Submit to Antibiotics Review for Antibiotics Propose a Special Issue

Journal Menu

Journal Browser

Appropriateness of Antibiotics in China

Print Special Issue Flyer
Special Issue Editors
Special Issue Information
Keywords
Published Papers

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 22249

Share This Special Issue

Special Issue Editors

Prof. Dr. Siyan Zhan

E-Mail Website
Guest Editor

Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Interests: pharmacoepidemiology; clinical epidemiology and evidence-based medicine
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Suodi Zhai

E-Mail Website
Guest Editor

Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China;
Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
Interests: evidence-based pharmacy; therapeutic drug monitoring; clinical pharmacy
Special Issues, Collections and Topics in MDPI journals

Dr. Pengxiang Zhou

E-Mail Website
Guest Editor

Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China
Interests: evidence-based pharmacy; clinical practice guidelines evaluation and development; clinical pharmacy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

From the ancient quinine to the newly synthesized oxazolidinones, antibiotics have drastically changed human civilization and modern medicine in just over 100 years. In medical institutions, antibiotics could be widely prescribed across all departments, patients and treatment places. In the community pharmacy, antibiotics are one of the most commonly prescribed drugs. The appropriateness of antibiotics is a global issue and is mainly associated with factors such as antibacterial resistance evaluation, the rational choice of drugs, the optimization of drug usage and dosage, and the management of drug adverse reaction and costs.

In China, antibiotic use has been strictly managed in hospitals, considering how widely it is used, the expenditure and the serious consequences of antimicrobial abuse. Additionally, the bacterial resistance surveillance system is relatively well established in China, providing antibacterial resistance data for guidance on the appropriateness of antibiotics. Nevertheless, with the increasing complexity of clinical infection, the rational use of antibiotics in China still needs further research and improvement.

This Special Issue will focus on the appropriateness of antibiotics in China and invite scholars to report the latest research and review results. This Special Issue also seeks manuscript submissions that further improve our understanding and experience of rational antibiotic use in China.

Prof. Siyan Zhan
Prof. Dr. Suodi Zhai
Dr. Pengxiang Zhou
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

appropriateness of antibiotics
China
bacterial resistance
optimization of antibiotics usage and dosage
prescription
medical institution
community pharmacy

Published Papers (9 papers)

Download All Papers

Research

Jump to: Review

19 pages, 17804 KiB

Open AccessArticle

Factors Affecting Voriconazole Trough Concentration and Optimal Maintenance Voriconazole Dose in Chinese Children

by Yi-Chang Zhao, Yang Zou, Jing-Jing Hou, Chen-Lin Xiao, Bi-Kui Zhang, Jia-Kai Li, Da-Xiong Xiang, Indy Sandaradura and Miao Yan

Antibiotics 2021, 10(12), 1542; https://doi.org/10.3390/antibiotics10121542 - 16 Dec 2021

Cited by 8 | Viewed by 2422

Abstract

Voriconazole is a triazole antifungal agent commonly used for the treatment and prevention of invasive aspergillosis (IA). However, the study of voriconazole's use in children is limited. The present study was performed to explore maintenance dose to optimize voriconazole dosage in children and the factors affecting voriconazole trough concentration. This is a non-interventional retrospective clinical study conducted from 1 January 2016 to 31 December 2020. The study finally included 94 children with 145 voriconazole trough concentrations. The probability of achieving a targeted concentration of 1.0–5.5 µg/mL with empiric dosing increased from 43 (45.3%) to 78 (53.8%) after the TDM-guided adjustment. To achieve targeted concentration, the overall target maintenance dose for the age group of less than 2, 2 to 6, 6 to 12, and 12 to 18 years old was approximately 5.71, 6.67, 5.08 and 3.31

mg \cdot {kg}^{- 1} / 12 h

, respectively (p < 0.001). Final multivariate analysis found that weight (p = 0.019), dose before sampling (p < 0.001), direct bilirubin (p < 0.001), urea nitrogen (p = 0.038) and phenotypes of CYP2C19 were influencing factors of voriconazole trough concentration. These factors can explain 36.2% of the variability in voriconazole trough concentration. Conclusion: In pediatric patients, voriconazole maintenance doses under the target concentration tend to be lower than the drug label recommended, but this still needs to be further studied. Age, body weight, dose, direct bilirubin, urea nitrogen and phenotypes of CYP2C19 were found to be influencing factors of voriconazole concentration in Chinese children. The influence of these factors should be taken into consideration during voriconazole use. Full article

