The Current Situation Regarding Antimicrobial Resistance (AMR) in China – Report Following a Three-Week Visit to China by the CMIR Medical Delegation During October-November 2013

For MP David Tredinnick to use at the Science Committee Meeting, 25th November 2013

Widespread overuse of antibiotic and antiviral drugs in China is now an increasing concern in Chinese media.

Prominent experts such as Professor Zhong Nan Shan warned that, unless measures are taken to nationally arrest the overuse of antibiotic and antiviral drugs, epidemics will spread at an unprecedented rate. Future challenges posed by infectious diseases in mainland China will pose a health threat of major proportions.

Professor Zhong cited a report revealing how the use of antibiotics has now reached 80- 90% in treatments of common flu with fever. He highlighted the three main reasons for the over-prescription of antibiotics. First is the convenience, immediate efficacy and the quality of the training of the doctor. Second is the demand from patients and the fear of responsibility from the doctor. The third is the financial reward from the pharmaceutical companies. The Chinese government have recently instituted an investigation into various sales, marketing and bribing tactics employed by certain drug companies.

Increased emergence of superbugs has been discovered in a number of provinces in China, firstly in the Fujian province, due to the increase of the antibiotic-resistant genes inthe gut microbes of people in mainland China. In a recent examination of 37 hospitals in southern China, superbugs were discovered in two of the hospitals. The Ministry of Health responded speedily by issuing guidelines for the use of antibiotics. China has now seen the world’s most rapid growth rate of resistance to antibiotic and antiviral drugs.

The recent comprehensive reform programme announced by the Chinese government in early November 2013 includes a substantial reformation of the healthcare system and environmental policy. During President Xi Jin-ping’s meeting with Margaret Chan, the Director-General of the World Health Organisation, in Beijing on 20th August 2013, he stressed China’s promotion of integrative medicine and the government’s emphasis on the development of Chinese medicine to cope with the overwhelming future health issues.

The over-prescription of antimicrobial drugs can be reduced by using Chinese medicine treatments, including Chinese herbal medicine and acupuncture therapy as both are known to possess antiviral and antibacterial therapeutic functions. According to research in China, the immunomodulatory actions of TCM formulations have a stimulatory effect on immune cells, immune organs, cytokine production as well as inhibitory effect on inflammations, allergies and autoimmune diseases. Studies on acupuncture have shown that this treatment can increase the release of endogen opioid peptides that affect the immune system. Indeed, acupuncture can strengthen the immune system. The effect can be further enhanced when acupuncture is combined with Chinese herbal medicine. This advantage of Chinese medicine over Western treatments was clearly illustrated during the previous SARS epidemic in China as well as in the global use of Artemisinin (Qing Hao) – a Chinese herbal drug created for the treatment and prevention of malaria.

During its three-week medical trip in China, the CMIR delegation visited hospitals and pharmaceutical research institutions while conducting a medical exchange between British and Chinese medical professionals. An insightful experience was gained in Shanghai’s Rui Jing Hospital’s A&E department where antibiotic and antiviral drugs were infused into patients automatically as part of routine treatment for acute common flu, various respiratory infections and other health problems. The sights and sounds witnessed by the delegation in those A&E rooms are rarely seen in British hospitals. Such an exchange is invaluable to the doctors, both East and West.

This report aims to urge for global collaboration and integration in order to cope with the alarming health crises resulting from antimicrobial resistance as cited in the annual report of the Chief medical officer, 2011. Both UK and China, and indeed other countries around the world, can learn from each other in their strategies and actions to address the problem of AMR. Chinese medicine is one modality that deserves serious consideration as part of the solution.

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