Table 1 Factors influencing antibiotic use in China
Factor | Influence |
|---|---|
Government policy | By poorly remunerating doctors and expecting hospitals to support themselves largely through the sale of drugs, government policy encouraged over-prescribing of expensive drugs and discouraged quality assessment and improvement exercises. |
Pharmaceutical industry | By spending a large amount of money on drug advertising, gifts and financial "kick-backs" to doctors who prescribed their drugs drug companies encouraged excessive prescribing ("kick-backs" were particularly attractive given the low salary of hospital doctors). |
Hospital Drug and Therapeutics Committees | Generally regarded as ineffective; in particular they provided no monitoring of prescriptions and little independent education to medical staff. |
Surgeons attitude and knowledge | By being less interested in drugs than physicians ("operations were more important") misunderstandings were perpetuated such as, "new antibiotics are stronger"; "new drugs kill most germs"; "the bigger the operation, the greater the need for newer and stronger antibiotics". |
Deteriorating relationship between doctors and patients | This led to doctors protecting themselves from being sued by prescribing unnecessary &/or expensive drugs; this practice was often acerbated by media reports of patients physically assaulting the medical staff &/or extorting money from hospitals when treatment failed. |