Published: 06-03-2020 15:36 | Updated: 07-07-2020 13:33

New thesis about antibiotic use in rural China

Hi there Oliver Dyer, doctoral student at the Department of Global Public Health at Karolinska Institutet. On Thursday 12 March you will defend your thesis. Tell us, what is your thesis about?

Portrait of Oliver James Dyar.

“My thesis is about responsible antibiotic use in rural China. It's increasingly clear that we need to tackle the misuse and overuse of antibiotics both for global sustainable development and to reduce social inequalities in the world. There is a need to assess how antibiotics are being used in resource-limited settings, which tend to have the highest burdens of infections and of antibiotic resistance. In such settings antibiotics are commonly overused and misused in agriculture too, so there is a need for ’One Health’ approaches that assess antibiotic use in humans and animal simultaneously.

In our studies we looked at the quality of antibiotic prescribing of doctors at different healthcare facilities in a rural area of Shandong province, and we conducted surveys with rural residents and backyard pig farmers to find out what they know about antibiotics and how they use them.”

"They were aware that antibiotics are not needed for treating the common cold, yet in practice they frequently prescribed antibiotics to patients with common cold symptoms."

What are the most important findings?

“We found that doctors, rural residents and backyard pig farmers in rural Shandong province are frequently overusing and misusing antibiotics. The majority of antibiotics prescribed at human healthcare facilities were prescribed for conditions that do not require them, and many of these antibiotics were broad spectrum antibiotics. We also found gaps between the knowledge, attitudes and actual practices of doctors. They were aware that antibiotics are not needed for treating the common cold, yet in practice they frequently prescribed antibiotics to patients with common cold symptoms.

We also found that rural residents commonly acquired antibiotics from pharmacies without prescriptions, despite this being illegal, and that they would often use antibiotics that were leftover in their homes from previous treatments. Many backyard pig farmers also reported that they routinely use antibiotics in healthy pigs. All of these practices can contribute to antibiotics being used unnecessarily or inappropriately and may result in worsening the situation of antibiotic resistance; but they can also have negative consequences for the individuals involved, such as drug side effects, impacts on their normal gut bacteria, and extra economic costs such as out-of-pocket expenditures.”

How can this knowledge contribute to improving people’s health?

"Our findings suggest several ways to improve antibiotic use in the region, investing in educating prescribers, rural residents and backyard pig farmers. There should also be efforts to restrict over-the-counter access to antibiotics, and to limit the use of antibiotics for as growth promoters for healthy animals in agriculture. We have used the results from these studies to develop and implement a pilot package of interventions to improve antibiotic use in the study region, as part of the IMPACT research programme that these studies are a part of.

Furthermore, our studies suggest that in resource-limited settings, high quality, cross-sectoral assessments of antibiotic use at a small number of study sites can provide valuable insights into how responsibly antibiotics are being used in both humans and animals.”

What are your plans for the future?

"I trained as a medical doctor before starting my PhD. After several years focussing on research, I am now looking forward to returning to work and starting my specialty training in primary care here in Sweden. Hopefully I will be able to apply many of the lessons about responsible antibiotic use that I have learnt from these studies!"