Rational use of antibiotics in clinic

Experts talk about the rational application of antibiotics

Interviewer: Xiao Yonghong, deputy director, professor and chief physician of Peking University Institute of Clinical Pharmacology.

Overview of antibiotics

Antibiotics are actually familiar to everyone. Strictly speaking, antibiotics are drugs that can inhibit and kill all living things at very low concentrations. For example, our drugs against bacteria, viruses, parasites and even anti-tumor drugs belong to the category of antibiotics. But the antibiotics we refer to in our daily life and medical treatment are mainly drugs against bacteria, viruses and microorganisms, and there are quite a few kinds. Can be divided into more than a dozen categories. There should be more than 100 varieties commonly used in clinic, such as penicillin, which we commonly use. There are also many kinds of cephalosporins and erythromycin. Each species has its own characteristics and is used for different diseases, people, bacteria and so on. Therefore, it is necessary to make appropriate choices according to different people and different diseases.

By definition, antibiotics can kill organisms such as bacteria and viruses at very low concentrations. There are many things that can kill living things. For example, disinfectants used at home can also kill living things, but they can only be called disinfectants. This disinfectant can't be used for human body, and can only be used for disinfection of external environment. Antibiotics are drugs with low toxicity and high safety, which can be used in human body at very low concentration. The role of antibiotics is to kill microorganisms that infect us, with the aim of killing pathogens, controlling diseases and finally treating diseases.

The difference between antibiotics and antibacterial and anti-inflammatory drugs

Antibiotics are widely used and varied, and their popularity among the general population is very high, resulting in the confusion of their names. For a long time, not only the general public, but also some professionals are not sure about the definition of strict antibiotics. Generally speaking, anti-inflammatory drugs are probably antibiotics, but in fact, strictly speaking, anti-inflammatory drugs and antibiotics should be two different types of drugs. Antibiotics we use do not work directly against inflammation, but kill microorganisms that cause inflammation, while anti-inflammatory drugs are aimed at inflammation, such as commonly used non-steroidal anti-inflammatory and analgesic drugs such as aspirin. What is the relationship between antibacterial drugs and antibiotics? They have a large-scale and small-scale relationship. Antibiotics are aimed at all organisms that can be cured and killed, including bacteria, viruses, parasites and tumor cells. Antibacterials mainly kill bacteria. Because in addition to bacteria, there are many microorganisms that can cause human infections. For example, last year's SARS epidemic was a virus infection and needed antiviral drugs. Both antiviral drugs and antibacterial drugs can be counted as antibiotics. Antibiotics are generalized, while antibacterial drugs are specific.

Current situation of antibiotic use in China

Clinically, almost every department and every professional doctor is using antibiotics, and the utilization rate is very high. Infection requires antibiotics, including viral infection, bacterial infection, parasitic infection, mycoplasma, chlamydia and other microbial infections. Many of our usual diseases are really infectious diseases, such as the common cold, upper respiratory tract infection, urinary tract infection, skin infection, etc., but the pathogens they cause are different. 80-90% of the upper respiratory tract is infected by virus, and the urinary tract is infected by bacteria. If it is a viral infection, use antiviral antibiotics, if it is a bacterial infection, use antibacterial antibiotics. The use of antibiotics in hospitals accounts for 30-50% of the total. Some of them are necessary, while others are unreasonable. In addition to hospitals, ordinary people also have antibiotics at home, and a large part of pharmacies are also antibiotics. Antibiotics are widely used in China, and there must be many unreasonable places that need strict scientific guidance and management.

In developed countries in Europe and America, the usage of antibiotics accounts for about 10% of all drugs. The lowest hospitals in China account for 30%, and the primary hospitals may be as high as 50%. Antibiotic abuse is an unavoidable problem. The reasons are as follows: First, due to the primary stage of social development, the country's research ability and original ability are not strong, drugs are mainly copied, and many pharmaceutical companies are producing antibiotics. Second, there are hundreds of pharmaceutical manufacturers producing the same antibiotic, and there may be vicious competition in market sales, leading to unreasonable use of antibiotics. Third, the professional division of labor in medical development is becoming more and more detailed, and every doctor has his own professional problems. Antibiotics are commonly used drugs, and their professionalism is not as strong as this major, so they will be misused or abused. Fourth, patients and their families habitually take antibiotics to treat diseases. For example, if you have a cold, according to the medical point of view, many colds are viral infections. Strictly speaking, there is no specific medicine, just symptomatic treatment, and no antibiotics are needed. However, everyone may have had such an experience. After catching a cold, they habitually buy some cold medicine in the drugstore and add some antibiotics to use. In fact, antibiotics are useless, wasted and abused at this time. Fifth, China's drug regulations have long been divided into prescription drugs and over-the-counter drugs. Antibiotics should belong to prescription drugs, but in the process of drug sales, does anyone need to show a prescription to buy drugs? In addition to traditional Chinese medicine, western medicine can be bought as long as it has a name, and there are even medicine supermarkets for you to choose your own medicine. Will this be accurate? It will undoubtedly lead to the abuse of antibiotics. Sixth, antibiotics are widely used in animal husbandry. We often hear reports that some antibiotic residues have been detected in the food exported from China and refused to leave the customs. As far as I know, the amount of antibiotics used in animal husbandry far exceeds the sum of human consumption. There are many antibiotics in the environment, and the bacteria in the environment have accepted antibiotics and developed drug resistance. It is more difficult for the human body to get the infection treatment of drug-resistant bacteria. This is not only a national problem, but also a global problem.

The nonstandard use of antibiotics, on the one hand, causes bacterial resistance, which is much faster than the development of new drugs. In the long run, we may return to the state before 1970s and 1980s. If antibiotics are not used, human beings will face the threat of many infectious diseases again. For example, tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Many years ago, people thought it was well controlled, but now there are so many drug-resistant mycobacterium tuberculosis that it is very difficult to treat. This may lead to an increase in mortality, and the social resources spent on treating drug-resistant tuberculosis are more than ten times that of treating a non-drug-resistant tuberculosis, resulting in a very heavy social burden. In the second aspect, antibiotics are also drugs. After entering the human body, they will play a therapeutic role and cause many adverse reactions. The more drugs are used, the higher the probability of adverse reactions. According to the records of China Adverse Drug Reaction Monitoring Center, one third of the adverse drug reactions in China are caused by antibiotics, which is consistent with the proportion of antibiotics used. There are many kinds of antibiotics, which cause adverse reactions or serious adverse reactions involving various systems of the body. Rational use of antibiotics is an urgent problem.

The State Food and Drug Administration of the United States issued a notice on promoting the rational use of antibacterial drugs, calling on people not to buy antibacterial drugs themselves, but to use antibacterial drugs reasonably under the guidance of doctors. This is a responsible move for the people, and everyone should actively participate. Not only professional medical personnel need to use antibiotics rationally, but also ordinary people and patients should have the awareness of rational use, use them under the guidance of doctors, and don't buy antibiotics blindly. Only in this way can we promote the rational use of antibiotics in China and avoid the adverse drug reactions and the increasing drug resistance of bacteria.