What is the problem?

China is estimated to be the second largest consumer of antibiotics in the world, with widespread and often inessential use in both humans and livestock. Widespread consumption leads to antibiotic residues in water and soil that may exacerbate the development and transmission of resistance through organisms and chemicals in the environment. Studies have investigated the epidemiology and pattern of drug-resistant infections in China, but the size of the health and economic burdens caused by antibiotic resistance on a national level and the role of the environment in the development and transmission of drug resistance are still unclear.

Approaches being taken

The consortium's research aims to bridge key evidence gaps and strengthen disciplinary and methodological research skills, through a set of closely linked projects that will generate the holistic knowledge which is needed to design, deliver and monitor targeted strategies to limit antibiotic resistance in China and comparable settings. The team will also establish sustainable partnerships with cross-disciplinary research expertise that is currently lacking in China and strengthen capacity in policy-relevant research. Since antibiotic resistant infections and their genetic components spread rapidly through international travel, research into ways of reducing the burden of antibiotic resistance in China is important not only for populations in China and the wider Asian region, but globally.

Through three linked programmes of work based at three leading universities in China (Peking, Fudan and Anhui Medical University), supported by UK academics (in Bristol, Bath, Leicester and Southampton) from a wide range of disciplines, the team will:

1. Estimate the economic burden of AMR and determine the cost-effectiveness of potential intervention strategies
2. Design and evaluate a tailored intervention to modify antibiotic prescribing behaviour among health professionals and reduce antibiotic consumption among outpatients
3. Measure human exposure to antibiotics from environmental and livestock sources, estimate their health effects & develop tools for risk assessment and monitoring of environmental exposures to antibiotics and antibiotic-resistant genes
4. Gather evidence on current patterns of antibiotic use and the implementation of antibiotic resistance-related policies and regulations at local, regional and national levels
5. Produce evidence-based recommendations on optimising antibiotic use, monitoring ABR and assessing the success of strategies to reduce antibiotic resistance in China
6. Build cross-institutional and international collaborative groups to increase China's research capacity in a range of relevant disciplines and methodologies, as well as in the design and conduct of inter-disciplinary research.

Anticipated outcome and impacts 

The study will generate evidence of i) effectiveness and cost effectiveness of an intervention to reduce antibiotic prescribing and demand; ii) environmental transmission pathways and priority targets for limiting antibiotic exposures; and iii) the magnitude of the antibiotc resistance burden and cost-effective strategies for reducing it.

The resulting policy and practice recommendations will help to inform behaviour, service, system and regulatory changes. This will have a potentially transformative effect on control and prevention of drug-resistant infections in China and is likely to be transferable to other low and middle income country (LMIC) settings. As antibiotc resistance is spread rapidly through international travel, reducing antibiotic resistance in this region will help to reduce global transmission.

For more information, please visit the study's website: http://www.bristol.ac.uk/population-health-sciences/centres/star-china/