Abstract: Objective To investigate the usage of second-line anti-tuberculosis drugs (SLD) in medical institutions at all levels, and provide scientific evidence for policy development in China.  Method A stratified purposive sampling method were adopted, and a total of 12 provinces were involved in the cross sectional survey. Questionnaires were performed to all TB prevention and control institutions, tuberculosis specialist hospitals, general hospitals and rural health clinics at each level.  Results A total of 4782 institutions were involved in the survey, and 72.6% of them have used SLD. The proportion of institutions using SLD decreased by level, as follows: 87.0% for provincial level, prefecture and city level 83.4%, district level 72.0%, township level 70.3%.The proportion of SLD use varied between different type of institutions, with 98.7% of TB institutions which were based in tuberculosis, chest, pulmonary hospital, as well as designated hospitals, 100% of TB special hospital, 99.4% of general hospital. However, only 22.9% of TB institutions which are based in CDC used SLD. For the usage of different kind of SLD, there were great variations in terms of proportion of institutions using. Among them, Amikacin(49.6%), Ofloxacin(42.3%), Levofloxacin(66.2%), Ciprofloxacin(39.5%) had a higher proportion. Only 92 （1.9%）institutions perform drug susceptibility testing (DST) for first-line TB drug. Factors affecting the use of SLD are: region, type of institution, whether there are TB clinics and wards, number of beds for tuberculosis patients, whether perform sputum smear, whether perform sputum culture (P all<0.001) and patients smear-positive rate (P<0.05) etc. Drug susceptibility testing is not the influencing factors for SLD use (P=0.771). Conclusion SLD is commonly used in China. The use of SLD varied between different level, different kind, and different type of institutions. DST is seldom performed. Therefore China should develop a policy on the rational use of SLD, and promote DST for SLD.

Key words: antibiotics, antitubercular, fluoroquinolines, amikacin, capreomycin sulfate