 14 provinces across China Mainland. Children's guardians completed surveys on their previous experience on using antibiotics in treating diarrhea of their children without a prescription from any pediatrician. Odds ratios (ORs) and 95% confidential intervals (CIs) for the association between antibiotic use and its predictors were estimated using multilevel logistic regression models, with antibiotic rational use group as a reference group.


RESULTS
The prevalence of antibiotic misuse among children with diarrhea in the eastern, middle and western areas of China and associations between antibiotic misuse and its predictors were studied. The average rate of antibiotic misuse is 35.12%. Multilevel logistic regression revealed that living in urban areas (OR = 0.79 (0.76, 0.83)), female children (OR = 0.92 (0.88, 0.96)), guardians having higher education (OR = 0.60 (0.55, 0.66)), being raised by parents (OR = 0.90 (0.85, 0.94)), guardians having basic health knowledge (OR = 0.82 (0.79, 0.86)) are protective factors and children's age (1-3 years OR = 1.62 (1.54, 1.71)); 4-6 years OR = 1.90 (1.77, 2.03)) is a risk factor of antibiotic misuse among children aged 0-6 years with diarrhea in China.


CONCLUSIONS
Our findings confirmed that there has been a high rate of antibiotic misuse without a prescription in children with diarrhea in China, which requires considerable attention. Suitable regulations and interventions are needed to solve this problem.
Children Health and Development Department, Capital Institute of Paediatrics , Beijing , China.
Ruili
R
Li
Children Health and Development Department, Capital Institute of Paediatrics , Beijing , China.
Feng
F
Xiao
Children Health and Development Department, Capital Institute of Paediatrics , Beijing , China.
Xiaoguo
X
Zheng
Children Health and Development Department, Capital Institute of Paediatrics , Beijing , China.
Huimin
H
Yang
Children Health and Development Department, Capital Institute of Paediatrics , Beijing , China.
Lihong
L
Wang
Children Health and Development Department, Capital Institute of Paediatrics , Beijing , China.
Delu
D
Yin
Children Health and Development Department, Capital Institute of Paediatrics , Beijing , China.
Tao
T
Yin
Children Health and Development Department, Capital Institute of Paediatrics , Beijing , China.
Qianqian
Q
Xin
Children Health and Development Department, Capital Institute of Paediatrics , Beijing , China.
Bowen
B
Chen
Antibiotic misuse; Children; China; Diarrhea; Self-medication