(This article belongs to the Special Issue Appropriateness of Antibiotics in China)

► Show Figures

Figure 1

11 pages, 1253 KiB

Open AccessArticle

Dose Optimization of Vancomycin for Critically Ill Patients Undergoing CVVH: A Prospective Population PK/PD Analysis

by Chuhui Wang, Chao Zhang, Xiaoxiao Li, Sixuan Zhao, Na He, Suodi Zhai and Qinggang Ge

Antibiotics 2021, 10(11), 1392; https://doi.org/10.3390/antibiotics10111392 - 13 Nov 2021

Cited by 7 | Viewed by 1881

Abstract

The optimal dose of vancomycin in critically ill patients receiving continuous venovenous hemofiltration (CVVH) remains unclear. The objective of this study was to identify factors that significantly affect pharmacokinetic profiles and to further investigate the optimal dosage regimens for critically ill patients undergoing CVVH based on population pharmacokinetics and pharmacodynamic analysis. A prospective population pharmacokinetic analysis was performed at the surgical intensive care unit in a level A tertiary hospital. We included 11 critically ill patients undergoing CVVH and receiving intravenous vancomycin. Serial blood samples were collected from each patient, with a total of 131 vancomycin concentrations analyzed. Nonlinear mixed effects models were developed using NONMEM software. Monte Carlo Simulation was used to optimize vancomycin dosage regimens. A two-compartment model with first-order elimination was sufficient to characterize vancomycin pharmacokinetics for CVVH patients. The population typical vancomycin clearance (CL) was 1.15 L/h and the central volume of distribution was 16.9 L. CL was significantly correlated with ultrafiltration rate (UFR) and albumin level. For patients with normal albumin and UFR between 20 and 35 mL/kg/h, the recommended dosage regimen was 10 mg/kg qd. When UFR was between 35 and 40 mL/kg/h, the recommended dosage regimen was 5 mg/kg q8h. For patients with hypoalbuminemia and UFR between 20 and 25 mL/kg/h, the recommended dosage regimen was 5 mg/kg q8h. When UFR was between 25 and 40 mL/kg/h, the recommended dosage regimen was 10 mg/kg q12h. We recommend clinicians choosing the optimal initial vancomycin dosage regimens for critically ill patients undergoing CVVH based on these two covariates. Full article

(This article belongs to the Special Issue Appropriateness of Antibiotics in China)

► Show Figures

Figure 1

10 pages, 1081 KiB

Open AccessArticle

Outpatient Antibiotic Prescribing Patterns and Appropriateness for Children in Primary Healthcare Settings in Beijing City, China, 2017–2019

by Haishaerjiang Wushouer, Kexin Du, Shicai Chen, Yue Zhou, Bo Zheng, Xiaodong Guan and Luwen Shi

Antibiotics 2021, 10(10), 1248; https://doi.org/10.3390/antibiotics10101248 - 14 Oct 2021

Cited by 10 | Viewed by 1817

Abstract

(1) Background: Few studies have focused on antibiotic use and appropriateness in children in primary health institutions (PHIs). This study aimed to identify the patterns and appropriateness of antibiotic use for children in PHIs in Beijing, China. (2) Methods: Outpatient prescriptions of 327 PHIs from 2017 to 2019 for patients <18 years old were collected. Prescriptions were described using quantity indicators. Antibiotics were categorized according to ATC classification J01 and Access, Watch, Reserve grouping. Appropriateness was reviewed by experts using three subtypes of irrational prescriptions (irregular, inappropriate, and abnormal). (3) Results: 20,618 prescriptions were collected in total. The antibiotic prescription rate (APR) was 15.1% (N = 3113). Among antibiotic prescriptions, J01FA Macrolides were the most used (N = 1068, 34.9%). The Watch group constituted 89.0% (N = 2818) of total antibiotic use. Bronchitis (N = 1059, 35.2%) was the most common diagnosis. A total of 292 instances of irrational antibiotic use were identified, with inappropriate prescriptions being the most prevalent subtype (N = 233, 79.8%). (4) Conclusion: Although APR for children in PHIs in Beijing was relatively low, the pattern of antibiotic use differed from other countries. Further studies are needed to optimize antibiotic use for children in PHIs under different levels of economic development. Full article

