www.sciencemag SCIENCE VOL 336 18 MAY 2012 795NEWS&ANALYSIS
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E T T Y I M A G E S SHANGHAI—In a true-life drama on the Chi-ne talk show Shihou Zhu Geliang , a young man has so little confi dence in the hygiene of his company’s cafeteria that he supple-ments each meal with antibiotics. That is his undoing. When the man later falls ill, drugs fail to save him. An autopsy reveals why: His body is riddled with multiple strains of drug-resistant bacteria.The ca may have been extreme, but Shi-hou Zhu Geliang had a rious message. The episode accompanied a government-led cru-sade to warn Chine against the perils of frivolous antibiotic consumption. The cam-paign culminated last week in a Health Min-istry directive laying out stricter regulations for prescription drugs. “Problems with public awareness and with doctors’ [pre-scribing] habits have led to exces-sive antibiotic u in China,” says Ni Y uxing, head of the clini-cal microbiology department at Ruijin Hospital here. “And that has created resistant bacteria.”Bacteria that cannot be stopped by common drugs are proliferat-ing around the world (Science , 18 July 2008, p. 356). But a health care system that encourages doc-tors to churn out prescriptions, intensive marketing by pharma-ceutical co
mpanies, and heavy u of antibiotics in animal hus-bandry and fi sheries make China a special ca. More than 60% of Staphylococcus aureus isolates from Chine patients in surveyed hospitals in 2009 were methicillin-resistant—the dreaded MRSA—up from 40% in 2000. The proportion of Streptococcus pneumoniae isolates resistant to macrolides, meanwhile, now tops 70%. Roughly the same share of Escherichia coli isolates are resistant to qui-nolones—the highest rate in the world.China’s health ministry hopes to ward off calamitous outbreaks of drug-resistant strains. The new regulations, which take effect 1 August, are the latest in a string of measures that started with the launch of a drug-resistance-monitoring network in 2004 and an ambitious 3-year program, now in progress, to combat the overprescription of drugs. But critics say that without an overhaul of the health care system, the new measures may have limited success. “Antibiotic resistance is a rious public health threat in China,” says Xiao Y onghong, an infectious dia specialist at Zhe j iang University in Hangzhou. He overes the Health Ministry’s National Antibacterial Resistance Investigation Net, which cov-ers 80 hospitals nationwide. Drug resistance is most acute in denly populated cities in the east. Erythromycin-resistant S. pneu-moniae , for example, appeared in 94% of iso-lates from children tested in hospitals here in 2004 and 2005. The sole strains of common drug-resistant bacteria not thriving in China are vancomycin-resistant Enterococci , Xiao says: “That’s the only good news.”China’s woes are in part the conquence of e
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arlier health care reforms. Until the early 1980s, China had government- p rovisioned care bolstered by “barefoot doctors”: min-imally trained health workers who min-istered to patients in remote areas. But near-universal care was ultimately scrapped in favor of a free-market approach. Hospi-tals needed new revenue streams.A burgeoning drug industry came to the rescue. The government allowed hospi-tals to skim a 15% profi t from pharmaceuti-cal sales, and doctors’ pay was soon linked to sales. Overprescription became rampant. “The whole thing really boils down to per-ver incentives,” says Lucy Reynolds, a public health expert at the London School of Hygiene and Tropical Medicine’s European Centre on Health of Societies in Transition. By the 1990s, Xiao, who then worked in a hospital in Chongqing, noticed that some-thing was awry: “Patients weren’t respond-ing to treatment.”In the meantime, growing numbers of Chine farmers discovered that rearing livestock on antibiotics yielded larger ani-mals and boosted profits. In a 2007 sur-vey, Xiao estimated that nearly half of the 210,000 tons of antibiotics produced in China end up in animal feed. The U.S. Food and Drug Administration warned in 2007 that Chine farm-raid fi sh are laced with fl uoroquinolones and other antibiotics not approved for u in U.S. afood.
Tho drugs fi nd their way into the human gut. In an unpublished study, Zhu Baoli of the Institute of Microbiology in Beijing and colleagues quenced gut microbes in Chi-ne, Danish, and Spanish people. Chine guts had the highest number of antibiotic-resistant genes. They were also dominated by genes resistant to tetracycline, which in China is mostly ud in animal feed. While that might not affect clinical treatment with drugs other than tetracycline, Zhu says, “some drugs that are ud in animals are also ud in humans.”China’s woes extend beyond the doctor’s office and the din-ner table. As the story of the man worried about cafeteria food shows, some Chine pop antibi-otics the way Americans pop vita-mins. Until 2004, antibiotics were legally available over the c
ounter in China, and families sometimes kept a stash at home. In 2010, the Health Minis-try parated doctors’ pay from prescription drug sales. Its new directive goes further, by requiring that drugs be divided into three class, with drugs with the highest resistance rates to be prescribed only by specialists. Violators can lo pre-scription rights or their medical licen, while offending hospitals can be fi ned. But the government has not offered hospitals an alternative source of funding to replace drug profi ts. “A comprehensive overhaul” is needed, Reynolds says.
Even with further reforms, significant obstacles remain. In a survey in Guizhou Province in southwest China, Reynolds found that many doctors mistakenly believed their patients—not the bacteria inhabiting their bodies—had developed antibiotic resistance. Meanwhile, resistance is climbing. Says Zhu: “Y ou now have genes resistant to almost every antibiotic available on the market.”–MARA HVISTENDAHL
China Takes Aim at Rampant Antibiotic Resistance四年级上册数学解决问题
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On the drip. In China, antibiotics are commonly taken intravenously for colds and other maladies that are often treated less aggressively in the west.Published by AAAS o n M a y 17, 2012w w w .s c i e n c e m a g .o r g D o w n l o a d e d f r o m
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