Antibiotic grading policy and antibiotic utilization : evidence from Sichuan province

Abstract

The misuse of antibiotics and the subsequent rise in bacterial resistance present substantial challenges to global public health. We examine the development of antibiotic policies in China, with a particular focus on Sichuan Province, and empirically assess the effects of Sichuan’s antibiotic grading policy implementation. First, we systematically compare Sichuan Province’s antibiotic management framework with the World Health Organization’s (WHO) AWaRe classification, revealing notable differences in drug classifications and regulatory intensity. These disparities highlight the localized adaptations of Sichuan’s policy in response to regional healthcare dynamics. Second, we find that the prevalence of certain major drug-resistant strains in Sichuan remains elevated, particularly within primary care facilities, underscoring the need for more balanced antibiotic management. Finally, using a difference-in-differences (DID) approach, we evaluate antibiotic utilization before and after the 2019 implementation of Sichuan’s graded antibiotic management policy. Results indicate that the policy significantly decreased the volume and the cost of antibiotics prescribed, though the policy’s effectiveness varied across departments. By providing an empirical analysis of Sichuan’s antibiotic policy, we offer insights for antibiotic management policies across other regions in China and recommend further alignment with international standards in the design of localized policies. Additionally, we emphasize the importance of strengthening the monitoring of drug-resistant strains and enhancing the practical application of graded management to further improve the effectiveness of antibiotic policies.