Present trajectories to forecasted future: A longitudinal analysis of hospital antibiotic use in China from 2013 to 2024 and projections to 2030

OBJECTIVE: To characterize the decadal trends in antibiotic use among hospitalized patients in China, and to project consumption trajectories through 2030. METHODS: We analysed quarterly data on inpatient antibiotic use from the Centre for Antibacterial Surveillance between 2013 and 2024, with consumption quantified as defined daily doses per 100 patient-days (DDDs/100 PDs). The analyses examined national trends by WHO Access, Watch, and Reserve (AWaRe) categories, and identified the 10 most-consumed antibiotics. A spatiotemporal mixed-effects model was applied to estimate long-term trends and pandemic-related effects and produced regional and hospital-level forecasts of antibiotic consumption through 2030. Point estimate and 95% Credible Intervals (CrIs) were reported. RESULTS: National inpatient antibiotic consumption declined steadily from 46.8 to 35.3 DDDs/100 PDs over the study period (annual percentage trend: -0.8; 95% CrIs: -0.9 to -0.6), with no significant long-term deviation attributable to COVID-19 pandemic. The overall decline was mainly driven by decreased use of Access antibiotics with an average annual percentage of 4.3% (95% CrIs: -6.1% to -2.4%), while Watch and Reserve antibiotics increased. Antibiotic selection became more concentrated, with the top 10 antibiotics accounting for 66.0% of total consumption in 2024, up from 46.7% in 2013. By 2030, overall antibiotic consumption is projected to decline by 11.4% from 2019 levels, mainly owing to reductions in Access antibiotic use. CONCLUSIONS: The shift away from Access antibiotics toward a narrow preference for a limited number of broad-spectrum drugs prone to promote resistance highlights the need to strengthen stewardship programs adapted to local epidemiology of resistance patterns.