I. restrictions on granting the right to prescribe antibiotics "Prescription Management Measures" stipulates that prescriptions prescribed by registered assistant practicing doctors in medical institutions shall be valid only after they are signed by the practicing doctors at their places of practice or stamped with special seals. Registered practicing assistant doctors independently engage in general practice activities in medical institutions in townships, ethnic townships and villages, and can obtain corresponding prescription rights at registered practice places. Article 24 of the Prescription Management Measures stipulates that doctors with senior professional and technical post qualifications may be granted the right to prescribe antibiotics of special use grade. Doctors with intermediate or above professional and technical post qualifications may be granted the right to prescribe antibiotics with restricted use. Physicians with primary professional and technical post qualifications, assistant practicing physicians who independently engage in general practice activities in medical institutions in townships, ethnic townships, towns and villages, and rural doctors may be granted the right to prescribe antibiotics with unrestricted use. Hospitals at or above the second level should regularly train clinicians on the clinical application knowledge and standardized management of antibiotics. Doctors can obtain the corresponding prescription right only after they have been trained and passed the examination in this institution. Doctors, rural doctors and pharmacists engaged in prescription adjustment in other medical institutions shall organize relevant training and assessment by local health administrative departments at or above the county level. Those who pass the examination shall be granted the right to prescribe antibiotics or the qualification to adjust antibiotics. Clinicians must be trained to obtain the prescription right and qualification of antibiotics, which is one of the important means to strengthen the management of antibiotics. In the management of clinical drug application in China, so far only the prescription right and dispensing qualification of psychotropic drugs, narcotic drugs, toxic drugs and radioactive drugs need prior authorization. In this way, the prescription right and dispensing qualification of antibacterial drugs are listed separately, which improves the working conditions of clinicians and clinical pharmacists, embodies the determination and confidence of the Health and Health Commission and relevant health administrative departments to strengthen the management of antibacterial drugs, and also strengthens the management of clinical application of antibacterial drugs, greatly preventing the abuse of antibiotics. Due to the variety of antibacterial drugs and product specifications, it is very difficult to use them reasonably in clinic. According to preliminary statistics, there are more than 15 kinds of antibacterial drugs used clinically in China, and there are more than 1, kinds of specifications. It is difficult for non-professional clinicians to master all the drug information and rational use, and some clinicians are even unclear about the categories and basic characteristics of some antibacterial drugs. Rational use of antibiotics also requires appropriate knowledge of infectious diseases and clinical microorganisms, and it is also necessary to be familiar with the management regulations of administrative departments. Only by popularizing the basic knowledge of rational use of antibiotics among clinicians and pharmacists, making them establish the basic concept of rational use of antibiotics, and fully recognizing their own shortcomings in the application of antibiotics, can it be possible to carry out the promotion and management of rational use of antibiotics. Popularizing education and training on the rational use and management of antibiotics, the main purpose is to require clinicians and clinical pharmacists to master the basic knowledge of rational use of antibiotics in their work, accept the basic concept of rational drug use, and practice according to laws and regulations: the training for obtaining antibiotic prescription rights or dispensing qualifications in medical institutions above the first level shall be organized and implemented by antibiotic management working groups of various institutions, and the training time shall not be less than 4 hours. Experts from this institution or other institutions may be invited to give lectures, and tests are required at the end of the lectures. Those who pass the tests will be granted the right to prescribe antibiotics or the qualification for dispensing antibiotics by medical institutions. The specific training situation and the authorization of clinicians and pharmacists should be recorded for the supervision of the management department. Medical institutions below the second level are limited by their own conditions, and the training needs to be organized and implemented by the health administrative department at or above the county level. The specific training process is the same as that of the above-mentioned medical institutions. Similarly, those who pass the examination are granted the right to prescribe or adjust antibiotics. After the professional title of clinicians is promoted, they need to obtain the right to prescribe antibacterial drugs at a higher level, and they also need to receive the above training again. The rational use of antibiotics is a process of continuous improvement, and Yamatonokusushi, a clinician, is not trained once and for all. Therefore, medical institutions need to establish a long-term training and education mechanism for the rational use of antibiotics, and incorporate this content into the continuing education system for clinicians and pharmacists. Yamatonokusushi, a doctor who has the right to prescribe or adjust, needs to receive at least 4 hours of education and training every year. The antibacterial drug management team needs to cooperate with the continuing education department of medical institutions to set up an annual training course for the rational use of antibiotics, and urge clinical medical workers to actively participate in the study.

