Abstract：
Antibiotic use, particularly inappropriate use by irrational prescribing or over-the-counter purchases, is of great concern for China as it facilitates the spread of antibiotic resistances. In this study, we applied wastewater-based epidemiology (WBE) to monitor the total consumption of eight common antibiotics in three cities in northern, eastern and southern China. Wastewater samples were successively collected from 17 wastewater treatment plants including weekdays and weekends spanning four seasons between 2019 and 2021. The concentration of antibiotics and their corresponding metabolites showed a significant correlation, confirming the measured antibiotics were actually consumed. Different seasonal trends in antibiotic use were found among the cities. It was more prevalent in the winter in the northern city Beijing, with the high antibiotic consumption attributed to peak influenza occurrence in the city. This is clear evidence of irrational prescription of antibiotics since it\'s known that antibiotics do little to treat influenza. In terms of overall consumption, Foshan is significantly lower, thanks to warmer climate and higher use of herbal tea as a prevention measure. WBE estimates of antibiotic consumption were relatively comparable with other data sources, with azithromycin as the top antibiotic measured here. The studied cities had higher WBE estimated antibiotics consumption than results of previous studies in the literature. Monitoring antibiotic use in different areas and periods through WBE in combination with complementary information, can better inform appropriate antibiotic guideline policies in various regions and nations.
摘要：
抗生素的使用，特别是不合理的处方或非处方药的不当使用，这是中国非常关注的问题，因为它促进了抗生素耐药性的传播。在这项研究中,我们应用基于废水的流行病学（WBE）来监测北方三个城市八种常见抗生素的总消费量，中国东部和南部。在2019年至2021年之间，从17个污水处理厂连续收集了废水样本，包括工作日和周末，跨越四个季节。抗生素及其相应代谢产物的浓度呈显著相关,确认测量的抗生素实际消耗。在城市中发现了不同的抗生素使用季节性趋势。它在北方城市北京的冬天更普遍，抗生素的高消费归因于该市流感的高峰发生。这是抗生素处方不合理的明确证据，因为已知抗生素对治疗流感作用不大。从整体消费来看,佛山明显较低，由于气候变暖和更多地使用凉茶作为预防措施。WBE对抗生素消费量的估计与其他数据来源相对可比，阿奇霉素作为这里测量的顶级抗生素。研究城市的WBE估计抗生素消费量高于文献中先前研究的结果。结合补充信息，通过WBE监测不同地区和时期的抗生素使用情况，可以更好地为不同地区和国家的适当抗生素指南政策提供信息。
