在没有处方的情况下从零售药店获得抗生素已被描述为全球抗微生物耐药性(AMR)的主要贡献者。在AMR率高的背景下，中国政府最近出台了关于医院抗生素使用的严格政策，但是现有的禁止在零售药店无处方销售抗生素的禁令并没有得到强有力的执行。2016年，宣布了到2020年仅处方抗生素的目标。该研究的目的是确定实现2020年目标的进展，通过估算在中国大陆三个地区无处方销售抗生素的零售药店比例。
使用模拟患者方法，我们对东部13个省的城乡零售药店进行了针对性抽样的横断面调查，中国中部和西部。医学生介绍了轻度上呼吸道感染的情况，遵循严格的三步协议。他们记录了药房的特点，以及他们经历的细节，包括提供抗生素的步骤。
从1106家药房获得完整数据。在没有处方的情况下，在925（83.6，95％CI：81.5，85.8％）药房获得了抗生素，279（25.2％）在第1阶段（症状仅描述），576（52.1％）在阶段2（要求抗生素），在第3阶段（要求青霉素或头孢菌素）和70（6.3％）。各省之间存在显著差异,在浙江（81/82）和贵州（98.8%）之间的抗生素使用（在任何阶段）范围为57.0%（57/100）。然而,不同城市在获得抗生素方面没有显著差异，县,乡镇或村庄(P=0.25)，药房是连锁的一部分还是独立的(P=0.23)，是否有执业药剂师参加（P=0.82）或是否有迹象表明需要抗生素处方（P=0.19）。
在中国的零售药店中，无需处方即可轻松获得抗生素，尽管这是违法的.这必须作为更广泛的抗微生物管理工作的一部分来解决，其中可能包括严格执行现有法律，在公共教育运动的支持下。
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.
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.
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).
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.
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