second, grasp the indications of antibiotic drugs to prevent infection. Article 26 of the Measures stipulates that medical institutions and medical personnel should strictly grasp the indications of using antibiotics and other antibacterial drugs to prevent infection. Non-restricted antibiotic drugs should be the first choice for preventing infection and treating mild or local infection. Restricted-use antibiotics can only be used when there is serious infection, low immune function complicated with infection or pathogenic bacteria are only sensitive to restricted-use antibiotics. Due to the long-term misunderstanding, the indications and application scope of antibacterial drugs have been invisibly expanded. These drugs are not only used for the treatment and prevention of various bacterial infections, but also widely used for the treatment of various non-bacterial infections such as fever, cough and food poisoning in upper respiratory tract infections. According to the Guiding Principles for Clinical Application of Antibiotics jointly issued by National Health Commission Administration of Traditional Chinese Medicine and the General Logistics Department in 218, the description of therapeutic antibiotics is that "according to the symptoms and signs of patients and the results of routine laboratory tests such as hematuria, it is indicated to use antibacterial drugs only after the initial diagnosis of bacterial infection and the diagnosis of bacterial infection by pathogen examination. Infections caused by pathogenic microorganisms such as fungi, Mycobacterium tuberculosis, non-Mycobacterium tuberculosis, mycoplasma, chlamydia, spirochete, rickettsia and some protozoa also indicate the application of organic bacteria drugs. Lack of evidence of bacteria and the above-mentioned pathogenic microorganisms, those who can't be diagnosed, and virus-infected people have no indication to use antibiotics. Preventive application is only limited to a few bacterial infections and some surgical operations that can be prevented by antibiotics, including: preventive drugs for internal medicine and pediatrics: 1. It may be effective to prevent infections caused by the invasion of one or two specific pathogens. If the purpose is to prevent any bacteria from invading people, it is often ineffective. 2. It may be effective to prevent infections that occur within a period of time. Long-term preventive medication often fails to achieve the goal. 3. If the patient's primary disease can be cured or alleviated, preventive medication may be effective. If the primary disease cannot be cured or alleviated (such as immunodeficiency), preventive drugs should be used as little as possible. Patients with immunodeficiency should be closely observed, and once there are signs of infection, they should be given experience treatment at the same time as sending relevant specimens for culture. Objective: To prevent postoperative bacterial infection of incision, postoperative infection of surgical site and possible systemic infection. The application of antibiotics in surgical operation period shall be carried out in accordance with National Health Commission's Guiding Principles for Clinical Application of Antibacterials and Notice on Relevant Issues Concerning the Management of Clinical Application of Antibacterials. According to the above requirements, clinicians must strictly abide by the principles and indications of the application of antibacterial drugs, and put an end to the phenomenon of unlimited expansion of the indications of antibacterial drugs. Medical institutions also need to take whether the application of antibacterial drugs has indications as the main supervision and management content. According to the requirements, methods and purposes of classified management of antibacterial drugs, relevant laws stipulate that clinicians must use antibacterial drugs according to their respective prescription authority and indications of antibacterial drugs. To prevent infection and treat mild or local infection, the first choice should be unrestricted use of antibacterial drugs. When severe infection, low immune function complicated with infection or pathogenic bacteria are only sensitive to restricted use of antibacterial drugs, you can choose restricted use antibiotics. Strictly control the use of special-purpose antibacterial drugs. In particular, the management regulations must be strictly implemented for restricted use and special use grade antibacterial drugs, including the applicable object of drug indications, prescription authority, consultation system and so on. Antibiotic drug management team should strengthen the supervision and comment on restricted and special-use antibiotics, find out the problems in clinical application in time, and correct them through education, training, face-to-face communication and administrative punishment. Medical institutions can use the information system to set the authority of doctors and the indications for special use of antibacterial drugs, and follow them in clinic.

