New study led by DLSPH researchers shows promise for combatting antimicrobial resistance
March 26/2026
Antimicrobial resistance is a rising global threat. A clinical trial led by DLSPH researchers Xiaolin Wei, Zhitong Zhang, Shishi Wu, Hongyu Huang and Adalsteinn Brown, published in Nature Medicine, shows how a multi-pronged initiative was able to curb the rate of unnecessary prescriptions of antibiotics in China.
By Ishani Nath
New research led by DLSPH experts demonstrates an effective way to combat antimicrobial resistance, one of the world’s greatest threats to public health.
Antimicrobial resistance — when bacteria, viruses or parasites no longer respond to antimicrobial treatments, such as antibiotics — has been deemed one of the “top global public health and development threats” by the World Health Organization (WHO). A key driver of antimicrobial resistance is the high rate of inappropriate prescription of antibiotics.
“The problem is that we do not give the right medicine when people have a problem,” says physician and Dalla Lana Chair Professor in Global Health Policy, Xiaolin Wei, the lead author of the new study. For example, patients suffering from the common cold, flu or a sore throat, which fall under the category of upper respiratory infections, may be given antibiotics. However, Wei explains that antibiotics are only effective for bacterial infections, and these conditions are nearly always viral infections. Not only does this treatment not help the patient’s condition, but it can damage their immune system, leaving patients and populations vulnerable to future infections.
In a clinical trial, recently published in Nature Medicine, researchers introduced a multi-pronged initiative in rural regions of China to educate healthcare providers and patients about antibiotics, the latest guidelines and the dangers of misuse. The program reduced the inappropriate prescription of antibiotics for acute respiratory infections in primary care by nearly 40 percent, with no notable harm to patients.
Wei notes that while antimicrobial resistance is a global issue, low- and middle-income countries (LMICs) show higher rates of antibiotic prescriptions and are disproportionately impacted by the effects of antimicrobial resistance, such as the increased spread of disease and patients experiencing severe illness or possibly death. The year-long randomized clinical trial took place in 34 rural primary care facilities, called townships hospitals, across the Nanxiong and Lechang county, in Guangdong Province of China. These real-world hospital and primary care settings provide care for an estimated one million patients.
Wei, who is a Professor at DLSPH’s Clinical Public Health, and Institute of Health Policy, Management and Evaluation (IHPME), and the Director of Global Implementation Science Lab, explains that healthcare providers in rural settings may not be aware of the latest guidelines, have gaps in training, or prescribe antibiotics to prevent secondary infections, which is not effective. Providers everywhere, as well as in China, also face the challenge of demand from patients, over-the-counter access to antibiotics, and a cultural expectation that patients will receive some sort of treatment at a doctor’s appointment.
Wei and colleagues focused on creating a scalable and low-cost program. “We need to think about what is currently going on in health facilities, and what additionally we can add on top of it,” says Wei. Building on previous studies, DLSPH researchers collaborated with local experts to create a stewardship program that provided concise prescribing guidelines, used electronic medical records to flag high rates of antibiotic prescribing, and peer-review feedback for physicians. For patients, the program delivered educational materials through widely used smartphone platforms.
Researchers analyzed more than 97,000 consultations and observed that their stewardship program corresponded with a reduction of 39 percentage points in antibiotic prescribing rates for acute respiratory infections compared to regular consultations.
“We want to provide evidence to the world that antibiotic stewardship in primary care is feasible and very effective,” says Wei, adding that because the program leveraged low-cost and existing resources, like electronic medical records and smartphone apps, this intervention could be replicated in other low- and middle-income settings.
Nanshan Zhong and DLSPH’s Xiaolin Wei
DLSPH Dean Adalsteinn Brown, who co-authored the study, underscores that antimicrobial resistance is a pressing threat to health system sustainability in all regions, making research and programs like these vital. “New challenges, whether they be conflict, pandemic, or natural disaster bring the challenges of controlling infection to the forefront,” says Brown. “If we cannot meet this challenge, we risk the future of our hospitals and health systems.”
Celebrated pulmonologist and public health advocate, Professor Nanshan Zhong, has led the results of the Nature Medicine study into national health policy changes on antibiotic stewardship in primary care facilities in China. “I’m excited about this because this is not only our research; it is evidence that has been used to change national policy that will reduce AMR among a population of 1.4 billion. This will provide policy recommendations to other countries to use the antibiotic stewardship program as a powerful and effective clinical tool to reduce overuse of antibiotics in primary care,” says Wei.