Original Article

Evaluation of Outpatient Antibiotic Use in Beijing General

Hospitals in 2015
Chuan Yang, Wen‑Qiang Cai, Zi‑Jun Zhou
Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China

Abstract
Background: Medical misuse of antibiotics is associated with the acquisition and spread of antibiotic resistance, resulting in a lack of
effective drugs and increased health‑care cost. Nevertheless, inappropriate antibiotic use in China remains common and the situation
requires urgent improvement. Here, we analyzed the prescriptions of antibiotics and evaluated the rationality of antibiotic use among
outpatients in Beijing general hospitals during 2015.
Methods: We collected basic medical insurance claim data from January 1, 2015 to December 31, 2015 in 507 general hospitals of
Beijing. A descriptive analysis of outpatient antibiotic prescribing was performed. The Anatomical Therapeutic Chemical Classification/
defined daily doses system was used to evaluate the rationality of antibiotic use.
Results: Over the study, an estimated 721,930, 613,520, and 822,480 antibiotics were dispensed in primary, secondary, and tertiary general
hospitals corresponding to 5.09%, 5.06%, and 2.53% of all prescriptions, respectively. Antibiotic combinations represented 2.95%, 7.74%,
and 10.18% of the total antibiotic prescriptions, respectively. Expenditure for the top twenty antibiotics in primary, secondary, and tertiary
general hospitals was RMB 42.92, 65.89, and 83.26 million Yuan, respectively. Cephalosporins were the most frequently prescribed class
of antibiotic in clinical practice. The antibiotics used inappropriately included azithromycin enteric‑coated capsules, compound cefaclor
tablets and nifuratel nysfungin vaginal soft capsules in primary hospitals, amoxicillin and clavulanate potassium dispersible tablets (7:1)
and cefonicid sodium for injection in secondary hospitals, cefminox sodium for injection and amoxicillin sodium and sulbactam sodium
for injection in tertiary hospitals.
Conclusions: Antibiotic use in Beijing general hospitals is generally low; however, inappropriate antibiotic use still exists. Inappropriately
used antibiotics should be subject to rigorous control and management, and public policy initiatives are required to promote the judicious
use of antibiotics.

Key words: Antibiotic; General Hospitals; Rationality

Introduction Health Organization.[5,6] Antibiotic resistance results in a lack

of effective drugs to fight infections, as well as increased
The use of antibiotics is known to be the single most important
health‑care cost, prolonged hospital stay, and substantially
driver of antibiotic resistance. Nevertheless, antibiotic
increased social and economic burdens.[5]
misuse remains common,[1] particularly in China, which has
the world’s most rapid growth of antibiotic resistance.[2,3] In 2009, the Chinese government launched a national
The rate of antibiotic prescriptions for both inpatients and program of health‑care reform and implemented the
outpatients is high in China.[4] In the primary care system,
which comprises a network of mostly rural facilities that Address for correspondence: Dr. Zi‑Jun Zhou,
are responsible for approximately two‑thirds of health‑care Department of Health Policy and Management, School of Public Health,
provision in China, more than 60% of antibiotic prescriptions Peking University, Beijing 100191, China
E‑Mail: [email protected]
were found to be inappropriate. The key concerns were the
overprescribing of antibiotics. Between 78% and 93% of
respiratory infections were treated with antibiotics, a rate This is an open access article distributed under the terms of the Creative Commons
that is far in excess of the levels recommended by the World Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix,
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Received: 24‑10‑2016 Edited by: Li-Min Chen

DOI: How to cite this article: Yang C, Cai WQ, Zhou ZJ. Evaluation of
10.4103/0366-6999.198929 Outpatient Antibiotic Use in Beijing General Hospitals in 2015. Chin
Med J 2017;130:288-96.

