Without any examination, an antibiotic was prescribed intravenously.
That's right, this happened not 15 years ago, nor 10 years ago, but now in 2025.
Liu Bing is a dentist at a Grade A hospital in the central region. Recently, a medical dispute occurred in the hospital where he is located. A patient with underlying diseases was admitted to the ICU less than 24 hours after he was admitted to the hospital. After a check, he found that he had drug-resistant bacteria infection.
The medical record itself is very detailed and standardized, but the family members thought that there was something wrong with the hospital's diagnosis and treatment process, so they started to check it back. As soon as they checked, the problem was found - on the day of the first visit, the hospital prescribed antibiotics without checking the infection indicators.
"Actually, our hospital has always been like this. You can prescribe medicine directly without examination." Liu Bing was helpless. "Even, some patients do not want to spend money on examinations in other hospitals, and the doctors there will say, then you go to XX Hospital (Liu Bing's hospital), and this hospital can be directly hanged with water."
Antibiotic restriction order has been 13 years, but antibiotic use is still not very standardized
The cliché issue of microbial resistance has attracted attention worldwide more than ten years ago. In 2011, the WHO designated the theme of World Health Day as “Resistant to Drug Resistance” and called for global action to address antibiotic abuse. [1]
At that time, the antibiotic usage rate of hospitalized patients reached 70%, of which the surgical usage rate was as high as 97% - almost everyone used antibiotics, but in fact, less than 20% of patients were really needed. [2]
Against this background, in May 2012, the former Ministry of Health issued the "Regulations on the Clinical Application of Antibiotics", proposing a third-level management method for antibiotics, which is known as the strictest "anti-restriction order" in history. [3]
Source: Reference 3
Now, the anti-restriction order is about to be released for 13 years. According to data from the National Antibacterial Clinical Application Monitoring Network last November, from 2011 to 2023, the antibacterial drug use rate in hospitals in core data hospitals dropped from 59.4% to 33.4%, and the antibacterial drug use rate in outpatients dropped from 16.2% to 7.1% - it seems to be quite effective. [4]
However, the data from the national monitoring network only comes from the "core data hospital". According to the "2022 Antibiotic Clinical Application Monitoring Data", as of September 30, 2022, there were 7,154 hospitals included in the data [5] , less than 1% of the total number of medical and health institutions nationwide at the end of 2022 [6] - This means that the use of antibiotics in the vast majority of medical institutions has not been monitored.
The access to hospitals of different levels of the National Antimicrobial Drug Clinical Application Monitoring Network, Image Source: Reference Materials 5
Secondly, the decrease in the usage rate does not mean that the usage becomes "standard".
In 2022, the Peking University School of Pharmacy team analyzed the prescriptions of 269 primary medical institutions in six provinces across the country from 2017 to 2019 and found that the cost of "unreasonable" antibacterial drugs accounted for as high as 66.8% . Among them, the most common diseases that should not be used include acute upper respiratory tract infection, acute bronchitis and non-infectious gastroenteritis. [7]
Guo Lan, a general practitioner at a community hospital in East China, said that for most patients, especially elderly patients, if they have symptoms of fever and cough, their hospital's first choice for treatment is the classic "Sansu and Yi Decoction": antibiotics, vitamins, hormones and glucose. "If the symptoms are slightly worse, they will be performed by infusion. Generally, it will improve significantly after 3 to 5 days."
In the comment section of Dingxiangyuan Community and previous articles in Dingxiangyuan, many doctors have appeared and confirmed that "Sansu and One Decoction" is indeed everywhere in primary medical institutions. Someone else said on social media that there is no source of trouble if you don’t use this.
Source (in turn): Dingxiangyuan Community, social media
It is clearly prohibited, why do doctors still dare to prescribe?
The 13-year restriction order has been in effect, and the reality is more skinny than imagined.
In the dental department, people who usually ask for water when they go to the hospital are patients with maxillofacial gap infection. "It usually comes with a swollen face, which is painful and uncomfortable, and has a higher requirement for "heating quickly". In their perception, intravenous infusion is "heating quickly" than taking medicine," Liu Bing explained.