(This article belongs to the Special Issue Appropriateness of Antibiotics in China)

► Show Figures

Figure 1

10 pages, 2156 KiB

Open AccessArticle

Population Pharmacokinetic Modeling and Dose Optimization of Vancomycin in Chinese Patients with Augmented Renal Clearance

by Sixuan Zhao, Na He, Yahui Zhang, Chuhui Wang, Suodi Zhai and Chao Zhang

Antibiotics 2021, 10(10), 1238; https://doi.org/10.3390/antibiotics10101238 - 12 Oct 2021

Cited by 6 | Viewed by 1780

Abstract

Patients with augmented renal clearance (ARC) have been described as having low vancomycin concentration. However, the pharmacokinetic model that best describes vancomycin in patients with ARC has not been clarified. The purpose of this study is to determine the pharmacokinetic of vancomycin in Chinese adults and the recommend dosage for patients with different renal function, including patients with ARC. We retrospectively collected 424 vancomycin serum concentrations from 209 Chinese patients and performed a population pharmacokinetic model using NONMEM 7.4.4. The final model indicated that the clearance rate of vancomycin increased together with the creatinine clearance, and exhibited a nearly saturated curve at higher creatinine clearance. The estimated clearance of vancomycin was between 3.46 and 5.58 L/h in patients with ARC, with 5.58 being the maximum theoretical value. The central volume of distribution increased by more than three times in patients admitted to Intensive Care Unit. Monte Carlo simulations were conducted to explore the probability of reaching the target therapeutic range (24-h area under the curve: 400–650 mg·h/L, trough concentration: 10–20 mg/L) when various dose regimens were administered. The simulations indicated that dose should increase together with the creatinine clearance until 180 mL/min. These findings may contribute to improving the efficacy and safety of vancomycin in patients with ARC. Full article

(This article belongs to the Special Issue Appropriateness of Antibiotics in China)

► Show Figures

Figure 1

14 pages, 1470 KiB

Open AccessArticle

Predictors of Voriconazole Trough Concentrations in Patients with Child–Pugh Class C Cirrhosis: A Prospective Study

by Yichang Zhao, Jingjing Hou, Yiwen Xiao, Feng Wang, Bikui Zhang, Min Zhang, Yongfang Jiang, Jiakai Li, Guozhong Gong, Daxiong Xiang and Miao Yan

Antibiotics 2021, 10(9), 1130; https://doi.org/10.3390/antibiotics10091130 - 20 Sep 2021

Cited by 10 | Viewed by 2186

Abstract

This prospective observational study aimed to clinically describe voriconazole administrations and trough concentrations in patients with Child–Pugh class C and to investigate the variability of trough concentration. A total of 144 voriconazole trough concentrations from 43 Child–Pugh class C patients were analyzed. The majority of patients (62.8%) received adjustments. The repeated measured trough concentration was higher than the first and final ones generally (median, 4.33 vs. 2.99, 3.90 mg/L). Eight patients with ideal initial concentrations later got supratherapeutic with no adjusted daily dose, implying accumulation. There was a significant difference in concentrations among the six groups by daily dose (p = 0.006). The bivariate correlation analysis showed that sex, CYP2C19 genotyping, daily dose, prothrombin time activity, international normalized ratio, platelet, and Model for end-stage liver disease score were significant factors for concentration. Subsequently, the first four factors mentioned above entered into a stepwise multiple linear regression model (variance inflation factor <5), implying that CYP2C19 testing makes sense for precision medicine of Child–Pugh class C cirrhosis patients. The equation fits well and explains the 34.8% variety of concentrations (R² = 0.348). In conclusion, it needs more cautious administration clinically due to no recommendation for Child–Pugh class C patients in the medication label. The adjustment of the administration regimen should be mainly based on the results of repeated therapeutic drug monitoring. Full article

(This article belongs to the Special Issue Appropriateness of Antibiotics in China)

