WANG Fengdi, a grey-haired old woman in Shanghai'sHongkou District, is busy searching for antibiotics in drugstores. So far, she has managed to collect 150 boxes of Cefradine, an antibiotic, after visiting all the drug stores in her neighbourhood.

And Wang is not the only resident of Shanghai crowding drug stores to buy antibiotics. Most of those in the drug-buying rush are retired workers like her.

And the pharmacies are glad about the spending spree on antibiotics - sales of the drugs have risen by 30 per cent in the past few months.

From July 1, people will find it harder to get the medicine because a new regulation issued by the Ministry of Health and the China Food and Drug Administration makes antibiotics accessible only with a doctor's prescription.

"The excessive and inappropriate taking of drugs has become a key threat to Chinese people's health and life security," said Zheng Xiaoyu, director of the State Food and Drug Administration.

"The regulation aims to monitor the sale and use of antibiotics and educate people about their correct use," said Professor Wang Longxing, director of the Shanghai Municipal Food and Drug Administration.

Antibiotics abuse

An increase in resistance to anti-microbial drugs, including the emergence of bacterial strains that are resistant to all available antibacterial agents, has created a public health problem of potentially crisis proportions.

"We have abused antibiotics too much in China. These one-time bacteria exterminators are gradually becoming useless in the face of more powerful bacteria. The danger is that we no longer have the medicines to cure infected Chinese people - just like the situation a century ago," said Zhang Yongxin, vice-director of Shanghai Huashan Hospital.

Antibiotics have been available in any drugstore in China and account for one third of the sales of the stores. No permission was needed to buy the medicines in any quantity.

Statistics from the Ministry of Health show 75 per cent of cases of cold or flu are treated with antibiotics and 95 per cent of surgical operations use them.

Strong side-effects

Figures also reveal that nearly 2.5 million Chinese are hospitalized annually due to adverse reaction to antibiotics and almost half of the country's cases of deafness are caused by excessive use of the drugs.

However, many people firmly believe that antibiotics are the most effective way to cure minor illnesses and they are their first choice when it comes to buying medicine. When people catch a cold, they reach for antibiotics which is wrong and useless in aiding recovery.

Big drugstores sell over 200 types of antibiotics which account for 15 per cent of all the medicines sold and 20 per cent of sales. The smaller ones rely on antibiotics to make their profits and about half of their income comes from those drugs, according to the Shanghai Municipal Food and Drug Administration.

Antibiotics, also known as antimicrobial drugs, are drugs that fight infections caused by bacteria. After their discovery in the 1940s they transformed medical care and dramatically reduced illness and death from infectious diseases. However, over the decades the bacteria that antibiotics controlled have developed resistance to the drugs. Today, virtually all important bacterial infections in the US and throughout the world are becoming resistant. For this reason, antibiotic resistance is a top concern internationally.

Antibiotic resistance can cause significant danger and suffering for children and adults who have common bacterial infections, once easily treatable with antibiotics.

"Each antibiotic medicine can cause a strong adverse drug reaction. It can cause harm to the organism such as lungs, liver and heart, especially in children," said Professor Yu Zhuowei, vice-director of Shanghai's Ruijin Hospital.

It is ignorance about the function of antibiotics that has led to the antibiotic overuse.

"People prefer self-diagnosis instead of going to a doctor. They buy the medicines in the drugstores and take them at their own will," said Professor Cai Weimin, director of Department of Pharmacy of Ruijin Hospital.

"They know the powerful effect of antibiotics but turn a blind eye to possible powerful adverse side-effects," Cai said.

"Most people do not show any interest in instructions on how to use the medicine. They do not bother to understand the medical instructions before taking them," said Professor Wang Longxing of the Shanghai Municipal Food and Drug Administration .

They take the medicine according to their habits or a former doctor's prescription. They self-diagnose their condition and decide on the amount of the medicine they will take at one time and the frequency of the dosages. They then stop taking the medicine when they feel better. Otherwise they continue.

"But these medicines should be used in accordance with the specific condition of the patients and their diseases. They only take proper effect when the dosage and the frequency is right," Professor Yu said.

"Wrongful use is adverse to recovery and will cause high resistance among bacteria," Professor Cai said.

"What's more, people have a strong conviction about the efficacy of antibiotics. They become angry when the doctor does not prescribe them."

Many residents who become ill believe they will not recover without antibiotics - and the more the better.

Older people make up the majority of the rush on the medicines. They are frequent visitors to doctors and think they know all about their diseases and the medicine they should be taking.

They buy the medicine in drug stores according to their past experience and the cost is much less than if they saw a doctor in hospital.

One patient who preferred to remain anonymous said: "It costs over 100 yuan (US$12) annually to cure a cold in the hospital but less than 20 yuan suffices if I buy it directly from a drugstore."

Coding prescription

But another concern has emerged now that the new regulation has come into force. "Fake prescriptions may become rampant as people try to buy antibiotics," said Professor Cai.

A hospital prescription for antibiotics can only be used in the hospital's drug store. Hospitals have been preparing for the new regulation with codes inscribed on prescription pads and on the electronic prescriptions available from big hospitals.

Education in need

But any inefficiencies in small hospitals, such as community hospitals, will likely be exploited by patients.

Another factor is the big price gap between a hospital drugstore and a chain drugstore.

But even if the new regulation is implemented effectively, the country still has a long way to go in educating people about the correct use of antibiotics.

"The regulation is just the first step," said Professor Yu.

While the regulation drives people to hospitals they will find that antibiotic abuse is sometimes worse in hospitals.

Statistics from the World Health Organization reveal that the use of antibiotics in Chinese hospitals can be as high as 80 per cent of overall cases, compared with the international average of 30 per cent.

"Eleven of the top 15 most used medicines are antibiotics in our hospitals," said Professor Cai Weimin of Shanghai Ruijin Hospital.

"Concern about antibiotic abuse emerged in China only a few years ago. Even doctors lack the necessary knowledge to deal with the problem," said Professor Cai.

As a front-line hospital, Shanghai Ruijin Hospital has released strict regulations and instructions covering the use of antibiotics and has launched a training course for staff.

But the use of antibiotics still accounts for 58.7 per cent of cases, higher than the national "alert" level of 50 per cent.