Originally, there are few opportunities for dentistry to require intravenous antibiotics unless they are combined with systemic infection. Liu Bing usually advises the patient to supplement the laboratory and imaging examinations first, but if the patient persists, he will also directly make a doctor's advice. "The gap infection is serious and critical, and the guide also mentioned that it can be treated empirically first. "
The "Guidelines for Diagnosis and Treatment of Oral, Maxillofacial Interstitial Infection (2022 Edition)" does mention that antibacterial drugs can be empirically selected based on the source of infection, clinical manifestations, pus traits and pus smear examinations, and antibacterial drugs with a wide antibacterial spectrum should be selected. [8]
But empirical treatment does not rely solely on empirical treatment.
All kinds of guidelines and the "Guiding Principles for the Clinical Application of Antibiotics (2015 Edition)" clearly point out that empirical treatment is not an isolated suggestion, with premises and needs to be coordinated with subsequent adjustments.
Image source (in turn): Reference materials 8, 9
During the actual diagnosis and treatment process, many doctors often only see the word "experience" and will not supplement etiology testing after treatment, nor will they adjust the medication. "The reason why patients come to us is that they are close, convenient and quick to treat. If you say that the dose of the medicine is reduced after two days of treatment, the patient is still worried, and he may have to go to other clinics to re-exercise it, and the final result is not the same." Guo Lan explained.
In addition, in some early guidelines, the prerequisites and subsequent assessments of empirical treatment should be vaguely described , which in turn led to some doctors extending the use time of the drug, expanding the scope of application based entirely on their personal experience, and gradually developing to the point where they still adhere to their personal experience even if there were clear regulations later.
For example, in the topic of preventing antibiotics after surgery, a survey was initiated in the Dingxiangyuan community. Although the "Guiding Principles for Clinical Application of Antibiotics (2015 Edition)" during the investigation had clearly stipulated the use of preventive drugs, for Class I incisions, 24% of doctors still applied antibiotics for more than 48 hours after surgery. (Click to view previous tweets in Dingxiangyuan: How many doctors dare not stop antibiotics 24 hours after the operation?)
Source (in turn): Reference 9, Dingxiangyuan Community
It is convenient to prescribe medicine directly, and use it for a few days if you are afraid of infection... I firmly believe in the banner of "empirical treatment", and every dose of antibiotic prescribed by the doctor really catalyzes every evolution of drug-resistant bacteria.
On the other hand, although the medical community had proposed the concept of "shorter is better" as early as 2008, and dozens of randomized controlled trials (RCTs) have repeatedly confirmed that shorter treatment antibiotic regimens have similar efficacy and higher safety [10], some doctors still worry about it-
I really encountered a patient whose condition worsened after not taking medication. Are you here to complain for me?
The strictest in history, but the hospital was not "strict"
Looking back at the "Regulations on the Clinical Application of Antibiotics" of Antibiotics, it is easy to find that although it is called "the strictest in history", the Antibiotics restrict only limits the prescription rights of different levels of antibiotics. There are no more detailed regulations on "non-restricted antibiotics" that almost all doctors are qualified to prescribe.
Source: "Regulations on the Clinical Application of Antibacterial Drugs" [3]
According to the anti-restriction order, non-restricted use-grade antibacterial drugs are defined as antibacterial drugs that have been proven safe and effective after long-term clinical applications, have a small impact on bacterial resistance, and are relatively low in price. [3]
First of all, we need to make it clear that non-restricted use of antibacterial drugs will not "have less impact on bacterial resistance."
The process of bacterial resistance is essentially a "natural selection". When the environment is filled with some antibiotic, bacteria that are sensitive to the antibiotic will die, and only those that produce drug-resistant antibodies through genetic mutations can survive. These mutant genes that can express drug-resistant antibodies will be inherited through division and reproduction, and eventually form drug-resistant bacteria.
That is to say, for bacteria, no matter which grade the antibiotic is artificially assigned, excessive use will cause them to develop drug resistance.