iii. restrictions on the use of special-use antibiotics article 27 of the measures stipulates that the use of special-use antibiotics should be strictly controlled. Antibiotics of special use grade shall not be used in outpatient department. This article is a specific regulation on the application and management of special antibiotic drugs in medical institutions. Medical institutions must strictly control the use of antibiotics such as special envoy grade antibiotics, strictly grasp their indications and establish special management procedures for their use. According to the provisions of Article 24, doctors with senior professional and technical post qualifications can obtain the right to prescribe antibiotics with special use level after passing the training on rational use of antibiotics. However, these doctors must obtain the consent of the consultant before prescribing special-use antibiotics. Therefore, medical institutions must clarify the consultant and his working authority. Due to the characteristics of special-grade antibiotics, it is required that they should not be used at will in clinic, and professional doctors should strictly control their scope of use, indications and methods of use. Most foreign infectious diseases physicians undertake this task, but there is still a shortage of clinical infectious diseases physicians in China, which needs to be cultivated and grown as soon as possible. Therefore, at this stage, medical institutions appoint doctors with senior professional and technical qualifications, such as respiratory department of infectious diseases and microbiology laboratory of critical medicine, who have clinical application experience of antibiotics, or clinical pharmacists with senior professional and technical qualifications. The identification of consultants for special use of antibiotics is related to the smooth development of clinical infection treatment and antibiotic drug management, which is a very serious and important work. Medical institutions adopt the method of combining experts' and departments' recommendations to determine the qualifications of consultants for special use of antibacterial drugs. These candidates generally need to have the qualifications of senior professional and technical positions in related majors, have been engaged in infection treatment and clinical application of antibacterial drugs for more than 1 years, have rich knowledge of antibiotics, diagnosis and treatment of infectious diseases, clinical microbial and bacterial resistance, be familiar with the management regulations on clinical application of antibacterial drugs, have rich experience in clinical treatment of infectious diseases and application of antibacterial drugs, and love the rational use of antibacterial drugs. The recommended candidates shall be determined after collective discussion by the Working Group on Antibiotic Drug Management. The number of consultants is determined according to the specific conditions of medical institutions, and can be set according to the number of beds and the nature of institutions. It is more appropriate for each consultant to consult 15 patients every day. In addition, the Working Group on Antimicrobial Management will standardize and guide the work of consultants, regularly evaluate the work of consultants (usually once a year), make an objective evaluation of their workload and quality of work, and make a decision on whether they will continue to serve as consultation tasks, thus effectively preventing the abuse of antibiotics. Consultants will be invited to consult before the use of special-use antibiotics. Consultants need to make scientific judgments and written opinions according to patients' needs and antibiotic drug management regulations (including the reasons for agreeing to use, the specific plan, course of treatment and matters needing attention, etc.). For patients who agree to use special-use antibiotics, the senior qualified doctors will prescribe them for use.

iv. restrictions on leapfrog use of antibiotics article 28 of the measures stipulates that clinicians may leapfrog use of antibiotics due to emergency situations such as saving dying patients. Leapfrog use of antibiotics should be recorded in detail, and the necessary procedures for leapfrog use of antibiotics should be completed within 24 hours. The basic principle of rational use of antibiotics is "safe, effective and economical", and the relevant laws and regulations restricting the use of antibiotics can also prevent the abuse of antibiotics.

V. Restrictions on the graded management of clinical application of antibacterial drugs Article 6 of the Measures stipulates that the clinical application of antibacterial drugs shall be subject to graded management. According to the safety, efficacy, bacterial resistance, price and other factors, antibacterial drugs including antibiotics are divided into three levels: unrestricted use level, restricted use level and special use level. In addition, similar laws and regulations include the selection and regular evaluation system of antibiotics, the investigation and handling of abnormal clinical application of antibiotics, etc., which also strictly controls the abuse of antibiotics.

VI. Early-warning mechanism of bacterial resistance stipulated in Article 32 and required in Article 42 of the Measures, the early-warning mechanism of bacterial resistance requires clinicians to be familiar with the types and usage of antibiotics in various clinical medical institutions, and make clear the main antibacterial spectrum of various antibacterial drugs, such as Staphylococcus and Escherichia coli as the main antibacterial spectrum of the first-generation cephalosporins, Streptococcus, Haemophilus and Enterobacteriaceae as the main antibacterial spectrum of the third-generation cephalosporins; To master the composition of infectious pathogens in clinical departments, such as streptococcus, Haemophilus, Moraxella catarrhalis, etc. in outpatient respiratory tract infection, anaerobic bacteria and enterococcus in abdominal cavity infection, staphylococcus, non-fermentative bacteria and enterobacteriaceae bacteria in ICU, etc., thus fundamentally eliminating the abuse of antibiotics by clinicians.