288 Chinese Medical Journal  ¦  February 5, 2017  ¦  Volume 130  ¦  Issue 3

National System for Basic Drugs. One of the goals by calculating the frequency of drug use (DDDs) and drug
was to urge the public to seek care scientifically, and utilization index  (DUI). DDDs were defined as the total
safe, effective, and appropriate use of medicines was amount of drugs prescribed during the study divided by the
proposed.[7] The progression of China’s health‑care reform DDD value. The DDD value increases with the frequency
and the implementation of the pharmaceutical policy of drug use. DDD values were obtained from the ATC/DDD
represent a positive change in ensuring the appropriate use index (2010) of the WHO Collaborating Center for Drugs
of antibiotics in China.[8] However, the measures adopted Statistics Methodology and the Chinese Pharmacopoeia,
to date are far from adequate[4] and inappropriate use of 2015.[10,12] DUI values were defined as DDDs divided by the
antibiotics in China remains common.[6,9] In this study, we medication duration. DUI values for an antibiotic exceeding
analyzed the prescriptions of antibiotics and evaluated the 1.0 indicate the existence of inappropriate use.[10,11]
rationality of antibiotic use among outpatients in Beijing’s
general hospitals during 2015. Results
Outpatient antibiotic prescriptions in general hospitals
Methods in Beijing, 2015
Data collection Table 1 provides a description of outpatient antibiotic
In this study, we collected basic medical insurance claim data prescribing in general hospitals in Beijing. In primary general
from January 1, 2015, to December 31, 2015, in Beijing’s hospitals, 721,930 antibiotics were dispensed, representing
507 general hospitals including 44 tertiary general hospitals, 5.09% of all prescriptions and costing RMB 46.98 million
60 secondary general hospitals, and 403 primary general Yuan. In secondary general hospitals, 613,520 antibiotics
hospitals. The data covered the patients’ demographic were dispensed, representing 5.06% of all prescriptions
information, medicines prescribed (including medicine and costing RMB 82.58 million Yuan. In tertiary general
name, dose, and duration), and expenditure. Stratified hospitals, 822,480 antibiotics were dispensed, representing
random sampling was conducted and 30% of hospitals 2.53% of all prescriptions and costing RMB 116.38 million
were selected as the study sample (13 tertiary hospitals, Yuan. The percentage of antibiotic prescriptions among
18 secondary hospitals, and 120 primary hospitals). all prescriptions in tertiary hospitals was significantly
lower than that in the primary and secondary general
Statistical analysis
hospitals (χ2 = 267,971.360, P < 0.01). The correlation
SQL Server 2008 (Microsoft Corporation Inc., Redmond,
between the proportion of antibiotic prescriptions among
WA, USA) was used for the storage, retrieval, and
all prescriptions and patient age is shown in Figure 1. In
manipulation of all data. SPSS 20.0 (SPSS Inc., Chicago,
primary and secondary hospitals, the proportion of antibiotic
IL, USA) was used for statistical analyses. P < 0.05 was
prescriptions decreased with increasing patient age. The
considered statistically significant.
decrease in the proportion of antibiotic prescriptions was
We performed a descriptive analysis of outpatient antibiotic similar for both primary and secondary hospitals. In tertiary
prescribing. The descriptive indexes included antibiotic hospitals, the proportion of antibiotic prescriptions decreased
expenditure, number of antibiotic prescriptions, average with patient age up to 70 years, with a subsequent increase
cost per antibiotic prescription, antibiotic prescriptions as with patient age. Furthermore, the initial decrease in the
a percentage of all prescriptions  (defined as the number proportion of antibiotic prescriptions for tertiary hospitals
of antibiotic prescriptions divided by the total number was smaller than those observed for primary and secondary
of prescriptions), injectable antibiotic prescriptions hospitals.
as a percentage of all antibiotic prescriptions (defined
as the number of injectable antibiotic prescriptions Injectable antibiotic prescriptions represented 6.55%,
divided by the total number of antibiotic prescriptions), 19.02%, and 21.41% of all antibiotic prescriptions
and antibiotic combinations as a percentage of all
antibiotic prescriptions (defined as the number of antibiotic
combination prescriptions divided by the total number
of antibiotic prescriptions). Differences in rates among
different general hospital ratings were compared using the
Chi‑squared test.
The Anatomical Therapeutic Chemical Classification/defined
daily doses (ATC/DDDs) system developed by the World
Health Organization serves as a tool for drug utilization
research to improve quality of drug use.[10] The ATC/DDD
system is independent of package size and sales price. It
allows comparisons not only within an institution but also
within a region, a country, or even internationally.[10,11] Figure 1: Proportion of antibiotic prescriptions among all prescriptions
Rationality of antibiotic use was analyzed quantitatively in Beijing general hospitals by age group.

