title: Antimicrobial prescribing patterns in a large tertiary hospital in Shanghai, China.
abstract: 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.
authors.affiliation: Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Zhabei, Shanghai 200072, China.
authors.forename: Yuan-Yuan
authors.initials: YY
authors.lastname: Wang
authors.affiliation: Department of Medicine and Department of Public Health Sciences, Penn State Hershey College of Medicine, 500 University Drive, Hershey, PA 17033-0855, USA. Electronic address: pud15@psu.edu.
authors.forename: Ping
authors.initials: P
authors.lastname: Du
authors.affiliation: Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Zhabei, Shanghai 200072, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Huang
authors.affiliation: Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Zhabei, Shanghai 200072, China.
authors.forename: Dong-Jie
authors.initials: DJ
authors.lastname: Li
authors.affiliation: Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Zhabei, Shanghai 200072, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Gu
authors.affiliation: Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Zhabei, Shanghai 200072, China.
authors.forename: Fu-Ming
authors.initials: FM
authors.lastname: Shen
authors.affiliation: Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Middle Road, Zhabei, Shanghai 200072, China. Electronic address: 13761571578@163.com.
authors.forename: Yuan-Ying
authors.initials: YY
authors.lastname: Jiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002681:China; D011307:Drug Prescriptions; D004363:Drug Utilization; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D019983:Guideline Adherence; D005102:Health Expenditures; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Ambulatory care; Antimicrobial prescriptions; Electronic health records; Unnecessary antibiotic use