中国基层医疗机构抗生素管理策略的挑战与对策

Challenges and Countermeasures of Antibiotic Management Strategy in Primary Medical Institutions in China

摘要: 抗生素的发现与应用是人类医学史上的里程碑，显著降低了细菌感染性疾病的死亡率。然而，全球范围内普遍存在的抗生素使用不当问题，正导致耐药菌株的迅猛产生与传播，严重威胁公共健康安全。中国基层医疗机构作为群众看病就医的首站，其抗生素使用是否合理，直接关系到国家遏制细菌耐药战略的成败。本文旨在聚焦中国基层医疗机构，系统分析其抗生素使用不当的主要现象与深层原因，重点剖析其在人员能力、诊断条件、监管落实等方面面临的特殊挑战，并在此基础上提出以“强化AMS模式本土化、提升快速诊断可及性、创新监管与激励方式”为核心的针对性对策，以期为提升基层抗生素合理用药水平、有效应对细菌耐药性挑战提供参考。

Abstract: The discovery and application of antibiotics represent a milestone in the history of human medicine, significantly reducing the mortality rate of bacterial infectious diseases. However, the widespread misuse of antibiotics globally is leading to the rapid emergence and spread of drug-resistant strains, posing a serious threat to public health security. Primary healthcare institutions in China, as the first point of contact for patients seeking medical care, play a crucial role in the rational use of antibiotics, which directly affects the success of the national strategy to contain bacterial resistance. This paper aims to focus on primary healthcare institutions in China, systematically analyze the main manifestations and underlying causes of improper antibiotic use, and delve into the specific challenges faced in terms of personnel capability, diagnostic conditions, and regulatory implementation. Based on this analysis, targeted strategies are proposed, centered on “strengthening the localization of Antimicrobial Stewardship (AMS) programs, enhancing the accessibility of rapid diagnostics, and innovating regulatory and incentive mechanisms”, to improve the rational use of antibiotics at the grassroots level and effectively address the challenge of bacterial resistance.