► Show Figures

Figure 1

10 pages, 1471 KiB

Open AccessArticle

Comparison of Pharmaceutical Characteristics between Brand-Name Meropenem and Its Generics

by Ping Yang, Shigeru Fujimura, Yawei Du, Bei Zhang, Li Yang, Masato Kawamura, Zhenhua Zhang and Suodi Zhai

Antibiotics 2021, 10(9), 1096; https://doi.org/10.3390/antibiotics10091096 - 10 Sep 2021

Cited by 1 | Viewed by 2667

Abstract

This study aimed to provide comparative information of pharmaceutical properties, including particle morphology and distribution uniformity, solubility, presence of residual solvent and insoluble particles, and antimicrobial activities, between brand-name meropenem (Mepem^®, BNM) and its six generic products (GPs A-F) marketed in China. Particles of GP-A and -C in dry powder had similar diameters of BNM, while other GPs were larger. Only BNM and GP-A were completely dissolved within 100 s in the lab condition. No insoluble particles >25 μm in diameter were detected in BNM and GP-E. Regarding stability of GPs solutions evaluated by concentration of open-ring metabolites at 6 h and 8 h, BNM showed the lowest open-ringed metabolite concentrates. Residual solvent of acetone detected in one GP showed the maximum value, while ethanol and ethyl acetate were detected both in product E and product F. The concordance rates (%) of minimum inhibitory concentration (MIC) of each generic compared to BNM were 89.5, 85, 87.5, 88, 88.5, and 86.5, respectively, although no significant difference was reached in MIC. Pharmaceutical characteristic differences between the BNM and GPs identified in this study could provide insights into understanding the deviations in the drug manufacturing processes of generic drugs. Full article

(This article belongs to the Special Issue Appropriateness of Antibiotics in China)

► Show Figures

Figure 1

16 pages, 563 KiB

Open AccessArticle

Antibiotic Prescriptions among China Ambulatory Care Visits of Pregnant Women: A Nationwide Cross-Sectional Study

by Houyu Zhao, Mei Zhang, Jiaming Bian and Siyan Zhan

Antibiotics 2021, 10(5), 601; https://doi.org/10.3390/antibiotics10050601 - 19 May 2021

Cited by 7 | Viewed by 2304

Abstract

Background: Antibiotic use in pregnant women at the national level has rarely been reported in China. Objectives: We aimed to investigate antibiotic prescriptions during pregnancy in ambulatory care settings in China. Methods: Data of 4,574,961 ambulatory care visits of pregnant women from October 2014 to April 2018 were analyzed. Percentages of Antibiotic prescriptions by different subgroups and various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Food and Drug Administration (FDA) pregnancy categories were used to describe the antibiotic prescription patterns. The 95% confidence intervals (CIs) were estimated using the Clopper––Pearson method or Goodman method. Results: Among the 4,574,961 outpatient visits during pregnancy, 2.0% (92,514 visits; 95% CI, 2.0–2.0%) were prescribed at least one antibiotic. The percentage of antibiotic prescriptions for pregnant women aged >40 years was 4.9% (95% CI, 4.7–5.0%), whereas that for pregnant women aged 26–30 years was 1.5% (95% CI, 1.4–1.5%). In addition, percentages of antibiotic prescriptions varied among different trimesters of pregnancy, which were 5.4% (95% CI, 5.3–5.4%) for the visits in the first trimester of pregnancy and 0.5% (95% CI, 0.4–0.5%) in the third trimester of pregnancy. Furthermore, the percentages of antibiotic prescriptions substantially varied among different diagnosis categories and nearly three-quarters of antibiotic prescriptions had no clear indications and thus might be inappropriate. In total, 130,308 individual antibiotics were prescribed; among these, 60.4% (95% CI, 60.0–60.8%) belonged to FDA category B, 2.7% (95% CI, 2.1–3.5%) were classified as FDA category D and 16.8% (95% CI, 16.2–17.4%) were not assigned any FDA pregnancy category. Conclusions: Antibiotic prescriptions in ambulatory care during pregnancy were not highly prevalent in mainland China. However, a substantial proportion of antibiotics might have been prescribed without adequate indications. Antibiotics whose fetal safety has not been sufficiently illustrated were widely used in pregnant women. Full article

