China is stepping up efforts to crack down on widespread prescription drug abuse that is leading to rising levels of antibiotic resistance across the country.

Children are put on drip in the crowded transfusion room of the pediatrics department at the Huangshi Central Hospital in Hubei province in June. Qiu Xiaowei / China Daily

In the latest move to tackle the problem, the Ministry of Health has launched a nationwide surveillance system to document cases of antibiotic-resistant bacteria at 1,349 large public hospitals across the mainland.

There will also be closer monitoring of the system that keeps track of doctors' prescriptions of antibiotics at public hospitals.

And tough new regulations to control the clinical use of antibiotics will take effect on Aug 1.

The moves come days after the World Health Organization weighed in on the growing threat from worldwide antibiotic-resistant gonorrhea. In a statement, the WHO warned that millions of people with gonorrhea could be at risk of running out of treatment options unless urgent action is taken.

Several countries, including Australia, France, Japan, Norway and Sweden, have reported cases of resistance to cephalosporin antibiotics — the last treatment option against the sexually-transmitted disease.

"Antibiotic resistance has no borders, and curbing its misuse is a responsibility shared by all," said Zhao Minggang, deputy director of the department of medical administration under the ministry.

"The ministry's latest initiative will help health authorities to accurately track the use of antibiotic drugs in real time and detect potential cases of antibiotic resistance as soon as possible to better guide clinical drug use in general."

Zhao said it usually takes 10 years to develop new antibiotics, but bacterial resistance develops within two years, largely due to antibiotic abuse.

The ministry estimates that an average of 138 grams of antibiotics are used per person on the mainland each year, nearly 10 times the amount in the United States.

Seventy percent of inpatients and 50 percent of outpatients have prescriptions for antibiotics, according to the ministry.

"Without intervention, there may come a time when there are no effective antibiotics left," Zhao said.

Xiao Yonghong, an expert with the Institute of Clinical Pharmacology at Peking University, said at least 80 percent of the antibiotics used on the mainland are not necessary.

"This drives up medicine costs for the patients and the country," Xiao said. "This helps speed up the development of germs resistant to antibiotics, which might cost lives and jeopardize human safety and health."

Xiao said antibiotic resistance is now widespread on the Chinese mainland but the types of antibiotics, and the severity of the issue, vary regionally.

Research has shown each year deaths related to antibiotic abuse total 80,000 on the Chinese mainland and cost 80 billion yuan ($13 billion) of the medical budget.

The ministry has now introduced a series of measures, including regulations many have said are the most stringent yet, to regulate the clinical use of antibiotics, which now account for 74 percent of total medicine usage, about 20 to 50 percent more than in Western countries.

The regulation will take effect on Aug 1.

It will restrict the amount of antibiotics allowed to be prescribed.

It will specify the amount of antibiotics that can be purchased and prescribed by hospitals specializing in stomatology, psychosis, oncology, pediatrics, gynecology and obstetrics.

Hospitals graded at the top level, three A, are only allowed to purchase 50 types of antibiotics, and hospitals at level two are only permitted 35 different kinds of drugs.

The regulation also stipulates that less than 60 percent of inpatients are allowed to take antibiotics, and no more than 20 percent of outpatients are allowed an antibiotic prescription.

"At present, a majority of large hospitals couldn't meet that target," said Lin Shaobin, deputy director of Fuzhou Second Hospital.

He said overprescription of antibiotics was largely related to the longtime clinical habits of doctors and hospitals' dependence on drug sales for income.

He said surgeons tend to rely heavily on antibiotics to avert postoperative infections.

Zhao Ping, former president of the Cancer Institute and Hospital of the Chinese Academy of Medical Sciences, said he agreed with strict management of antibiotic uses, which could also help hospital authorities better regulate prescriptions involving antibiotics.

He said that at his hospital, graded three A, 40 kinds of antibiotics could meet all clinical demands.

But he conceded it would take time because overprescription is common at Chinese hospitals due to the clinical habits of the doctors.

Under the new regulations doctors will be limited or deprived of their right to prescribe antibiotics if they are found improperly prescribing large amounts of drugs more than three times.

"Hospitals will also be punished for that, and we'll also beef up monitoring to strictly implement the regulation," Zhao Minggang said.

Xiao said he appreciated the firm stance by the ministry and urged patients to play a role in the process as well.

"For a long time, many Chinese people have wrongly taken antibiotics as a panacea," he said. Even without seeing a doctor, many Chinese people will buy antibiotics for something as simple as a sore throat.

Antibiotics are widely available at drugstores without prescriptions, Xiao said. He urged drug authorities to close that loophole.

Huo Jian, a 30-year-old website editor in Beijing, said she was concerned ordinary antibiotics may not be effective.

"For a long time, we took antibiotics via intravenous drips. Will it work if we now shift to oral pills?" she said.

Xiao said Huo's comments demonstrated a common misunderstanding.

"Cheap antibiotics taken orally also work well to kill bacteria if prescribed properly. People should follow doctors' advice for antibiotic use," he said.

Contact the writer at shanjuan@chinadaily.com.cn