Pathways to optimising antibiotic use in Anhui: Identifying key determinants in community and clinical settings

抗生素的广泛使用被认为是许多国家日益严重的抗菌素耐药性问题的主要原因，但缺乏证据表明中国的主要驱动因素，特别是在农村环境和医院外，以及这些因素是否与其他地方不同。这些证据对于确定最有可能限制中国抗生素耐药性传播的卫生系统、行为和政策干预措施至关重要，同时确保公平获得抗生素以进行细菌感染的基本治疗。这个创新的跨学科项目旨在通过调查和量化目前处方和非处方抗生素的使用以及其他形式的护理来治疗安徽省农村地区的常见感染，从而更好地了解抗生素使用的关键社会，经济，文化，系统和其他影响。我们的研究将记录当地卫生机构和一般人群中来自所有来源（包括非正式、中医（TCM）、民间、家庭、私人和政府医疗保健）的选定常见感染的寻求治疗的做法。我们将收集关于较低一级卫生系统的检测、临床诊断和抗生素治疗程序的信息，以及关于从药房和药店非处方购买抗生素的信息。我们将确定安徽省人群中常见呼吸道感染的年发病率，并评估他们使用的不同形式的治疗（包括抗生素）对报告的疾病严重程度和持续时间的影响。我们还将确定评估临床诊断准确性的可行性，患者报告的症状与临床诊断之间的关系，以及非住院患者的抗生素耐药性负担，并通过微生物采样调查现有实验室数据中可能的人群偏倚。这一系列证据将使我们能够制定适当干预措施的建议，以优化安徽省和中国其他地区的抗生素使用。

Widespread antibiotic use is considered to be a major contributor to the growing problem of antimicrobial resistance in many countries, but there is a lack of evidence regarding its key drivers in China, particularly in rural settings and outside hospitals, and whether these differ from those found elsewhere. This evidence is essential for identifying the health system, behavioural and policy interventions that have most potential for limiting the spread of antibiotic resistance in China, while ensuring equitable access to antibiotics for essential treatment of bacterial infections. This innovative interdisciplinary project aims to acquire greater understanding of key social, economic, cultural, systemic and other influences on antibiotic use by investigating and quantifying current use of both prescribed and non-prescribed antibiotics and other forms of care to treat common infections in rural parts of Anhui Province. Our study will document treatment-seeking practices for selected common infections from all sources (including informal, Traditional Chinese Medicine (TCM), folk, home-based, private and government medical care) among patients at local health facilities and in the general population. We will gather information on testing, clinical diagnosis and antibiotic treatment procedures at lower levels of the health system and on over-the-counter purchasing of antibiotics from pharmacies and medicine shops. We will ascertain the annual incidence of common respiratory tract infections in the population of Anhui Province and assess the effects of the different forms of treatment they use, including antibiotics, on reported severity and duration of illness. We will also ascertain the feasibility of assessing clinical diagnostic accuracy, relationship between patient-reported symptoms and clinical diagnosis, and burden of antibiotic resistance in non-hospitalised patients, and investigate possible population biases in existing laboratory data through microbiological sampling. This range of evidence will enable us to formulate recommendations for appropriate interventions to optimise the use of antibiotics in Anhui Province and other regions of China.