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Table 1: Outpatient antibiotic prescriptions in Beijing general hospitals, 2015
Age Primary general hospital
(years)
Antibiotic Number of antibiotic Average cost per Antibiotic as a Injectable antibiotic as a
expenditures (RMB, prescriptions antibiotic prescription percentage of all percentage of all antibiotic
million Yuan) (RMB Yuan) prescription (%) prescriptions (%)
18−30 1.76 27,960 62.98 8.03 12.25
31−40 5.29 83,050 63.77 7.41 8.18
41−50 7.62 120,860 63.12 6.42 6.12
51−60 12.87 200,750 64.12 4.88 5.28
61−70 11.07 170,110 65.10 4.37 5.92
>70 8.34 119,200 70.04 4.21 7.56
Total 46.98 721,930 65.08 5.09 6.55

Age Secondary general hospital

(years)
Antibiotic Number of antibiotic Average cost per Antibiotic as a Injectable antibiotic as a
expenditures (RMB, prescriptions antibiotic prescriptions percentage of all percentage of all antibiotic
million Yuan) (RMB Yuan) prescriptions (%) prescriptions (%)
18−30 6.18 49,100 125.94 7.56 28.85
31−40 12.97 102,280 126.85 7.45 22.19
41−50 13.01 100,500 129.41 5.65 16.81
51−60 19.11 142,150 134.41 4.51 16.27
61−70 16.47 118,460 139.07 4.16 16.22
>70 14.84 101,040 146.86 4.36 20.36
Total 82.58 613,520 134.60 5.06 19.02

Age Tertiary general hospital

(years)
Antibiotic Number of antibiotic Average cost per Antibiotic as a Injectable antibiotic as a
expenditures (RMB, prescriptions antibiotic prescription percentage of all percentage of all antibiotic
million Yuan) (RMB Yuan) prescriptions (%) prescription (%)
18−30 10.51 90,070 116.71 3.21 21.09
31−40 20.21 167,670 120.57 3.01 18.12
41−50 13.79 108,070 127.61 2.42 15.82
51−60 23.21 160,020 145.02 2.27 19.19
61−70 19.66 130,640 150.46 2.07 20.77
>70 29.00 166,020 174.70 2.61 31.20
Total 116.38 822,480 141.50 2.53 21.41

in primary, secondary, and tertiary general hospitals,

respectively, with significantly lower rates in primary
hospitals compared with those in secondary and tertiary
hospitals (χ2 = 70,785.984, P < 0.01). The correlation
between the proportion of injectable antibiotic prescriptions
among all antibiotic prescriptions and patient age is shown in
Figure 2. The proportion of injectable antibiotic prescriptions
among the total antibiotic prescriptions for all general
hospitals decreased initially with increasing patient age,
with a subsequent increase observed after the age of 50 years
in primary hospitals, 60 years in secondary hospitals, and
40 years in tertiary hospital.
Figure 2: Proportion of injectable antibiotic prescriptions among all
The average cost per antibiotic prescription in primary, antibiotic prescriptions in Beijing general hospitals by age group.
secondary, and tertiary general hospitals was RMB 65.08,
134.60, and 141.50 Yuan, respectively. The correlation with increasing patient age, while in secondary and tertiary
between average cost per antibiotic prescription and patient hospitals, it increased with patient age. The increasing
age is shown in Figure 3. In primary hospitals, the average average cost per antibiotic prescription of tertiary hospitals
cost per antibiotic prescription remained almost constant was higher than that of secondary hospitals.

