4 scenarios to understand why antimicrobials are misused! The 4 familiar scenarios in this article show that antimicrobial abuse has become a serious social problem, and to solve it, we need to increase publicity and education, and everyone in society has an inescapable responsibility for it. When it comes to the abuse of antimicrobial agents in China, knowledgeable people express their concern and also their dissatisfaction and anger towards doctors: It is the profit-oriented doctors who do not care about the health of others in order to make money for themselves. Is this really the case? The abuse of antimicrobial agents has become a serious social problem, and in order to solve it, we must increase publicity and education, and everyone in society has an unshirkable responsibility for it. For a simple example, the child has a disease, fever, runny nose, and a little cough, their own home to feed the child cold medicine and fever medicine, the effect is not good, rush to take the child to the hospital to see a doctor. Scene 1 After the doctor’s visit, he asked for a routine blood test, but the parents disagreed: the child is so young, how painful it is to have blood drawn! Can’t we not do the test? The doctor replied: then it is not easy to distinguish whether it is a bacterial or viral infection. Parents: Whatever the infection, the fever is inflammation, right? You can prescribe some anti-inflammatory drugs, right? Doctor: Inflammation is not always caused by bacteria, most upper respiratory infections like this are viral infections. Parents: Well, you can prescribe anti-inflammatory drugs and antiviral drugs together, right? Doctor: antibacterials are not effective for viral infections, but increase adverse drug reactions and drug resistance. Parents: Then I will give my child a few days less, and stop the medicine when the fever goes down. Doctor: The use of antimicrobial agents has strict indications and dosage, only when the bacterial infection is diagnosed, and must be sufficient amount of full course of treatment, can not be seen as good, otherwise it is easy to resurface, but also easy to develop drug resistance. Parents: Don’t scare me, I’m not going to take a blood test anyway, just give me the medicine, it’s okay! I used to give anti-inflammatory drugs to my children as soon as they had a fever, and I didn’t see any side effects as you said. Scene 2 The parents agreed to the laboratory test, the results came out, the doctor said it was a viral infection, no need to use antibacterial. Parent: Is it possible to have inflammation without antimicrobials? What if the child becomes pneumonia? If the fever persists, or if the cough worsens, the child may have a bacterial infection, so come back to the hospital. Parents: What kind of logic is this? If we don’t use antimicrobials now and wait until the child’s fever turns into pneumonia, won’t that delay the child’s illness? Doctor: Children are small, immune system is low, there is a possibility of bacterial infection after viral infection, but not every child will be combined with bacterial infection, and early application of antimicrobial agents can not play a role in preventing infection. The main thing now is to take good care of the child to promote the transformation of the disease in a good direction. Parent: I still think it is safer to use antimicrobial agents, and I feel confident. Scenario 3: The test results indicate a bacterial infection and the need for antimicrobial agents. Parent: Give some good medicine so that the child can get well quickly, we are not short of money. Doctor: What is a good medicine? Is the more advanced and expensive the better? No! The right medicine is the right medicine for the right condition. The child is an upper respiratory tract infection, just use penicillin type drugs. Parent: Hasn’t penicillin gone out of fashion long ago? I heard that they are now using cephalosporins of several generations. Doctor: There are many kinds of antimicrobial agents, and they should be chosen according to the location of the infection, the type of bacteria that may be present, and the severity of the disease. If your child is not seriously ill, use penicillin first, and then change the medicine after 3 days if the effect is not good. Parents: If the effect is not good, 3 days of medicine for nothing, not to say that the child’s illness is delayed? It is better to use the advanced one first, and hurry up to sedate it. Scene 4: The doctor wants to give oral medication, parents: Oral medication is too slow, look at the child’s fever is quite uncomfortable, infuse some fluids to get better quickly, we all work, no time with the child. Doctor: The principle of medication is to take medication without injections, and to give injections without infusions, the child is not seriously ill and does not need infusions. Parents: Isn’t it faster to get an infusion? Doctor: oral drugs have to be absorbed through the gastrointestinal tract, while intravenous infusion of drugs directly into the blood vessels, is faster, but the effect of drugs into the body is the same, and oral drugs are much safer than intravenous infusion. Parents: My child doesn’t like to take medicine, and it’s a lot of work to feed it. Whenever my child is sick, he is always given an infusion, and the medicine doesn’t work. You give some good medicine, not afraid to spend money. See? Even if it is a common cold and fever, it is necessary to use antimicrobial agents, not only to use advanced antimicrobial agents, but also to infuse fluids. In fact, there are many times that the doctor does not count, in the end, you have to listen to the patient. If a doctor insists on not using antimicrobials, the patient will be fine, but if not, the doctor will be unlucky, and the patient will complain about the doctor’s irresponsible use of improper medication leading to aggravation of the condition, or worse, may be beaten and scolded or even face life threatening. With the current tension between doctors and patients, which doctor has to stick to his principles and take that risk? The end result is that the antimicrobial agent should not be used, not only with, but also with advanced, oral not, but also intravenous infusion. So ah, the abuse of antimicrobials, do not blame the doctor! Personal experience: can take medicine not injections, can injections not infusions, this has been the world recognized principles of medication, but many of us do not know, even if you know, but also do not take it seriously! When a doctor has only 3-4 minutes to see a child, the safest way is obviously to go with the flow of injections and infusions! The health literacy of many parents also dictates that they think giving their child an infusion is the only way to take their child seriously. All of this, needs to change!