For years, China has been plagued by the overuse of antibiotics. According to a British economist, China suffers 1 million deaths a year from antibiotic-resistant infections, representing an economic loss of $20 trillion by 2050, AFP reported.

Last week, the first ever report outlining the emissions of the world’s largest user and producer of antibiotics was released to Chinese media.

The report, titled Comprehensive Evaluation of Antibiotics Emission and Fate in the River Basins of China: Source Analysis, Multimedia Modeling, and Linkage to Bacterial Resistance, was published in the US journal Environmental Science and Technology in May.

Researchers at the Guangzhou Institute of Geochemistry based the study on 10 years of field research into China’s major rivers.

The report found that the total antibiotic usage in China was estimated to be 162,000 tons in 2013, accounting for half of the total usage in the world.

Human consumption accounted for about 48 percent, and domestic animals mainly consumed the rest.

The average emission densities of antibiotics in East and South China were more than six times higher than those in West China.

“The report provides comprehensive data for policymakers in environmental protection, drug administration and health authorities, to help them to control the use of antibiotics. It details the usage and pollution level of different antibiotics,” Ying Guangguo, a professor in environmental chemistry and ecotoxicology and head of the research team, told the Global Times.

A vicious circle

The report studied 36 frequently detected antibiotics in China. The usage for the 36 chemicals was 92,700 tons in 2013. About 53,800 tons entered into rivers. Some 54,000 tons were excreted by humans and animals.

Research into China’s major rivers found that Dongting Lake in central China received the largest discharge of antibiotics, with a total of 3,440 tons. The Senge Zangbu River located in the west part of Tibet received the lowest antibiotics discharge of 1.18 tons.

The Yellow River, Huaihe River and Yangtze River downstream basins received more than 3,000 tons in 2013.

Among the 36 antibiotics, amoxicillin, florfenicol, lincomycin, penicillin, and norfloxacin were the top five used in China. Amoxicillin had the largest usage for both humans and animals, the report found.

The use of antibiotics in hospitals in developed countries accounts for 10 percent of total prescriptions, but the share in China is up to 50 percent, Xiao Yonghong, deputy director with Institute of Clinical Pharmacology Peking University, told sohu.com.

“Apart from overuse in Chinese hospitals, antibiotics are widely used in livestock to lower a risk of illness,” Ying said.

After use, these antibiotics end up in rivers and fields through wastewater, and then would return to human bodies through aquatic and agricultural products, which form a vicious circle, Ying said.

Previous studies have also linked antibiotics exposure to the contaminated environment. A Fudan University study, published in April, found that Chinese children are frequently exposed to antibiotics found in their environment and food, according to the Xinhua News Agency.

Researchers tested 1,064 children aged 8 to 11 in Shanghai and Jiangsu and Zhejiang provinces for 18 antibiotics, and found that antibiotics were detected in roughly 60 percent of the children’s urine.

“Taking excessive antibiotics could lead to antibiotics resistance, and pose a great threat to the treatment efficacy of patients with bacteria-related infections,” Ying said.

The World Health Organization released its first global report on antibiotics resistance in 2014, which said that antibiotic resistance - when bacteria change so antibiotics no longer work in people who need them - is now a major threat to public health. It causes people to be sick for longer and increases the risk of death.

A total of 300,000 children in China become deaf through overuse of antibiotics, accounting for 30 to 40 percent of total deaf children, Zhou Xiaoqing, an expert with the Chinese Pharmaceutical Association, told the Global Times.

Control measures

Ying pointed out that the management of antibiotics-containing wastewater in China faces various problems.

In rural areas, the sewage treatment rate is quite low due to limited infrastructure, and it’s a common practice to directly discharge animal wastewater into rivers and agricultural land, he said.

“Despite the regulations on medical waste emissions, some hospitals and pharmacies also discharge wastes containing excessive chemicals in the rivers,” Ma Jun, the director of the Institute of Public Environmental Affairs (IPE), told the Global Times.

On the website of the IPE, there were 220 pollution emission violations involving medical institutions and pharmacies in 2014.

Antibiotics are not included in tap water’s quality test, although the general environment is widely contaminated by antibiotics, Zhang Jinliang, professor with the Chinese Research Academy of Environmental Sciences, told the Global Times.

So far, the antibiotics contained in the environment are of low concentration, Zhang said.

Experts believe that the only way to curb antibiotics abuse is to strictly control use in hospitals and the agriculture sector.

China’s top health authority started to launch regular campaigns to crack down on the impropriate use of antibiotics for clinical use in 2011. Doctors who violate the rules are warned or have their licenses revoked.

In February, the National Health and Family Planning Commission announced that the national antibiotics usage for hospitalized patients dropped 41 percent in 2014. The usage in outpatient prescriptions has dropped to 10 percent.

The management of antibiotics usage will extend to all local medical institutions and private clinics by the end of this year, the commission said.

Some patients demand antibiotics in prescriptions, contributing to this abuse, Zhang said.

A survey conducted by the China Food and Drug Administration in 2012 showed that 24 percent of the residents in China chose to take antibiotics after catching a cold, which has absolutely no medical benefit, and 60 percent of the residents stored antibiotics at home.