290 Chinese Medical Journal  ¦  February 5, 2017  ¦  Volume 130  ¦  Issue 3

Table 2 provides a description of antibiotic combinations primary, secondary, and tertiary general hospitals represented
prescribed to outpatients in general hospitals in Beijing 2.89%, 6.77%, and 8.42% of all antibiotic prescriptions while
during 2015. Dual antibiotics combination prescriptions in prescriptions for combinations of three or more antibiotics
represented 0.06%, 0.97%, and 1.75% of all antibiotic
prescriptions, respectively. Overall, antibiotic combinations
prescribed to outpatients were relatively low as a percentage
of all antibiotics prescriptions in general hospitals in Beijing,
with significantly increasing percentages as the rating of
hospitals increased from primary to tertiary (χ2 = 31,911.939,
P  < 0.01). Dual antibiotic combinations were the most
frequently prescribed, accounting for more than 80% of
all antibiotic combination prescriptions. The correlation
between antibiotic combination prescriptions as a proportion
of all antibiotic prescriptions and patient age is shown in
Figure 4. In primary hospitals, the percentage of antibiotic
combination prescriptions remained almost constant with
Figure 3: Average cost per antibiotic prescription among outpatients increasing patient age while the percentage increased with
in Beijing general hospitals by age group. patient age in secondary and tertiary hospitals.

Table 2: Outpatient antibiotic combinations in Beijing general hospitals, 2015

Age Primary general hospital
(years)
Single‑drug as a Dual combination as a Triple or more combination Combination as a
percentage of antibiotic percentage of antibiotic as a percentage of percentage of antibiotic
prescriptions (%) prescriptions (%) antibiotic prescriptions (%) prescriptions (%)
18–30 96.86 3.08 0.07 3.14
31–40 96.76 3.17 0.07 3.24
41–50 97.15 2.80 0.06 2.85
51–60 96.99 2.95 0.06 3.01
61–70 97.09 2.86 0.06 2.91
>70 97.22 2.72 0.06 2.78
Total 97.05 2.89 0.06 2.95

Age Secondary general hospital

(years)
Single‑drug as a Dual combination as a Triple or more combination Combination as a
percentage of antibiotic percentage of antibiotic as a percentage of percentage of antibiotic
prescriptions (%) prescriptions (%) antibiotic prescriptions (%) prescriptions (%)
18–30 92.69 6.82 0.49 7.31
31–40 92.50 7.03 0.47 7.50
41–50 92.31 7.17 0.52 7.69
51–60 92.56 6.83 0.61 7.44
61–70 93.00 6.17 0.84 7.00
>70 90.58 6.75 2.67 9.42
Total 92.26 6.77 0.97 7.74

Age Tertiary general hospital

(years)
Single‑drug as a Dual combination as a Triple or more combination Combination as a
percentage of antibiotic percentage of antibiotic as a percentage of percentage of antibiotic
prescriptions (%) prescriptions (%) antibiotic prescriptions (%) prescriptions (%)
18–30 92.13 7.08 0.79 7.87
31–40 91.20 8.02 0.78 8.80
41–50 90.66 8.22 1.12 9.34
51–60 90.34 8.18 1.48 9.66
61–70 89.54 8.42 2.04 10.46
>70 86.69 9.79 3.53 13.31
Total 89.82 8.42 1.75 10.18