(This article belongs to the Special Issue Appropriateness of Antibiotics in China)

► Show Figures

Figure 1

Review

Jump to: Research

11 pages, 251 KiB

Open AccessReview

The Progress of Global Antimicrobial Resistance Governance and Its Implication to China: A Review

by Jia Yin, Yu Wang, Xueran Xu, Yinqi Liu, Lu Yao and Qiang Sun

Antibiotics 2021, 10(11), 1356; https://doi.org/10.3390/antibiotics10111356 - 06 Nov 2021

Cited by 16 | Viewed by 2873

Abstract

China has great potential for engaging in global actions on antimicrobial resistance (AMR) control. This study aims to summarize the process of global AMR governance and provide relevant policy recommendations on how China could take more initiative in the global AMR governance. We searched for academic articles and official document published or issued before December 2020 in e-journal databases, official websites of major organizations, and the relevant national ministries. This review revealed that global action on AMR control has experienced three stages: (1) The beginning stage (1980s and 1990s) when actions were mainly sponsored by high-income countries and AMR surveillance was focused on hospitals; (2) The rapid development stage (2000–2010) when global AMR governance began to concentrate on joint actions in multi-sectors, and developing countries were gradually involved in global actions; (3) The comprehensive stage (2011 to present) when global actions on AMR have covered various fields in different countries. China’s AMR governance has fallen behind at the beginning but recently began to catch up with the global trend. The central government should take a far-fetched view, act decisively and positively towards the global efforts of addressing AMR to play a more active and greater role on the international stage. Full article

(This article belongs to the Special Issue Appropriateness of Antibiotics in China)

17 pages, 432 KiB

Open AccessReview

Extended or Continuous Infusion of Carbapenems in Children with Severe Infections: A Systematic Review and Narrative Synthesis

by Pengxiang Zhou, Yahui Zhang, Zhenhuan Wang, Yingqiu Ying, Yan Xing, Xiaomei Tong and Suodi Zhai

Antibiotics 2021, 10(9), 1088; https://doi.org/10.3390/antibiotics10091088 - 09 Sep 2021

Cited by 8 | Viewed by 2745

Abstract

We systematically reviewed the efficacy and safety of an extended or continuous infusion (EI/CI) versus short-term infusion (STI) of carbapenems in children with severe infections. Databases, including PubMed, Embase, the Cochrane Library, Clinicaltrials.gov, China National Knowledge Infrastructure, WanFang Data, and SinoMed, were systematically searched from their inceptions to 10 August 2020, for all types of studies (such as randomized controlled trials (RCTs), retrospective studies, and pharmacokinetic or population pharmacokinetic (PK/PPK) studies) comparing EI/CI versus STI in children with severe infection. There was no limitation on language, and a manual search was also conducted. The data were screened, evaluated, extracted, and reviewed by two researchers independently. Quantitative (meta-analysis) or qualitative analyses of the included studies were performed. Twenty studies (including two RCTs, one case series, six case reports, and 11 PK/PPK studies) were included in this review (CRD42020162845). The RCTs’ quality evaluation results revealed a risk of selection and concealment bias. Qualitative analysis of RCTs demonstrated that, compared with STI, an EI (3 to 4 h) of meropenem in late-onset neonatal sepsis could improve the clinical effectiveness and microbial clearance rates, and reduce the rates of mortality; however, the differences in the incidence of other adverse events were not statistically significant. Retrospective studies showed that children undergoing an EI of meropenem experienced satisfactory clinical improvement. In addition, the results of the PK/PPK study showed that an EI (3 or 4 h)/CI of carbapenems in severely infected children was associated with a more satisfactory goal achievement rate (probability of target attainment) and a cumulative fraction of response than STI therapy. In summary, the EI/CI of carbapenems in children with severe infection has a relatively sufficient PK or pharmacodynamic (PD) basis and satisfactory efficacy and safety. However, due to the limited quantity and quality of studies, the EI/CI therapy should not be used routinely in severely infected children. This conclusion should be further verified by more high-quality controlled clinical trials or observational studies based on PK/PD theories. Full article

(This article belongs to the Special Issue Appropriateness of Antibiotics in China)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Appropriateness of Antibiotics in China

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Published Papers (9 papers)

Research

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI