China - What ails China? It's antibiotics abuse

It is not often the head of a top Chinese hospital draws a parallel between a medical threat and nuclear weapons.

But the dangers of the gross overuse of antibiotics in China have grown to the point where Dr Liu Yuchun, president of the Peking University No. 1 Hospital, felt compelled to warn that this phenomenon - like the misuse of nukes - "may bring mankind difficulty and disaster".

"As our weapons get stronger, the resistance of bacteria to (our) drugs becomes greater," he told a press conference jointly held by the European Union and the Chinese Health Ministry to announce plans for joint cooperation in tackling the problem.

It is the latest in a series of efforts by the ministry to target antimicrobial resistance, which occurs when antibiotics lose their effectiveness to fight disease, leading to stronger drugs being used.

Earlier this month, Beijing set caps on the variety and usage of antibiotics. And a range of penalties await errant doctors.

The tougher rules, which came after a six-month national campaign last year, point to an urgency to solve a problem that has already taken a serious health and financial toll on the country.

Last year, data showed some 840,000 cases of adverse reactions, including 600 fatalities, caused by antibiotics abuse, a 22 per cent rise from the previous year.

The cost of treating such cases reached as much as 13.9 billion yuan (US$2.2 billion) between 2001 and 2005, independent researchers estimated in a 2010 report.

There have been other wake-up calls against antibiotics abuse in China.

Take the discovery in October last year of a 'superbug' - the NDM-1 - which is resistant to nearly all antibiotics.

Or reports that 6.8 per cent of tuberculosis cases in this country are multidrug resistant, more than three times the level in developed countries.

Or even news that a 650g baby in Guangzhou was born resistant to seven kinds of drugs, possibly because the mother had ingested them as medicine or had eaten meat and eggs containing them.

All this stems from the liberal use of antibiotics by both humans and animals in China - the world's largest producer of antibiotics, and its own people consume the bulk of them. Some 93,000 tonnes reportedly end up in livestock each year.

More than 83 per cent of the 147,000 tonnes of antibiotics produced in China were consumed domestically in 2009, according to the China Daily, which dubbed it a national addiction.

Antibiotics are often sold over the counter at pharmacies without needing a doctor's prescription, though the government is trying to clamp down on this.

Housewife Yang Rongjie, 47, from the northern Inner Mongolia region, has been taking them for years, even for something as minor as a cold.

She now finds that she needs ever-bigger doses, even though her annual intake has likely already exceeded the 138g taken by the average Chinese. It is also 10 times the amount consumed by an American.

"Whenever the weather gets colder, I get sick. Antibiotic pills don't work well any more, so now I go to the hospital, where I'm put on a drip," she said.

Many blame widespread ignorance among Chinese - especially those living in rural areas - who demand antibiotics even when they do not need them.

But some researchers find that China's problem is largely supply-driven. "Hospitals and physicians have substantial monetary incentives to prescribe medications," wrote Princeton University professor Janet Currie, the lead author of a paper on this issue published last year.

Poorly funded hospitals largely subsidise the cheap fees they charge by marking up the cost of medication, which more often than not are antibiotics.

Seven in 10 hospital patients end up getting prescribed antibiotics. The figure that the World Health Organisation recommends is no more than 30 per cent.

Some smaller rural hospitals, where state controls are even more lax, are said to sell even more of such drugs.

"Antibiotics can make up up to 70 per cent of our total medicine sales," said Feng Xia, 36, a pharmacist at a local hospital in Fushun city in north-eastern Liaoning province. "It's good money."

Some doctors can receive kickbacks of up to 20 per cent of the value of the antibiotics prescription from pharmaceutical companies, researchers Winnie Yip and William Hsiao wrote in a 2008 paper.

But the government's recent measures have made some hospitals more cautious now, said Liu Yanqing, a medical intern at a Beijing hospital, who is in her 20s. "We're told to explain the side-effects of antibiotics to patients," she said.

Beijing announced this month that doctors who use antibiotics inappropriately could get a warning, be suspended or banned from writing prescriptions.

A top-level general hospital or children's hospital can stock at most 50 varieties of antibiotics. Some facilities carry more than 100 types.

But such rules alone cannot end the abuse. Said Chinese Academy of Social Sciences researcher Zhu Hengpeng: "The key problem is hospitals and doctors needing to supplement their incomes with drug sales. This relates to (broader) health-care reforms, which are difficult to tackle.

"I don't think this can be fundamentally solved in five years."

Grace Ng

The Straits Times

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