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 2015 to evaluate the current situation in terms of antibiotic
prescribing patterns and rationality of use in this population.
The results of our analysis showed that antibiotic prescriptions
as a proportion of all prescriptions during the study were far
below the proportion of antimicrobial agent prescriptions
that is recommended 20% by the guidelines for the clinical
application of antibiotics in China.[13] The proportion in
tertiary hospitals was lower than that reported nationwide
in 2012 (estimated to be 10%).[14] It was also lower than that
reported in another study in Hubei Province.[15] However,
compared with the proportion in the United States[16]
and some European countries,[17] such as Sweden, where
Figure 4: Antibiotic combination prescriptions as a proportion of all
antibiotic prescriptions among outpatients in Beijing general hospitals
antibiotic prescriptions represent 1.1% of all prescriptions,[14]
by age group. the proportion remains high in Beijing tertiary hospitals. In
primary general hospitals, the proportion in Beijing was also
lower than that in other provinces, such as Jilin and Jiangsu
Outpatient antibiotic expenditures
Province.[5] Compared with other countries, the proportion
Table 3 provides the expenditure for each antibiotic as a
in Beijing primary general hospitals is relatively higher than
proportion of the total antibiotic expenditure in general
that in the United States and other developed countries,[18]
hospitals in Beijing during 2015. Expenditure for the top
although it is comparable to that in India and South Korea.[19,20]
twenty antibiotics in primary, secondary, and tertiary general
Antibiotic prescriptions represented significantly higher
hospitals was RMB 42.92, 65.89, and 83.26 million Yuan
proportions of all prescriptions in primary and secondary
representing 91.35%, 79.79%, and 71.54% of the expenditures
hospitals than that in tertiary hospitals. This shows that
for the total antibiotic expenditure, respectively. Compared
antibiotics are more frequently prescribed in the primary care
with secondary and tertiary hospitals, antibiotic use in primary
setting, thus increasing the risk of inappropriate antibiotic
hospitals was predominantly confined to the top twenty
use. The primary and secondary general hospitals include
antibiotics. The top two antibiotics in terms of expenditures
most of the township health centers and county hospitals.
were cephalosporins in all three general hospitals’ ratings.
The application of antibiotics in these medical institutions
Rationality of antibiotic use has a great impact on antibiotic resistance in rural areas.[21]
Table 4 provides the DDDs and DUI values for outpatient Antibiotic prescriptions as a proportion of all prescriptions
antibiotic prescriptions for general hospitals in Beijing showed a decreasing trend with increasing patient age. The
during 2015. To evaluate the rationality of antibiotic use, we morbidity of most diseases increases with patient age, with
calculated the DDDs and DUI values of the top 15 antibiotics a concomitant increase in drug use for the disease; therefore,
in terms of expenditure (with the exception of polymyxin B, antibiotic prescriptions as a proportion of all prescriptions
for which a DDD value was not assigned). In terms of may show a relative decrease.
DDDs rankings, cephalosporins accounted for the top five
The WHO recommends that oral antibiotics should be given
antibiotics (with the exception of the third most commonly
priority in antibiotic use and injectable antibiotics should
used antibiotic, azithromycin enteric‑coated capsules)
be used only when necessary.[22] The analysis showed that
in primary hospitals, the top six antibiotics in secondary
injectable antibiotic prescriptions as a proportion of all
hospitals, and the top eight antibiotics (with the exception
antibiotic prescriptions were lower than recommended by the
of the fifth, fosfomycin trometamol powder) in tertiary
WHO.[23] Injectable antibiotic prescriptions as proportions of
hospitals. Thus, cephalosporins represent the most frequently
all antibiotic prescriptions in secondary and tertiary hospitals
prescribed class of antibiotic in clinical practice and the first
were significantly higher than that in primary hospitals. In a
choice of antimicrobial agent among clinicians. In primary
nationwide study, the proportion is estimated to be 20% in
hospitals, antibiotics with DUI >1 were azithromycin
tertiary hospitals, which is similar to that in Beijing, while
enteric‑coated capsules, compound cefaclor tablets and
in Sweden, the proportion is estimated to be only 0.1%.[14]
nifuratel nysfungin vaginal soft capsules. In secondary
Injectable antibiotics are absorbed rapidly, with a significant
hospitals, antibiotics with DUI >1 were amoxicillin and
curative effect that mitigates the disease effectively and
clavulanate potassium dispersible tablets (7:1) and cefonicid
efficiently. The patients in secondary and tertiary hospitals
sodium for injection. In tertiary hospitals, antibiotics with
are usually in a more serious condition than those in primary
DUI >1 were cefminox sodium for injection and amoxicillin
hospitals. Thus, injectable antibiotics may be more frequently
sodium and sulbactam sodium for injection.
applied in secondary and tertiary hospitals. However, in this
setting, the consequences of serious adverse drug reactions
Discussion are difficult to control.[24] Therefore, injectable antibiotics
In this study, we analyzed the data for antibiotic prescriptions should be used only when necessary and the application
among outpatients of general hospitals in Beijing during should be supervised rigorously.

