Table 1.

Factors influencing antibiotic use in China

Factor	Influence
Government policy	By poorly remunerating doctors and expecting hospitals to support themselves largely through the sale of drugs, government policy encouraged over-prescribing of expensive drugs and discouraged quality assessment and improvement exercises.
Pharmaceutical industry	By spending a large amount of money on drug advertising, gifts and financial "kick-backs" to doctors who prescribed their drugs drug companies encouraged excessive prescribing ("kick-backs" were particularly attractive given the low salary of hospital doctors).
Hospital Drug and Therapeutics Committees	Generally regarded as ineffective; in particular they provided no monitoring of prescriptions and little independent education to medical staff.
Surgeons attitude and knowledge	By being less interested in drugs than physicians ("operations were more important") misunderstandings were perpetuated such as, "new antibiotics are stronger"; "new drugs kill most germs"; "the bigger the operation, the greater the need for newer and stronger antibiotics".
Deteriorating relationship between doctors and patients	This led to doctors protecting themselves from being sued by prescribing unnecessary &/or expensive drugs; this practice was often acerbated by media reports of patients physically assaulting the medical staff &/or extorting money from hospitals when treatment failed.