Antibiotic overprescription for respiratory infections fell sharply in rural Chinese clinics that adopted digital decision tools and peer-review systems, according to a new clinical trial. 

Published Feb. 17 in the journal “Nature Medicine,” the study, led by respiratory specialist  Zhong Nanshan and researchers from China and abroad, tracked more than 97,000 patient visits for acute respiratory infections at 34 rural hospitals in southern China’s Guangdong province between 2020 and 2021.

Clinics that introduced the intervention reduced antibiotic prescriptions to 26% of cases, compared with 71% in clinics providing standard care — a reduction of 39 percentage points when statistically adjusted. Researchers also found the intervention cut patient spending by about 9 yuan ($1.5) per visit by eliminating unnecessary drugs. 

Antibiotic resistance has increasingly been cited as a global health threat. China, the world’s largest consumer of antibiotics, introduced reforms in 2012 to limit hospital antibiotic prescriptions. But overuse in primary care remains common. 

The intervention program required doctors to participate in a half-day clinical training session and sign a commitment letter. Treatment guidelines were embedded into electronic medical record systems, generating real-time recommendations when physicians entered patients’ symptoms.

Doctors were also placed in peer support groups on the messaging app WeChat where they received monthly peer reviews comparing their prescribing patterns to colleagues. Patients were given QR codes linking to information about appropriate antibiotic use, and hospitals distributed material to further educate patients. 

Throughout the study, researchers found no evidence of increased harm. Hospital rates within 30 days were similar in clinics using the intervention and those providing standard care.  

The trial has since drawn praise from the broader medical community. An accompanying editorial in “Nature Medicine” said interventions that integrate into real-world medical environments — as in the Guangdong trial — are key to curbing drug resistance in resource-poor areas. 

Editor: Marianne Gunnarsson.

(Header image: VCG)