- The Washington Times - Thursday, January 29, 2004

BEIJING — Whenever Ye Zhiming feels a cold coming on and gets that scratchy feeling in his throat, he goes to a drugstore and buys some antibiotics.

“I used to go to the doctor for a prescription,” said Mr. Ye, 37, an office clerk. “Now I just buy it myself. I know what works for me.”

It costs him about 60 cents for a box of 24 spiramycin capsules.

Buying any of a range of powerful antibiotics in China is as easy as buying aspirin — not that a doctor would have refused him a prescription. Up to 90 percent of people who visit hospitals in China are given some type of antibiotic.

The overuse of antibiotics has resulted in a new generation of drug-resistant “supergerms” in the world’s most populous country.

Drug resistance has become an urgent problem in many countries, but the danger has arisen especially quickly in China, where rapid improvements in living standards have allowed people access to better health care. Resistance rates that took the United States decades to reach have been surpassed by China in just 10 years.

Germ-killing antibiotics have saved millions of lives throughout the world in the last half-century. But because antibiotics widely have been misused and overused, the bacteria they were meant to kill are able to mutate.

The U.S. Centers for Disease Control and Prevention has called it one of the most pressing global health problems. With some pathogens becoming more virulent than ever, doctors are running out of drugs to treat them. The Atlanta-based agency initiated a national campaign in the United States in September on proper antibiotic use.

In China, growing global ties mean that public-health problems are no longer just domestic problems.

“The faster we internationalize, the faster the germs will spread,” said Xiao Yonghong, deputy director of the Institute of Clinical Pharmacology at Peking University. Dr. Xiao said the levels of resistance are alarming.

In the United States, 6 percent of cases of infection by E. coli are resistant to Ciproflaxacin, recently best-known as the antibiotic used to fight anthrax, but in China 70 percent of E. coli cases are resistant to the drug.

Resistance of MRSA, the staphylococcus bacterium that is the main cause of hospital infections, is also 70 percent, twice the rate in the United States. Gonorrhea in China is 85 percent resistant to penicillin, more than four times the level in Australia.

Tuberculosis had been under control in China, but its growing resistance to multidrug treatment is the main reason for the recent increase of the disease, Dr. Xiao said.

“In America it’s simple to get a gun, but at least you need a doctor’s prescription to get an antibiotic,” said Dr. Xiao, an authority on drug-resistant infections.

The government has issued no guidelines on antibiotic use and no specific policies for combating drug resistance, Dr. Xiao said. Still, the outbreak last year of severe acute respiratory syndrome (SARS) has heightened awareness.

“The entire society and government leaders now know the concept of public health,” Dr. Xiao said.

Aware of the widespread abuse, government authorities have announced that a doctor’s prescription will be required starting in July. Chinese news outlets also have started running stories about the issue.

“I’ve seen programs on TV,” said Mr. Ye. “But they don’t tell you if you don’t take antibiotics, what else you can take.”

Some wonder whether the new restrictions can be implemented, because a doctor’s prescription already is required for antibiotics and has been for years. But the law is virtually never enforced.

Zhang Aiqin, head pharmacist at Beijing’s Anzhen Hospital, said the rule won’t work in China with its lax regulations of prescriptions and vast population.

“How will each drugstore identify which doctor and which hospital wrote the prescription? How are they going to check?” she said. “It can’t be done in China.”

Even if prescriptions could be verified, it would not control the offhand ways in which doctors prescribe antibiotics.

“Doctors say they’re rushed and don’t have time, or they just want to be sure, or patients demand them,” said Dr. Zhang. “They have all sorts of excuses, but in a word, it’s just reckless.”

Hospitals rely on drug sales for the bulk of their revenue. Often, doctors get commissions from drug companies. Outpatients pay less than $1 to see a doctor, maybe $2 for a specialist, but might spend $30 or more on drugs. For inpatients, half of their hospital bills could be for antibiotics, the Beijing Daily said.

“They always ask if we have medical coverage or if we’re paying ourselves,” said Mr. Ye. “If we have coverage, they always prescribe more drugs, and more expensive drugs.”

Kitty Tempel, an American living in Beijing, found herself at a small city hospital last month after a bicycle accident in southwestern China. Her shoulder was banged up, but she wasn’t bleeding, and X-rays confirmed she didn’t have a fracture. Then the doctor asked her if she wanted some medicine.

“He gave me Amoxicillin,” a penicillinlike antibiotic, she said. “He had a cigarette in his mouth the entire time.”

The situation is worse in bigger cities.

Two years ago, the magazine Capital Medicine sent five young reporters to 49 hospitals in Beijing. The five initially were confirmed to have no respiratory symptoms but went to the hospitals complaining of cough, sore throat and other mild symptoms. Doctors at 32 of the hospitals, which included some of the best in the city, prescribed antibiotics.

Because hospitals are so afraid of dealing with infections, some immediately will give patients vancomycin, a powerful antibiotic that is known in the United States as “the drug of last resort.”

That, said Dr. Philip Jenkins, a World Health Organization authority on drug resistance, “is the last thing we want.”

Besides the public-health threat, inappropriate use of antibiotics can be perilous to the patients taking them. Allergies, organ damage and other complications from antibiotic use lead to 80,000 deaths a year in China, Dr. Zhang said.

As in the United States, drug resistance in China also is spread through the food supply.

“Use of antibiotics in agriculture far exceeds that in medicine,” said Dr. Xiao.

In recent years, European countries have banned imports of Chinese shrimp, honey and chicken because of excessive levels of antibiotics. Dairy cows are given large amounts of antibiotics, too, but milk generally is not inspected.

There is little oversight of livestock farming, and enforcement of standards — where they exist — is minimal. The administrative issue falls into a black hole because it’s unclear which agency should be in charge.

“Right now, inspection and control pretty much depend on conscience,” a Guangdong provincial agriculture official was quoted as saying in the Southern Daily newspaper.

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