International Journal of Clinical Pharmacy

, Volume 39, Issue 4, pp 927–934 | Cite as

How does the general public view antibiotic use in China? Result from a cross-sectional survey

  • Dan Ye
  • Jie Chang
  • Caijun Yang
  • Kangkang Yan
  • Wenjing Ji
  • Muhammad Majid Aziz
  • Ali Hassan Gillani
  • Yu FangEmail author
Research Article


Background Resistance to antibiotics is a major threat to global health and general public play a significant role in the fight against antimicrobial resistance. Objective The present study aimed to identify the knowledge, attitudes, and practice of the general public towards antibiotic use in China. Setting Randomly selected parks in three cities of western, central and eastern China: Xi’an, Changsha, and Nanjing. Method A cross-sectional survey was conducted on a sample of 1400 residents, from January to June 2015. Main outcome measures Knowledge, attitudes and practices scores toward self-medication with antibiotics and compliance with antibiotic regimens. Results The response rate was 86.0% (n = 1204). Only 192 (19.5%) respondents gained a score of 3 or above, and the maximum score of 4, reflecting poor knowledge towards antibiotics. Just over half (54.8%) of respondents incorrectly believed antibiotics were effective against viral infections and only one-third (34.3%) knew that antibiotics were not anti-inflammatories. Nearly half of the respondents (49.0%) had changed the dosage when taking antibiotics, 35.6% switched to another class, 33.4% had not finished the full treatment course and over 60.0% kept leftover antibiotics for future use. Almost half of the respondents (45.7%) stated they had used antimicrobials during the last 6 months and 64.4% of them had self-medicated. Conclusion This study identified serious misconceptions regarding antibiotics use in the Chinese general public. Effective interventions should be developed to provide practical and appropriate advice to effect behaviour change within this population.


Antibiotic Attitudes and practice China General public Knowledge 



The “Young Talent Support Plan” of Xi’an Jiaotong University; the China Medical Board Open Competition Program (14–196).

Conflicts of interest


Supplementary material

11096_2017_472_MOESM1_ESM.doc (64 kb)
Supplementary material 1 (DOC 64 kb)


