China suffers from serious overuse of antibiotics.  The World Health Organization says doctors prescribe them for half of all outpatients, far above recommended levels. The report found that nearly two-thirds of Chinese believe antibiotics should be used to treat colds and flu. One-third thinks antibiotics are effective against headaches. This report explores antibiotics overuse in China. 

It was this institute that made the shocking revelation: That many of China’s rivers are full of antibiotics.

The man who led the research is Professor Ying Guangguo. He and his team from the Guangzhou Institute of Geochemistry spent ten years examining rivers across China.

They tested 58 river basins. They found that waterways in Beijing and Tianjin and in the Pearl River Delta contain some of the highest concentrations of antibiotics.

Professor Ying, an expert on Environmental Chemistry and Ecotoxicology, concluded that a major cause of the high concentrations of antibiotics was their misuse by people who had been prescribed them.

As part of their findings, the team calculated that a whopping 162,000 tonnes of antibiotics were consumed in China in 2013.

That’s partly due to a perception that antibiotics are a magical cure for all illnesses. Yet, experts caution that they can produce long-term negative effects, including drug resistance.

The same goes for intravenous drip therapy.

To better understand the problem, we visited Pamela Luan, who wanted to speak out about her three children’s experience with antibiotics in China.

Pamela describes a “horrible year” when her daughter, Sabrina, was two years old and was hospitalized three times.

After a week in hospital and several rounds of antibiotics, Sabrina’s symptoms would disappear.

Then, when her daughter was diagnosed with asthma, the family decided to move somewhere with cleaner air. They packed their bags for Sanya.

But as soon as her daughter came down with a cold, Pamela’s panic kicked in again. She wanted the quick-fix that the IV drip had always produced.

After just three days Sabrina had recovered. The far lower dose than she was used to had worked. It made Pamela realize that she’d effectively been giving her daughter an antibiotics overdose.

From someone who was a big believer in the curative powers of an IV drip, Pamela became far more cautious. Having built up a mistrust of doctors, she took to educating herself.

From thereon-in her answer to “should I prescribe your daughter antibiotics?” was almost always a flat-out ”no”.

To discover more about how medical professionals prescribe antibiotics here in China, we visit Peking University’s People's Hospital.

There we meet Professor Gao Yau. She works in the infectious disease clinic. She has an expert knowledge of antibiotics, which means she has a broader consulting role across the hospital’s departments.

"In my view, there are still problems with the use of antibiotics. Some doctors have little understanding of antibiotics. And sometimes, it’s hard to diagnose a condition. For example, it can be hard to say whether a patient is infectious or not. A physical examination and other tests are needed to decide. But it can be hard to identify the symptoms," said Dr. Gao Yau.

Pamela’s second child, Andy, was allergic to dairy food and contracted pharyngitis at just six months old. Their doctor advised that he should be hospitalized and given antibiotics. But Pamela had heard it all before - she went to another hospital in Beijing for a second opinion. The doctor there gave him a one-off inhaler to help open up his airwaves and said he could stay at home.

Andy was fine, but Pamela again realized that if she had taken the first doctor’s advice her son would have been given an unnecessary dose of antibiotics. By this time, she had taught herself a lot about white blood cell counts and what treatment a child should receive. But she was almost too confident.

Doctor Zhuo Chao is a member of the Ministry of Health’s Committee of Experts on Rational Drug Use. He says the problem can be alleviated by shifting mindsets and habits towards antibiotics.

"Chinese people have a rooted belief that if you get sick, you should take antibiotics. Many families even store antibiotics
for future use. Some doctors aren’t sure about properly prescribing antibiotics. And we’re weak when it comes to
specialists on infectious diseases. It’s not like the States where, when it comes to prescribing antibiotics, a specialist must be consulted. Because we lack such specialists almost any doctor can decide. This leads to irregularities," said Dr. Zhou Chao.

Over-prescription of antibiotics is clearly a big problem in China. But how did it become one? How is it that Chinese people turn so quickly to antibiotics as the cure for all illnesses?

"Firstly, in the case of a respiratory infection caused by a virus, such as a common cold, you recover naturally within a week. If you take antibiotics during this period and recover, you believe the antibiotics worked. Secondly, if you go to hospital and the doctor gives you a drip, since you know it contains antibiotics, when you recover it reinforces your belief in antibiotics," Dr. Zhou Chao said.

And there is a bigger problem at play. Widespread antibiotic use is driving resistance, with the possibility of creating superbugs for a whole range of diseases. That potential outcome has made the need to combat overuse all the more pressing.

For Pamela, her biggest nightmare came when her third child, Ethan, began suffering seizures. After five episodes in one day, she took him to hospital – the same one she’d taken her daughter to. The doctors suspected he had a brain infection.

But Pamela wondered why, since Ethan’s infection was viral.

This time Pamela felt she had no choice - standard practice is standard practice. And she rationalised that she would rather the doctor felt trusted. Anyway, she’d witnessed a big change in attitudes since her first daughter became sick.

That’s because those like Doctor Gao are on the case. It’s her job to guarantee that doctors aren’t overprescribing – or indeed under-prescribing – antibiotics.

"Doctors from different departments have a different focus. Some deal with infectious diseases on a daily basis, so they focus more on pathogens and antibiotics. A doctor from the cardiovascular department pays more attention to blood pressure and heart rate. A doctor specializing in diabetes pays more attention to a patient’s blood sugar. We all have our different focus," said Dr. Gao Yau.

A key part of the medical reform taking part in China right now, is improving the management of medication.

The China Antimicrobial Resistance Surveillance System was established in 2005 to help tackle the problem. At People's Hospital it’s used in tandem with centralised monitoring software.

With the help of technology, Zhuo is hoping Chinese hospitals will be able to better manage antibiotics dosage.

"Since the surveillance system was established in 2005, we’d expanded the scope of monitoring to more than 1300 hospitals in China by the end of last year. The number of cases of antimicrobial resistance was more than two million. This alarming statistic’s found in a WHO report. It tells us what is the current state of antimicrobial resistance in China. It should guide the general public and doctors in choosing medication and treating diseases properly," Dr. Zhou Chao said.