A comparative study of antibiotic use in China under Chinese restriction list and world health organization AWaRe classification

Antimicrobial resistance (AMR) represents a major threat to human health with significant global economic and security implications. To improve the rational use of antibiotics, in 2017, the WHO introduced the Access, Watch, and Reserve (AWaRe) classification of antibiotics for the evaluation and monitoring of use and set up a global target to reduce AMR, i.e. by 2023, 60% of all antibiotics consumed must come from Access—the group of antibiotics at lowest risk of resistance [ [1] WHO. Adopt AWaReHandle antibiotics with care. WHO, Geneva, Switzerland2019 Google Scholar ]. China is one of the largest consumers of antibiotics in the world and is also under the threat of AMR [ [2] van Boeckel T.P. Gandra S. Ashok A. Caudron Q. Grenfell B.T. Levin S.A. et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014; 14: 742-750 Abstract Full Text Full Text PDF PubMed Scopus (1504) Google Scholar ]. Informed by international success stories, the government undertook antibiotic restriction as a core strategy, which categorized antimicrobials into 3 classes (non-restricted, restricted, and highly-restricted) [ [3] Xiao Y. Antimicrobial stewardship in China: systems, actions and future strategies. Clin Infect Dis. 2018; 67: S135-S141 Crossref PubMed Scopus (45) Google Scholar ]. Previous studies showed that China only had approximately 20% Access group antibiotic use, indicating that there was a large gap with the WHO national-level target [ [4] Pauwels I. Versporten A. Drapier N. Vlieghe E. Goossens H. Global-Pps network Hospital antibiotic prescribing patterns in adult patients according to the WHO Access, Watch and Reserve classification (AWaRe): results from a worldwide point prevalence survey in 69 countries. J Antimicrob Chemother. 2021; 76: 1614-1624 Crossref PubMed Scopus (47) Google Scholar ]. One possible reason for this gap could be the disparities in the local restriction classification and the WHO AWaRe classification. Hence, we aimed to analyse antibiotic use in China under the Chinese restriction list and the WHO AWaRe classification.