Non-drug-resistant bacteria and drug-resistant bacteria, source: Reference 11
Does the hospital care?
In fact, according to our investigations of Grade A hospitals in Zhejiang, Henan, Shandong and other regions, it is difficult for most hospitals to truly find the root cause of the problem by reviewing antibiotic use. Different regions and hospitals also have very different examination intensity and scope.
Take Liu Bing’s own experience as an example. His regular training hospital and the hospital he worked in are not the same. According to him, a Grade A hospital in the southwest region where the regular training is located is very strict in the retrospective examination of antibiotics. If you want to get diagnosed with "XX inflammation" and "XX infection", you must have corresponding inflammatory indicators, otherwise it will be an invalid diagnosis and the system will automatically identify and report.
Although the hospital where he is currently working also has routine examinations, it has only been found to have the "main diagnosis". As for how this main diagnosis comes from, is it based on the auxiliary examination of our hospital, or just based on the patient's sentence "I have drawn blood in an external hospital", it is difficult to confirm the examination work without confirmation.
This is the case with the tertiary hospital restriction management, let alone personal clinics.
Li Renyuan, who once runs a community clinic in a fourth-tier city, said: "Actually, even if the above checks, the punishment will be just not painful."
In October last year, the Fujian Provincial Health Supervision Institute reported several violations, and all the medical institutions involved used antibiotics with excess prescription rights, and were eventually fined ranging from 4,500 to 10,000 yuan [12]. "To be honest, the amount of such a penalty is far less than the amount of benefits gained from antibiotics. " Li Renyuan said.
Even some routine examinations are just in name only. Guo Lan mentioned that since she joined the company, although she has heard about relevant notices many times, she has not really seen the inspectors. She has only counted the annual usage of antibiotics several times. It has never been involved where to use them and how to use them.
Source: "Regulations on the Clinical Application of Antibacterial Drugs" [3]
Compared with the loose examination status, macro data on antibiotic problems remain unoptimistic.
At the end of last year, The Lancet published an article pointing out that it is expected that microbial resistance will directly lead to more than 39 million deaths and 169 million related deaths in the next 25 years. [13]
At the same time, according to my country's latest version of the National Bacterial Resistance Monitoring Report, although the detection rates of many important drug-resistant bacteria have been slowly declining in recent years, the detection rates of drug-resistant bacteria such as carbapenem-resistant Acinetobacter baumannii (CR-ABA) and third-generation cephalosporin-resistant Escherichia coli (CTX/CRO-R-ECO) are still at a high level.
Source: 2023 National Bacterial Resistance Monitoring Report [14]
Going back to the beginning story, without any examination, I prescribed antibiotic intravenous drops - In the present in 2025, don’t let the strictest restrictions on anti-orders in history be just a document.
In the article, Liu Bing, Guo Lan and Li Renyuan are all pseudonyms
Planning: Kent Sheep | Producer: islay
Source of title picture: Visual China (without pictures and text)
References:
[1]https://www.gov.cn/jrzg/2011-04/07/content_1839418.htm
[2]https://news.cntv.cn/china/20111019/102130.shtml
[3]https://www.gov.cn/flfg/2012-05/08/content_2132174.htm
[4]https://www.news.cn/fortune/20241122/6a183acc30d4453a9649860c67b6c1b4/c.html
[5]https://mp.weixin.qq.com/s/JlgHqhyUO7IkiyVod21oqw
[6]http://www.nhc.gov.cn/guihuaxxs/s3585u/202408/6c037610b3a54f6c8535c515844fae96.shtml
[7]https://www.sciencedirect.com/science/article/pii/S1198743X22005870
[9]http://www.nhc.gov.cn/ewebeditor/uploadfile/2015/09/20150928170007470.pdf
[10]https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(22)00209-9/fulltext
[11]https://en.wikipedia.org/wiki/Antimicrobial_resistantance
[12]https://mp.weixin.qq.com/s/6vBQmbOGM0FeKIKdNizZgQ
[13]https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01867-1/fulltext
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