论文标题：Widespread illegal sales of antibiotics in Chinese pharmacies – a nationwide cross-sectional study

期刊：Antimicrobial Resistance & Infection Control

作者：Jie Chen, Yanmei Wang et al

发表时间：2020/01/15

DOI：10.1186/s13756-019-0655-7

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最近发表在开放获取期刊《抗生素耐药性与感染控制》（Antimicrobial Resistance & Infection Control）上的一项研究表明，在中国的零售药店里很容易可以在没有处方的情况下买到抗生素，尽管这样销售抗生素违背了相关规定。中国浙江大学医学院的研究人员指出，还需要做更多工作来确保只能通过处方获取抗生素。

在2016年举行的二十国集团（G20）峰会上，宣布了一个解决抗生素耐药性（AMR）的全面计划，其中就包括在2020年之前在中国所有省份实现只有凭处方才可获取抗生素。作者调查了实现这项目标的进展情况，并量化了中国三个区域中无处方也可购买抗生素的药店比例。

来自浙江大学和伦敦大学学院的通讯作者Thérèse Hesketh说：“在中国政府强有力的领导下，中国医院的抗生素管理工作已有所改善，但零售药店中的情况人们所知甚少。我们记录了药店中无需处方就可获得抗生素的情况。作为控制AMR的管理工作的一部分，需要谨慎地执行有关这类销售的法规。”

作者使用“模拟病人”法，在中国的13个省份中进行了一项调查。从2017年7月至9月，四十个医学生扮作真实患者，到药店声称有轻度上呼吸道症状，但症状并不明显可见。学生们记录下了他们所到药店的特征，如地点、与最近的医院之间的距离以及是独立药店还是连锁药店。他们还记录下了体验详情，包括他们是在购药过程中的哪个阶段——描述症状，要求购买抗生素，要求购买指定的抗生素——拿到了抗生素。

作者发现，在研究涉及的共1106家药店中，有925家（83.6%）病例无需处方便可获得抗生素。在这其中，279家（25.2%）是患者只描述了轻微症状便开出了抗生素，576家（52.1%）是在患者要求购买抗生素后开出了抗生素，70家（6.3%）是在患者指定要某一种抗生素（青霉素或头孢菌素）后开出了抗生素。在没有开出抗生素的181家（16.4%）药店中，拒绝的原因包括需要处方（113家药店，10.2%）、不需要使用抗生素（58家药店，5.2%）或店里抗生素缺货（6家药店，0.5%）。

作者发现，获取抗生素的难易程度在药店的城乡位置（位于城市、县区、乡镇或乡村）之间、药店为独立或连锁之间，并无明显差异。但是在距离医院2公里以上的药店中，更容易获得抗生素。

研究结果表明，就零售药房而言，要在2020年之前实现抗生素必须凭处方获得的目标，到目前为止都进展甚微。作者认为，研究结果对药房在抗生素滥用中的潜在作用以及对AMR的贡献提出了疑虑。作者建议，药剂师需要进行培训以便向顾客解释为什么不能给他们提供抗生素，另外可能还需要进行公众教育活动，让普罗大众提高对抗生素滥用及其后果的认知。

作者提醒，由于中国的远西部和远北部并未包含在研究区域中，该研究结果的全国普适性可能受到限制。

摘要：

Background

Access to antibiotics without a prescription from retail pharmacies has been described as a major contributor to anti-microbial resistance (AMR) globally. In the context of high rates of AMR, the Chinese government has recently introduced strict policies regarding hospital antibiotic use, but the existing ban on antibiotic sales without prescription in retail pharmacies has not been strongly enforced. In 2016, a goal of prescription-only antibiotics by 2020 was announced. The objective of the study was to determine progress towards the 2020 goal, through estimating the proportion of retail pharmacies selling antibiotics without prescription across the three regions of mainland China.

Methods

Using the Simulated Patient method, we conducted a cross-sectional survey across purposively-sampled retail pharmacies in urban and rural areas of 13 provinces in eastern, central and western China. Medical students presented a scenario of a mild upper respiratory tract infection, following a strict three-step protocol. They recorded the pharmacy characteristics, and details of their experience, including at which step antibiotics were offered.

Results

Complete data were obtained from 1106 pharmacies. Antibiotics were obtained in 925 (83.6, 95% CI: 81.5, 85.8%) pharmacies without a prescription, 279 (25.2%) at Stage 1 (symptoms only described), 576 (52.1%) at stage 2 (asked for antibiotics), and 70 (6.3%) at Stage 3 (asked for penicillin or cephalosporins). There were significant differences between provinces, with antibiotic access (at any stage) ranging from 57.0% (57/100) in Zhejiang (81/82) to 98.8% in Guizhou. However, there were no significant differences in access to antibiotics by level of city, county, township or village (P = 0.25), whether the pharmacy was part of a chain or independent (P = 0.23), whether a licensed pharmacist was attending (P = 0.82) or whether there was a sign saying that prescriptions were required for antibiotics (P = 0.19).

Conclusions

It is easy to obtain antibiotics without a prescription in retail pharmacies in China, despite the fact it is against the law. This must be addressed as part of the wider anti-microbial stewardship effort which could include intense enforcement of the existing law, supported by a public education campaign.

来源：科学网