Lead researchers

  • Helen Lambert, Professor (University of Bristol)
  • Bo Zheng, Professor (University of Peking)

About the project 

China is estimated to be the second largest consumer of antibiotics in the world, with widespread and often inessential use in both humans and livestock. Studies have investigated the epidemiology and pattern of drug-resistant infections in China, but the scale of health and economic burdens caused by antibiotic resistance (ABR), and the role of the environment in the development and transmission of drug resistance, are still unclear.

This collaborative research and training programme is designed to support the reduction of ABR in China, bringing together a team of international experts from three major Universities in Eastern China – Peking, Fudan and Anhui Medical – with researchers at the University of Bristol, Public Health England, North Bristol NHS Trust and the Universities of Southampton, Leicester and Bath.

Project aim

The aim of the project is to design, deliver and monitor targeted strategies to limit ABR in China, bridging evidence gaps and strengthening disciplinary and methodological research skills in China.

Project objectives will be addressed through three interdisciplinary work packages: 

1. Reducing antibiotic prescribing and over-the-counter purchase of antibiotics

Developing a complex intervention aimed at health professionals and patients to reduce antibiotic  prescribing for common respiratory tract infections, investigating novel intervention components to reduce self-treatment with antibiotics purchased from pharmacies and evaluating the effectiveness of these through a cluster randomised controlled trial.

2. Assessing human exposure to antibiotics from multiple sources and its consequences

Comprehensively assessing the level of human exposure to antibiotics from a range of sources and evaluating the consequences in terms of the health hazards posed, through:  

  • investigating types and abundance of ABR genes and exploring possible pathways of transmission among livestock, environment and populations 
  • assessing spatio-temporal community-wide public exposure to antibiotics and resulting ABR using Wastewater-Based Epidemiology (WBE)
  • understanding the policy context and antibiotic usage monitoring systems, and looking at policies to limit antibiotic use in health, agricultural and environmental sectors.

3. Assessing the economic burden of antibiotic resistance in China from a societal perspective by estimating:

  • the trends of antibiotic use and the incidence and prevalence of ABR in hospital settings 
  • the mortality, excess length of stay and costs of ABR in these settings
  • the economic burden of ABR in China and investigating the cost effectiveness of different intervention strategies, including the WP1 intervention.

Anticipated impacts

By determining the magnitude of the ABR burden and assessing the effectiveness and cost-effectiveness of different interventions to reduce it, better targeted strategies for ABR reduction can be created. 

The resulting policy and practice recommendations will inform the behaviour, service, system and regulatory changes required to maintain a reduction in ABR in China, with positive consequences for the region and even globally.


Newton Fund.

Project dates 

February 2019 to January 2022

Research team

  • Helen Lambert, Professor (University of Bristol)
  • Bo Zheng, Professor (Peking University) 
  • Matthew Hickman, Professor (University of Bristol)
  • Lucy Yardley, Professor (University of Bristol)
  • Luwen Shi, Professor (Peking University) 
  • Yanping Deng, Professor (Peking University)
  • Chaowei Fu, Professor (Fudan University)
  • Alasdair MacGowan, Professor (North Bristol NHS Trust)
  • Paul Little, Professor (University of Southampton)
  • Debin Wang, Professor (Anhui Medical University)
  • Yehuan Sun, Professor (Anhui Medical University)
  • Nicola Cooper, Professor (University of Leicester)
  • Barbara Kasprzyk-Hordern, Professor (University of Bath)
  • Samuel Sheppard, Professor (University of Bath)
  • Christie Cabral, Dr (University of Bristol)
  • Lily Yao Guiqing, Dr (University of Leicester)
  • Carolyn Tarrant, Dr (University of Leicester) 
  • Isabel Oliver, Dr (Public Health England)
  • Beth Stuart, Dr (University of Southampton)
  • Xiaowen Hu, Dr (Anhui Medical University)
  • Fei Yan, Dr (Fudan University)
  • Hexing Wang, Dr (Fudan University)