OBJECTIVES: The consumption of antibiotics is a major driver in the development of antimicrobial resistance. The objective of this study was to identify the trends and patterns of total antibiotic use in China, to assist monitoring of the rise of resistance. METHODS: A five year surveillance data on antibiotic sales from 2012 to 2016 were collected from 9 hospitals and 30 primary healthcare settings in Shandong and used as a proxy for consumption. Antibiotic consumption was expressed in DDD per 1,000 inhabitants per day (DID) based on Anatomical Therapeutic Chemical (ATC)/DDD methodology. RESULTS: Between 2012 and 2016, total antibiotic consumption across all healthcare settings in Shandong increased by 8.51% (from 16.07 DID to 17.44 DID) in the first 4 years and then fell to 13.53 DID in 2016 with a 22.41% reduction. The underdeveloped regions consumed more antibiotics. In 2016, two-thirds of the antibiotic sales were to hospitals and one-third to primary healthcare institutions. Cephalosporins, the most frequently used antibiotic class, accounted for 28.03% of total DID, and followed by penicillins (22.22%), macrolides (12.13%), fluoroquinolones (8.89%) and beta-lactam-beta-lactamase inhibitor combinations (8.70%). Antibiotic in parenteral form accounted for 40% of all antibiotics. There was increased consumption of carbapenems, from 0.029 DID in 2012 to 0.64 DID in 2016. CONCLUSIONS: A substantial reduction in antibiotic usage and a consistent preference for cephalosporins, penicillins, macrolides, fluoroquinolones, as well as parenteral preparations were observed in Shandong during the study period. The increase in use of last-resort antibiotic drugs raised a concern for public health. Findings could provide valuable evidence to national and provincial governments for further developing antibiotic stewardship policies, and also provide a baseline for future assessment.