The over-use of antibiotics has been identified as a major global challenge, where there is insufficient knowledge about the use of antibiotics in primary healthcare settings, especially at a population level. This study aims to investigate the trends and patterns of antibiotic sales in primary care in Hubei, China over a six-year period from 2012 to 2017. Antibiotic sales were expressed with Defined Daily Doses per 1000 inhabitants per day (DIDs) and compared with European countries using the 12 quality indicators proposed by the scientific advisory board of the European Surveillance of Antimicrobial Consumption (ESAC) project. Antibiotic sales increased from 12.8 DID in 2012 to 15.3 DID in 2013, and then declined afterwards. The most commonly used antibiotics, J01C (beta-lactam antimicrobials, penicillins), accounted for 40.5% of total antibiotic sales. Parenteral administration of antibiotics accounted for over 50% of total antibiotic sales. Total antibiotic sales were almost on a par with the 31 European countries monitored by the ESAC project, but cephalosporin sales were higher than at least three quarters of the compared countries, resulting in a significant higher proportion of third-generation cephalosporin consumption (13.8–19.43%). The relative consumption of Fluoroquinolone (9.26–9.89%) was also higher than at least half of the compared countries. There is a lack of robust evidence to show that antibiotic consumption in primary care is lower in Hubei compared with other countries. The preference of clinicians in China to use broad-spectrum and parenteral antibiotics deserves further study and policy attention.

Background The overuse of antibiotics is a major public health problem worldwide, especially in low-income and middle-income countries. However, there are few polices specific to antibiotic stewardship in primary care, and their effectiveness is unclear. A restrictive-prescribing stewardship policy was introduced in Hubei province, China, in November, 2014. We aimed to evaluate the effects of this policy on antibiotic consumption in primary care in the region. Methods Monthly antibiotic consumption data were extracted from the Hubei Medical Procurement Administrative Agency system from Sept 1, 2012, to Aug 31, 2017. An interrupted time-series analysis combined with Anatomical Therapeutic Chemical/Defined Daily Dose methodology and European Surveillance of Antimicrobial Consumption Quality Indictors was performed to evaluate the effects of the restrictive-prescribing stewardship policy on antibiotic consumption in primary care. The Durbin-Watson test was used to check for autocorrelation, and p values and coefficients were estimated by use of the generalised least squares method. Findings Over the entire study period, a significant reduction (–32·58%, p<0·001) was observed in total antibiotic consumption, which occurred within 1 month after introduction of restrictive prescribing (r=–2·4518, p=0·005) and continued to 2017 (r=–0·1193, p=0·017). Specifically, the use of penicillins (r=–0·0553, p=0·035), cephalosporins (r=–0·0294, p=0·037), and macrolides/lincosamides/streptogramins (r=–0·0182, p=0·003) decreased from before to after the intervention. The restrictive intervention was also associated with an immediate decline in the contribution of β-lactamase-sensitive penicillins to total antibiotic use (r=–2·9126, p=0·001) and a decline from baseline in the use of oral antibiotics (r=–0·0815, p=0·018). However, an immediate increase in the contribution of third-generation and fourth-generation cephalosporins to total antibiotic use (r=5·0352, p=0·005) and an increase from baseline in the contribution of fluoroquinolones to total antibiotic use (r=0·0406, p=0·037) were observed after the intervention. Finally, restrictive prescribing was associated with an immediate increase in the ratio of broad-spectrum to narrow-spectrum antibiotic use (r=1·8747, p=0·001), although use of both types of antibiotics significantly declined from before to after the intervention (broad-spectrum antibiotics: r=–0·0423, p=0·017; narrow-spectrum antibiotics: r=–0·0223, p=0·006). Interpretation Restrictive antibiotic prescribing in primary care in China was effective in reducing total antibiotic consumption, especially use of penicillins, cephalosporins, and macrolides/lincosamides/streptogramins. However, the effects of the intervention on some other antibiotics were mixed. Stronger administrative regulation focusing on specific antibiotics, such as third-generation and fourth-generation cephalosporins, fluoroquinolones, and broad-spectrum antibiotics, is needed in the future. Funding National Natural Science Foundation of China Youth Fund (grant number 71704058 ).