Unnecessary use of antibiotics for inpatient children with pneumonia in two counties of rural China

  • Xiaoyun Liang
  • Chenggang JinEmail author
  • Li Wang
  • Lian Wei
  • Goran Tomson
  • Clas Rehnberg
  • Rolf Wahlstrom
  • Max Petzold
Short Research Report


Objective To assess unnecessary use and cost of antibiotics for inpatient care for children under 14 years of age with pneumonia, and to identify the cost distribution in relation to different socio-economic status. Setting The study was hospital-based and cross-sectional. Method Between July 2007 and June 2008, 226 participants were interviewed in two county hospitals and three township health centers in two counties in rural China. The healthcare facilities provided medical and financial records for all study participants. Appropriateness of antibiotic treatment was assessed, in accordance with guidelines, by a paediatrician from a university teaching hospital, who reviewed all medical records. The cost of unnecessary antibiotics was based on the health facilities’ price lists. Results Unnecessary antibiotic prescriptions occurred in 43% of all patients. The median unnecessary cost of antibiotics was 40 RMB yuan (IQR: 22–100), and this extra cost increased the financial burden for the pneumonia inpatients by 18%. There were no statistically significant differences related to socio-economic categories for unnecessary antibiotics cost (F = 1.43, P = 0.2444). Conclusion Unnecessary prescribing of antibiotics use laid an extra burden on children with pneumonia at inpatient care. Implications for policy and practice might be considered regarding incentives, guidelines and training for health care providers.


Antibiotics China Pneumonia Rural China Unnecessary use 



This publication is an output of the POVILL Consortium of ten research institutions in Asia and Europe (, supported by the Sixth Framework Programme of the European Commission. All partners participated in the design of studies.


The Sixth Framework Programme of the European Commission (517657).

Conflicts of interest

No conflicts of interest to declare.


  1. 1.
    Cars O, Hogberg LD, Murray M, Nordberg O, Sivaraman S, Lundborg CS, et al. Meeting the challenge of antibiotic resistance. Br Med J. 2008;337:a1438.CrossRefGoogle Scholar
  2. 2.
    WHO. The world health report 2007: a safer future: global public health security in the 21st century. Geneva: WHO Press; 2007.Google Scholar
  3. 3.
    Reynolds L, McKee M. Factors influencing antibiotic prescribing in China: an exploratory analysis. Health Policy. 2009;90(1):32–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Hu S, Liu X, Peng Y. Assessment of antibiotic prescription in hospitalised patients at a Chinese university hospital. J Infect. 2003;46(3):161–3.PubMedCrossRefGoogle Scholar
  5. 5.
    Liu X, Mills A. Evaluating payment mechanisms: how can we measure unnecessary care? Health Policy Plan. 1999;14(4):409–13.PubMedCrossRefGoogle Scholar
  6. 6.
    Hopkins A. What do we mean by appropriate health care? Report of a working group prepared for the director of research and development of the NHS management executive. Qual Health Care. 1993;2(2):117–23.CrossRefGoogle Scholar
  7. 7.
    The Subspecialty Group of Respiratory Diseases, The Society of Pediatrics, Chinese Medical Association. Guidelines for management of childhood community acquired pneumonia (for trial implementation). Zhonghua Er Ke Za Zhi. 2007;45(2–3):83–90, 223–230.Google Scholar
  8. 8.
    Wagstaff A, O’donnell O, Van doorslaer E, Lindelow M. Analyzing health equity using household survey data: a guide to techniques and their implementation. Washington: World Bank Publications; 2007.Google Scholar
  9. 9.
    Bonati M. Epidemiologic evaluation of drug use in children. J Clin Pharmacol. 1994;34(4):300–5.PubMedGoogle Scholar
  10. 10.
    Zhang W, Liu X, Wang Y, Chen Y, Huang M, Fan M, et al. Antibiotic use in pulmonology wards of Chinese children’s hospitals: 2002–2006. J Clin Pharm Ther. 2009;34(1):61–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Xiaoyun Liang
    • 1
  • Chenggang Jin
    • 1
    Email author
  • Li Wang
    • 2
  • Lian Wei
    • 3
  • Goran Tomson
    • 4
    • 5
  • Clas Rehnberg
    • 5
  • Rolf Wahlstrom
    • 4
  • Max Petzold
    • 4
    • 6
  1. 1.School of Social Development and Public PolicyBeijing Normal UniversityBeijingChina
  2. 2.General OfficeAnhui Medical UniversityHefeiChina
  3. 3.Department of MarketingBeijing SL Pharmaceutical Co., LtdBeijingChina
  4. 4.Division of Global Health (IHCAR), Department of Public Health SciencesKarolinska InstitutetStockholmSweden
  5. 5.Medical Management Centre (MMC)Karolinska InstitutetStockholmSweden
  6. 6.Nordic School of Public HealthGoteborgSweden

Personalised recommendations