  1. 1.
    World Health Organization. The world health report 2007. A safer future: global public health security in the 21st century. Accessed 28 Oct 2015.
  2. 2.
    World Health Organization. WHO global strategy for containment of antimicrobial resistance. Accessed 28 Oct 2015.
  3. 3.
    Kumarasamy KK, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010;10:597–602.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    World Health Organization. Antimicrobial resistance: global report on surveillance 2014. Accessed 28 Oct 2015.
  5. 5.
    Xiao Y, Zhang J, Zheng B, et al. Changes in Chinese policies to promote the rational use of antibiotics. PLoS Med. 2013;10:e1001556.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Xiao YH, Giske CG, Wei ZQ, et al. Epidemiology and characteristics of antimicrobial resistance in China. Drug Resist Update. 2011;14:236–50.CrossRefGoogle Scholar
  7. 7.
    Xiao YH, Shen P, Wei ZQ, et al. Mohnarin report of 2011: monitoring of bacterial resistance in China. Chin J Nosocomiol. 2012;22:4946–52.Google Scholar
  8. 8.
    Taylor J, Hafner M, Yerushalmi E, et al. Estimating the economic costs of antimicrobial resistance: model and results. Accessed Oct 11 2016.
  9. 9.
    You JHS, Yau B, Choi KC, et al. Public knowledge, attitudes and behavior on antibiotic use: a telephone survey in Hong Kong. Infection. 2008;36:153–7.CrossRefPubMedGoogle Scholar
  10. 10.
    World Health Organization. Guidelines for the regulatory assessment of medicinal products for use in self-medication. Accessed 28 Oct 2015.
  11. 11.
    Council USNI. National intelligence estimate: the global infectious disease threat and its implications for the United States. ECSP Rep. 2000;6:33–65.Google Scholar
  12. 12.
    Morgan DJ, Okeke IN, Laxminarayan R, et al. Non-prescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis. 2011;11:692–701.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Grigoryan L, Haaijer-Ruskamp FM, Burgerhof JGM, et al. Self-medication with antimicrobial drugs in Europe. Emerg Infect Dis. 2006;12:452–9.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Li Y. China’s misuse of antibiotics should be curbed. BMJ. 2014;348(feb125):g1083.CrossRefPubMedGoogle Scholar
  15. 15.
    Kan Q, Wen J, Liu X, et al. Inappropriate use of antibiotics in children in China. Lancet. 2016;387:1273–4.CrossRefGoogle Scholar
  16. 16.
    Wun YT, Lam TP, Lam KF, et al. The public’s perspectives on antibiotic resistance and abuse among Chinese in Hong Kong. Pharmacoepidemiol Drug Saf. 2013;22:241–9.CrossRefPubMedGoogle Scholar
  17. 17.
    State Food and Drug Administration. The five prescription sales only antibacterial released by SFDA. Accessed 11 Oct 2016.
  18. 18.
    McNulty CAM, Boyle P, Nichols T, et al. Don’t wear me out—the public’s knowledge of and attitudes to antibiotic use. J Antimicrob Chemother. 2007;59:727–38.CrossRefPubMedGoogle Scholar
  19. 19.
    Pan H, Cui B, Zhang D, et al. Prior knowledge, older age, and higher allowance are risk factors for self-medication with antibiotics among university students in southern China. PLoS ONE. 2012;7:e41314.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Togoobaatar G, Ikeda N, Ali M, et al. Survey of non-prescribed use of antibiotics for children in an urban community in Mongolia. Bull World Health Organ. 2010;88:930–6.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Grigoryan L, Burgerhof JG, Degener JE, et al. Attitudes, beliefs and knowledge concerning antibiotic use and self-medication: a comparative European study. Pharmacoepidemiol Drug Saf. 2007;16:1234.CrossRefPubMedGoogle Scholar
  22. 22.
    Li YF, Rao KQ, Ren XW. Use of and factors associated with self-treatment in China. BMC Public Health. 2012;12:1–9.CrossRefGoogle Scholar
  23. 23.
    Gu J, Zhao J, Huang Y, et al. Use of antibiotics by urban and rural residents in Heilongjiang Province, China: cross-sectional study. Trop Med Int Health. 2015;20:1815–22.CrossRefPubMedGoogle Scholar
  24. 24.
    Sun Q, Dyar OJ, Zhao L, et al. Overuse of antibiotics for the common cold–attitudes and behaviors among doctors in rural areas of Shandong Province, China. BMC Pharmacol Toxicol. 2015;16:6.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Lv B, Zhou ZL, Xu GP, et al. Knowledge, attitudes, and practices concerning self-medication with antibiotics among university students in western China. Trop Med Int Health. 2014;19:769–79.CrossRefPubMedGoogle Scholar
  26. 26.
    Huang Y, Gu J, Zhang M, et al. Knowledge, attitude and practice of antibiotics: a questionnaire study among 2500 Chinese students. BMC Med Educ. 2013;13:163.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Zhu X, Pan H, Yang Z, et al. Self-medication practices with antibiotics among Chinese university students. Public Health. 2016;130:78–83.CrossRefPubMedGoogle Scholar
  28. 28.
    Yu M, Zhao G, Lundborg CS, et al. Knowledge, attitudes, and practices of parents in rural China on the use of antibiotics in children: a cross-sectional study. BMC Infect Dis. 2014;14:1–8.CrossRefGoogle Scholar
  29. 29.
    Sample size calculator. Accessed 28 Oct 2015.
  30. 30.
    Lim KK, Teh CC. A cross sectional study of public knowledge and attitude towards antibiotics in Putrajaya, Malaysia. South Med Rev. 2012;5:26–33.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Jose J, Jimmy B, AlSabahi AGMS, Al Sabei GA. A study assessing public knowledge, belief and behavior of antibiotic use in an Omani population. Oman Med J. 2013;28:324–30.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Ling OA, Hassali MA, Al-Haddad MS, et al. Public knowledge and attitudes towards antibiotic usage: a cross-sectional study among the general public in the state of Penang, Malaysia. J Infect Dev Ctries. 2011;5:338–47.Google Scholar
  33. 33.
    Iacobucci D, Duhachek A. Advancing alpha: measuring reliability with confidence. J Consum Psychol. 2003;13:478–87.CrossRefGoogle Scholar
  34. 34.
    Awad AI, Aboud EA. Knowledge, attitude and practice towards antibiotic use among the public in Kuwait. PLoS ONE. 2015;10:e0117910.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Napolitano F, Izzo MT, Di GG, Angelillo IF. Public knowledge, attitudes, and experience regarding the use of antibiotics in Italy. PLoS ONE. 2013;8:e84177.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Shehadeh M, Suaifan G, Darwish RM, et al. Knowledge, attitudes and behavior regarding antibiotics use and misuse among adults in the community of Jordan. A pilot study. Saudi Pharm J. 2012;20:125–33.CrossRefPubMedGoogle Scholar
  37. 37.
    Biswas M, Roy MN, Manik MI, et al. Self medicated antibiotics in Bangladesh: a cross-sectional health survey conducted in the Rajshahi City. BMC Public Health. 2014;14:847.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Ramalhinho I, Cordeiro C, Cavaco A, et al. Assessing determinants of self-medication with antibiotics among Portuguese people in the Algarve Region. Int J Clin Pharm. 2014;36:1039–47.CrossRefPubMedGoogle Scholar
  39. 39.
    Jorgji K, Bebeci E, Apostoli P, Apostoli A. Evaluation of use of antibiotics without prescription among young adults in Albania case study: Tirana and Fier District. Hippokratia. 2014;18:217–20.PubMedPubMedCentralGoogle Scholar
  40. 40.
    World Health Organization. Promoting rational use of medicines: core components. Accessed 28 Oct 20.

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  • Dan Ye
    • 1
    • 2
  • Jie Chang
    • 1
    • 2
  • Caijun Yang
    • 1
    • 2
  • Kangkang Yan
    • 1
    • 2
  • Wenjing Ji
    • 1
    • 2
  • Muhammad Majid Aziz
    • 1
    • 2
  • Ali Hassan Gillani
    • 1
    • 2
  • Yu Fang
    • 1
    • 2
    Email author
  1. 1.Department of Pharmacy Administration and Clinical Pharmacy, School of PharmacyXi’an Jiaotong UniversityXi’anChina
  2. 2.Center for Drug Safety and Policy ResearchXi’an Jiaotong UniversityXi’anChina

Personalised recommendations