Rule of antibiotics, to hold the doctor first

08:58 September 22, 2016

Source: People's Daily life times

Experts questioned: guangdong province medical association vice President, professor of pediatrics at southern medical university Once the yi

Editor's note:

This year, all over the country were halted outpatient infusion, introduced the resistance limit. September 16, this newspaper launched after the rest of the intravenous drop ", the enthusiasm of the feedback received many experts readers. Medical association, vice chairman of guangdong province, southern medical university, professor of pediatrics at once the yi, said the abuse of antibiotics in clinic is still there, and many doctors don't really know the dangers of antibiotics, in this respect, he has a lot to say.

Problems in a "abuse" word

Abuse of antibiotics and infusion bag or bottle is often referred to as "a pair of brothers". In recent years, the local health administrative departments have cancel outpatient infusion, to prevent abuse of antibiotics. To this, the yi has a unique view.

"Life times" : some people think that cancel outpatient intravenous fluids too "one size fits all", how do you think?

Once the yi: intravenous fluids to split in two. For patients with high fever for several days, is heavier, through the gastrointestinal tract absorb large amounts of fluid are difficult, intravenous fluids can supplement loss of liquid in a short time, rapid recovery of water and electrolyte balance. We want to stop is intravenous drug abuse, there are five types of drugs is very terrible, antibiotics and antiviral drugs, hormone, vitamin, Chinese medicine intravenous preparations, biological agents.

"Life times" : "in a high-level antibiotics against superbugs" reports of frequent, in the United States, more than 60% of doctors and senior preferences using antibiotics. It can achieve better result?

Once the yi: "no equal, curative effect is accurate, the fittest for good", is my view. Many doctors prefer a senior antibiotics, because medical concept has a deviation. They think, use advanced antibiotics, the bacteria were killed, can cure. But at the same time, it may be pathogenic, and even increase the risk of death. Bacteria are killed, will release a large amount of antigen, stimulate the body's immune response, to have more serious, in turn, produce a large number of inflammatory substances, autoimmune injury induced host, increase the risk of "antibiotics induce sepsis, and even the multiple organ dysfunction.

The life times: once formed "resistance", will have a huge damage to human body?

Once the yi: usually, people will put the "resistance" as a big threat to antibiotics abuse. But I think, the generation of drug resistance, and can prevent excessive sterilization, in turn, damage the body, is the body to adapt to the external damage mechanism of self-protection. So, the worst effects of antibiotics is not prompted the emergence of resistant strains, and it can cause serious damage, induce multiple organ damage. But even senior hospital doctors, is not entirely clear how to reasonable use of antibiotics. If someone think, fever, elevated white blood cell, an indication is the use of antibiotics. But warmer white blood cells is a kind of inflammation and immune response, not necessarily is a bacterial infection. Doctors wrong use of antibiotics has affected the public perception, so a lot of people also followed that diminish inflammation to use antibiotics.

Children with antibiotics should be "gentle"

Once the yi is the national famous pediatrician, as a critical care medicine branch committee, director of the association of guangdong province children, he more worried about the use of antibiotics for children, something he needs to parents.

"Life times" : at present, child abuse of antibiotics was it serious?

Once the yi, let me very sad that some parents of drug dependence is very high, children have a, minor illness soon want to take medicine to the child, the resulting drug abuse is a concern. Since childhood diseases is given priority to with infection, even some 3 armour hospital doctors think fastest antibiotic effect. But compared with adults, antibiotics in children caused by an immune response, stronger antibiotics under adverse reaction ability is worse, the side effects of many drugs need longer time to appear. Used widely for children to use, for example, tetracycline, was found only after several years could cause tooth staining and enamel hypoplasia. Medicine for children because of the lack of "children", the doctor feels half or break two-thirds to take their children, so bring a lot of negative problems.

The Times of life: if must use antibiotic, how to give the child medication?

Once the yi: in 1987, I learned when I study at Columbia University in Canada, the international on the use of antibiotics to bacterial culture and etiology inspection as the basis. Children's resistance to infection, I believe, should be "gentle, don't jolt", using less advanced antibiotics can save critically ill patients. Children's intensive treatment centers in guangzhou that I created, there was a 14-year-old girl, transfer to come over to cystitis is combined for severe acute pancreatitis, viral encephalitis, multiple organ damage and in a coma. I immediately stop using the antibiotics and hormones, to her change into a made-up "anti-inflammatory cocktail therapy", the second day is better. This suggests that cure don't ignore the body's self-healing force.

The surgeon operated on to antibiotics

Once the yi is the earliest a batch to "antibiotics" operation, 2006, guangzhou children's hospital, he ordered a halt to purchase two kinds of antibiotics; In 2009, as zhujiang hospital, southern medical university, announced it was scrapping some expensive antibiotics. Today, in the pearl river hospital pediatric care unit, antibiotics utilization rate is only 13%, while countries require no more than 50%.

"Life times" : have you ever put forward "can't hold a doctor, to manage pharmacy director's point of view, what are the real reasons?

Once the yi: the understanding of the antibiotics and use habits, director of various branches have their own ideas. To hold large quantities of director of difficult, you might as well keep the pharmacy, director of the rein some antibiotic use, enable clinicians "no cure". But which belonged to a necessity. In recent years, the administrative department of health is to strengthen the management of antibiotics, but the effect is not big. Really reasonable, through continuous education and training, let the doctor really know antibiotics. For more than ten years, I devoted to the rational use of antibiotics in clinical practice and industry in the preaching, with the outcome.

The Times of life: how to manage antibiotics, achieve the goal of fair use?

Once the yi: first, to strengthen the professional training of doctors. Second, the use of antibiotics to formulate strict, let more doctors. According to statistics, many clinicians witting rate was only twenty percent of the relevant specification. Third, the large medical institutions should establish infection management section and clinical infection division, from two levels of the administrative and clinical medical regulation. In a word, antibiotics is not "a disaster". The rational use of antibiotics, which should be followed: in accordance with the drug susceptibility reasonable choose medicine; There are indications as soon as possible; No indications without drug abuse; It is necessary to use powerful antibiotics at the same time, corresponding measures should be taken to avoid antibiotics induce autoimmune damage "" host, should closely observe more, pay attention to and avoid bacteria killed by a large number of may induce sepsis. Bring (this article titled by our reporter zhang jie)