In a Beijing pharmacy, near the headquarters of China’s State Food and Drug Administration, a clandestine transaction takes place involving antibiotics.
Twenty-four amoxicillin capsules are sold without a prescription for 23 yuan ($3.60) by a middle-aged pharmacist in a white coat. The druggist scribbles the Chinese character for “medicine” onto a receipt, whispering that the vague description is in case of an audit. If caught, the pharmacist could receive a warning or a fine of as much as 1,000 yuan.
Now health officials want those dispensing prescription antibiotics without the obligatory doctor’s note to be stripped of their license. The tougher penalties are part of a plan to rein in a market worth more than $11 billion. Reckless use of the life-saving pills is making them lose their potency faster than new ones can be developed, researchers say.
“We are seeing more patients display drug resistance, which is why it is very important now to manage the use of antibiotics,” said Ma Xiaojun, an infectious diseases doctor at Peking Union Medical College Hospital, who serves on a panel advising the Ministry of Health on rational antibiotics use.
A ministry plan to curb consumption of bacteria-fighting drugs may be introduced as early as this month. Drugmakers have lobbied to delay its implementation, and some companies have already slowed production in anticipation of a drop in demand in the second half of the year, said Jacqueline Mei, a Shanghai-based health-care analyst at CLSA Ltd.
United Labs, Lijun
United Laboratories International Holdings Ltd., whose products include amoxicillin capsules, has plunged 65 percent on the Hong Kong Stock Exchange this year. The shares gained 0.7 percent to end trading at HK$5.56 at the 4 p.m. close. Lijun International Pharmaceutical (Holding) Co., which got 60 percent of its revenue from antibiotics in 2010, has slumped 70 percent since Jan. 1 and closed 3 percent higher at HK$0.68.
Lijun reported a 12 percent slide in first-half antibiotic sales. It’s trying to cut its reliance on the medicines to about 30 percent of revenue by the end of the year, Chief Executive Officer Wang Xian Jun said in an interview.
“There is pressure on our sales,” Wang said. “It will be as bad in the second half.”
Antibiotics generated 71.5 billion yuan ($11 billion) in hospital sales alone in 2010, according to IMS Health, a pharmaceutical research company based in Danbury, Connecticut. The country’s top three sellers were Harbin Pharmaceutical Group Co., Pfizer Inc., and closely held Yangtze River Pharmaceutical Group. The medicines account for about 20 percent of China’s pharmaceutical sales, compared with 10 to 15 percent of global drug sales, CLSA’s Mei said.
Seventy percent of hospital patients take antibiotics and half of outpatients get the medicines, according to the health ministry. It wants to cut antibiotic use to one in five prescriptions and half of inpatients by the end of the year.
“China is definitely overusing antibiotics,” Mei said.
The problem is illustrated by the speed at which penicillin and cephalosporin-based medicines are losing their effectiveness against E. coli, the biggest cause of urinary tract infections. The proportion of infections caused by the bowel-dwelling bug resistant to both groups of antibiotics in China tripled to 65 percent in 2009 from 21 percent in 2002, researchers reported in a study last year.
The use of any antimicrobial for any infection forces microbes to either adapt or die in a process known as “selective pressure,” the World Health Organization says. Germs which adapt and survive carry genes for resistance that can spread from one person to another.
No Miracle Cures
“The world is on the brink of losing these miracle cures,” WHO Director-General Margaret Chan said in an April 6 speech for World Health Day, which was devoted to antimicrobial resistance. “In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era. Many common infections will no longer have a cure and, once again, kill unabated.”
China is taking action. The government will “strictly control” overuse of antibiotics nationwide by giving regulators greater powers to inspect and intervene on the prescriptions made by doctors and hospitals, the health ministry said in an e-mailed response to questions last month.
Under health ministry proposals, doctors caught “unreasonably” administering antibiotics face warnings and may have their authority to prescribe suspended. The ministry also wants to identify the medicines by the frequency in which they ought to be given -- from “unrestricted” to use “only in special situations.”
Overuse of the medicines is being driven by hospitals’ reliance on drug sales to generate revenue, unlawful marketing by pharmaceutical companies, “unethical” doctors and patient demands, the ministry said.
The use of antibiotics is “inappropriate” in 58 percent of cases, according to a review of 1,000 patient records at 10 hospitals in Beijing and four provinces from 2005 to 2010, said Yang Li, an associate professor of health-care policy at Peking University’s School of Public Health.
In hospitals and clinics across China, patients often sit in rows of chairs or on gurneys in “infusion rooms,” where treatments are injected into a vein via a drip attached to an overhanging bottle or bag. Last year, 87 percent of the antibiotics used in China's hospitals were administered intravenously, compared with 42 percent in Japan and 53 percent in the United Kingdom, according to IMS.
“Chinese have sort of a superstition when it comes to medicines,” said Ma, the Peking Union Medical College Hospital doctor. “They feel that drugs are all good and it doesn’t hurt to take more.”