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If you're a doctor in China and you want to alienate your patient as quickly as possible, there's one simple way: deny him antibiotics. "Patients often say they want antibiotics even when they don't need them, and then they get angry at the doctors when they try to explain why the drugs won't help," says Dr. Tong Zhaohui, vice director of the respiratory department at Beijing's Chaoyang Hospital. To many Chinese patients, antibiotics are silver bullets: a cure for everything from skin infections to life-threatening lung ailments; and if a little is good, then more must be better—especially if you can get dosed directly through an intravenous line. "They say, 'I want an IV,' and they'll fight with you when you refuse it," says Tong. "Doctors often feel like they don't have any time to argue, so they just say, 'Fine, if this is what you want, I'll give it to you.'"

But keeping the peace in the waiting room may be contributing to one of the most troubling issues facing medicine today. Worldwide, overuse of antibiotics is increasing the resistance of bacteria to drugs, leading to stubborn, virulent infections that are invulnerable to almost everything doctors can throw at them. Already, more than 90% of some bacteria species in Asia have developed strong immunity to frequently administered antibiotics such as penicillin and ampicillin, according to the World Health Organization. Despite growing awareness of the problem, health-care experts now fear that widespread misuse of antibiotics in populous developing countries such as China will accelerate the emergence of new strains of supergerms, making everything from common diseases like pneumonia to routine surgery more dangerous. "Drug resistance overshadows everything," says Dr. Stuart Levy, president of the Boston-based Alliance for the Prudent Use of Antibiotics. "It's almost a disease in itself, a shadow epidemic."

Infections are becoming harder to suppress because bacteria operate under the Nietzscheian principle: what doesn't kill them makes them stronger. As germs reproduce, some mutate, randomly developing genetic traits that give them some protection against treatments that were effective against their progenitors. (Viruses, which cause the common cold, are impervious to antibiotics.) By administering antibiotics at even the slightest symptom, physicians and patients are multiplying the opportunities for stronger strains to flourish. Trouble has already appeared in the developed world: in the U.S., where experts estimate that half of all antibiotic prescriptions are unnecessary, about 90,000 people died from antibiotic-resistant infections last year, up from 13,000 in 1992.

Now, as large numbers of people in developing countries are increasingly able to afford drugs, doctors are worried that the problem could spiral out of control. According to the China Medicine Development and Research Center, 70% of drug prescriptions in China are for antibiotics, compared with roughly 30% in the West. "Resistance has risen dramatically in the past 10 years," says Tong, who is also a leading researcher on antibiotic resistance. He notes that a survey of 10 cities conducted three years ago revealed that in Shenyang, all pneumonia cases exhibited resistance to erythromycin.

China's tendency to overprescribe antibiotics can be traced back to its traditional medical beliefs. "According to Chinese medicine, every single illness has a remedy," says Dr. Lam Tai-pong, an assistant dean of the faculty of medicine at the University of Hong Kong. That means Chinese patients are more likely than Westerners to visit the doctor for minor illnesses, and when they go, they are more likely to expect some kind of medication. In addition, most mainland Chinese hospitals lack modern diagnostic resources, leaving doctors unable to tell which bacteria might be causing an infection or whether it's even bacterial at all, so they'll dose patients with more than one antibiotic at a time just to be safe—a practice that also encourages resistant bacteria. It doesn't help that drugs are a vital revenue source. Mainland hospitals generate at least 80% of their revenues from drug sales, according to China's National Development and Reform Commission.

The Chinese government is working to reduce antibiotic abuse. Over-the-counter sales were made illegal a year ago and advertisements targeting consumers have been curtailed. But enforcing regulations in a country of 1.3 billion people is hard; TIME reporters had little difficulty purchasing antibiotics without prescriptions in several Beijing pharmacies recently. Experts say too few people understand the risks of overuse. Physicians and consumers need to be educated. Says Dr. Raymond Yung, head of infection control at Hong Kong's Department of Health: "Antibiotics are a double-edged sword"—one the world must learn to wield with care.

• Bryan Walsh
• Overuse of antibiotics in China is breeding dangerous new strains of drug-resistant bacteria