Massive misuse of antibiotics by university students in all regions of China: implications for national policy

- Chinese young adults massively misuse antibiotics for self-limiting illnesses.
- Poor knowledge is associated with more antibiotic misuse behaviours.
- Demand-side contributed over one-half of antibiotic misuse compared with supply-side.

Antimicrobial resistance (AMR) is one of the greatest threats to global health this century. The primary cause of AMR is antibiotic misuse, especially routine use of antibiotics for self-limiting illnesses. This study aimed to explore behaviours related to antibiotic use in university students across China. An electronic questionnaire was distributed at a major university in each of the six regions. A cluster random sampling method was adopted. The χ2 test and logistic regression were used to assess the relationship between knowledge and behaviour. A total of 11,192 students completed the questionnaire. In the past month, 3337 students (29.8%) reported a self-limiting illness, of whom 913 (27.3%) saw a doctor, 600 (65.7%) of whom were prescribed antibiotics [190 (31.7%) by infusion]; 136 students (22.7%) asked for and received antibiotics. Of the 1711 students (51.3%) who treated themselves, 507 (29.6%) self-medicated with antibiotics. In the past year, 23.0% of students had used antibiotics as prophylaxis, 63.1% kept a personal stock of antibiotics and 56.0% had bought antibiotics at a drugstore (two-thirds without a prescription). Students with lower knowledge scores about antibiotics were significantly more likely to see a doctor, be prescribed with antibiotics, self-medicate with antibiotics, and use antibiotics prophylactically. This massive misuse of antibiotics for self-limiting illnesses by well-educated young adults is a serious concern. A national campaign is urgently required to address rational prescribing of antibiotics by doctors, enforce existing restrictions on over-the-counter sale of antibiotics, and educate the general public about antibiotics and the management of self-limiting illnesses.