292 Chinese Medical Journal  ¦  February 5, 2017  ¦  Volume 130  ¦  Issue 3

Table 3: Expenditure for each antibiotic as a proportion of the total antibiotic expenditure among outpatients in
Beijing general hospitals, 2015 (ranking by proportion)
Primary general hospital Secondary general hospital Tertiary general hospital
Antibiotic Proportion (%) Antibiotic Proportion (%) Antibiotic Proportion (%)
Cefuroxime axetil tablets 19.54 Cefixime dispersible 12.75 Cefdinir dispersible 9.00
tablets tablets
Compound cefaclor 12.05 Cefdinir dispersible 7.50 Cefoxitin sodium for 6.11
tablets tablets injection
Azithromycin 9.54 Cefdinir capsules 5.61 Cefminox sodium for 5.95
enteric‑coated capsules injection
Cefuroxime axetil 7.32 Cefmetazole sodium 4.83 Cefuroxime axetil 4.88
dispersible tablets for injection tablets
Cefotaxime sodium for 6.00 Cefoxitin sodium for 4.60 Etimicin sulfate 4.77
injection injection injection
Fosfomycin trometamol 5.34 Cefaclor sustained 4.30 Cefdinir capsules 4.72
powder release tablets
Amoxicillin dispersible 4.66 Etimicin sulfate 4.25 Cefixime dispersible 4.10
tablets injection tablets
Erythromycin 4.62 Cefonicid sodium for 3.75 Ceftizoxime sodium 4.07
cyclocarbonate tablets injection for injection
Cefaclor capsules 4.53 Cefixime capsules 3.38 Ertapenem for 3.83
injection
Etimicin sulfate injection 3.62 Cefprozil dispersible 3.37 Fosfomycin 3.83
tablets trometamol powder
Etimicin sulfate and 3.09 Cefminox sodium for 3.34 Cefixime capsules 3.45
sodium chloride injection
injection
Cefuroxime sodium for 2.77 Amoxicillin 3.23 Cefotaxime sodium 2.58
injection dispersible and sulbactam
tablets (7:1) sodium for injection
Cefonicid sodium for 1.34 Cefprozil tablets 2.79 Cefmetazole sodium 2.09
injection for injection
Nifuratel nysfungin 1.30 Nifuratel nysfungin 2.71 Compound polymyxin 1.81
vaginal soft capsules vaginal soft capsules b ointment
Clindamycin 1.26 Cefuroxime axetil 2.58 Latamoxef sodium for 1.78
hydrochloride for tablets injection
injection
Clindamycin phosphate 1.17 Cefuroxime sodium 2.39 Piperacillin sodium 1.76
for injection for injection and sulbactam
sodium for
injection (4:1)
Dirithromycin 0.94 Ceftazidime for 2.25 Nifuratel nysfungin 1.74
enteric‑coated tablets injection vaginal soft
capsules
Amoxicillin dispersible 0.85 Cefixime tablets 2.18 Azithromycin tablets 1.73
tablets (7:1)
Amoxicillin dispersible 0.77 Azithromycin 2.02 Azithromycin 1.71
tablets (2:1) enteric‑coated lactobionate for
capsules injection
Erythromycin 0.66 Cefotaxime sodium 1.95 Clarithromycin tablets 1.63
enteric‑coated capsules and sulbactam
sodium for injection
Total 91.36 Total 79.79 Total 71.54

Average cost per antibiotic prescription in primary general hospitals, which may lead patients to be treated with more
hospitals was RMB 65.08 Yuan, which was similar to the cost effective drugs or antibiotic combinations at high cost.
of RMB 60 Yuan reported in a nationwide survey in 2009.[25] Second, this could be accounted for the cumulative effects
The average cost per antibiotic prescription in secondary and of increased drug prices in secondary and tertiary hospitals
tertiary hospitals was significantly higher than that in primary that have not completely cancelled the rates of drug price
hospitals. Two hypotheses may explain this observation. addition,[26] and also the financial incentives offered to
First, patients develop more severe and complicated disease motivate clinicians to prescribe more expensive drugs in
in secondary and tertiary general hospitals than in primary some hospitals.[6]

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Table 4: DDDs, DUI values for outpatient antibiotics prescriptions in Beijing general hospitals, 2015 (ranking by
DDDs)
Primary general hospital Secondary general hospital Tertiary general hospital
Antibiotic DDDs (million) DUI Antibiotic DDDs (million) DUI Antibiotic DDDs (million) DUI
Cefuroxime 10868.01 0.72 Amoxicillin and 4912.42 2.41 Cefuroxime axetil 6409.66 0.92
axetil tablets clavulanate tablets
potassium dispersible
tablets (7:1)
Azithromycin 5778.12 1.18 Cefixime dispersible 3158.84 0.72 Cefdinir 1520.5 0.27
enteric‑coated tablets dispersible
capsules tablets
Cefuroxime 2860.32 0.60 Cefuroxime axetil 2216.52 0.74 Cefoxitin sodium 1001.71 0.58
axetil tablets for injection
dispersible
tablets
Compound 2453.61 1.08 Cefaclor sustained 2006.18 0.66 Cefminox sodium 709.82 1.09
cefaclor tablets release tablets for injection
Cefaclor 1647.38 0.54 Cefprozil tablets 1791.07 0.89 Fosfomycin 635.32 0.80
capsules trometamol
powder
Amoxicillin and 1643.78 0.55 Nifuratel nysfungin 1738.50 0.97 Cefixime 559.75 0.29
clavulanate vaginal soft capsules dispersible
potassium tablets
dispersible
tablets
Erythromycin 801.3 0.62 Cefprozil dispersible 1525.42 0.87 Cefixime capsules 541.59 0.30
cyclocarbonate tablets
tablets
Nifuratel 745.56 1.16 Cefdinir dispersible 1273.26 0.38 Cefdinir capsules 502.45 0.19
nysfungin tablets
vaginal soft
capsules
Fosfomycin 365.56 0.48 Cefdinir capsules 1057.49 0.43 Amoxicillin 404.99 1.21
trometamol sodium and
powder sulbactam
sodium for
injection
Cefotaxime 170.4 0.54 Cefixime capsules 634.14 0.45 Cefmetazole 125.12 0.20
sodium for sodium for
injection injection
Clindamycin 148.83 0.99 Cefonicid sodium for 421.19 1.13 Piperacillin sodium 116.98 0.34
hydrochloride injection and sulbactam
for injection sodium for
injection (4:1)
Cefuroxime 123.15 0.61 Cefoxitin sodium for 306.00 0.40 Latamoxef sodium 87.28 0.38
sodium for injection for injection
injection
Etimicin sulfate 113.73 0.81 Cefminox sodium for 303.62 0.63 Ertapenem for 72.62 0.32
injection injection injection
Etimicin sulfate 100.06 0.76 Cefmetazole sodium 233.08 0.37 Ceftizoxime 65.93 0.10
and sodium for injection sodium for
chloride injection
injection
Cefonicid 93.96 0.97 Etimicin sulfate 194.55 0.51 Etimicin sulfate 65.11 0.11
sodium for injection injection
injection
DDDs: Defined daily doses; DUI: Drug utilization index.

Prescriptions for antibiotic combinations represent a in Beijing was significantly lower than that in Hubei
low proportion of all antibiotic prescriptions although the Province. Antibiotic combinations were prescribed for
proportion increased with the rating of the hospital from serious diseases or patients who were infected by multiple
primary to tertiary. A study showed that almost 30% of all microorganisms to provide broad‑spectrum antibacterial
antibiotic prescriptions were for antibiotic combinations efficacy.[27] Inappropriate use of antibiotic combinations
in tertiary hospitals in Hubei Province.[15] The proportion may cause adverse events such as increasing the selective

294 Chinese Medical Journal  ¦  February 5, 2017  ¦  Volume 130  ¦  Issue 3

pressure of antimicrobial agents and driving the acquisition of antibiotics in primary health care settings in China. JAMA Intern
of antibiotic resistance.[28] Thus, the relevant guidelines Med 2014;174:1914‑20. doi: 10.1001/jamainternmed.2014.5214.
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Conflicts of interest consumption in a population of South Korea (2008‑2009). Int J Clin
There are no conflicts of interest. Pharmacol Ther 2013;51:585‑92. doi: 10.5414/CP201827.
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