Selection of antibiotics for whistle infections Upper whistle infections are a collective term that includes the common cold, acute sinusitis, tonsillopharyngitis, laryngitis, and pharyngitis. More than 90% of the pathogens are viruses, such as rhinovirus, adenovirus, influenza virus and parainfluenza virus. Bacteria only account for about 10%. Most of these patients are clinically not high blood count, and the duration of the disease is relatively short (usually 1 week). Treatment is based on rest, drinking plenty of fluids and symptomatic treatment without the use of antibiotics. If the symptoms do not improve in 7-10 days, and there is fever, elevated white blood cells, or septic or non-septic complications (rheumatism, glomerulonephritis), antibiotics can be used. The first choice of antibiotics is penicillin (penicillin G, amoxicillin), but also the first and second generation cephalosporins and macrolides can be used. The general course of antibiotics is 5~7 days, and 10~14 days for those with rheumatism and glomerulonephritis. If there are serious septic complications, the course of antibiotics can be extended depending on the condition. Lower whistle infection is the most common infectious disease. Including acute and chronic bronchitis, lung infections, etc.. The pathogens are bacteria (common Gram-positive cocci, such as Streptococcus pneumoniae, Staphylococcus aureus; Gram-negative bacilli, such as Klebsiella pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli, Aspergillus; anaerobic bacilli, such as Corynebacterium, Clostridium difficile, etc.), viruses, fungi, protozoa, Mycoplasma, Chlamydia, etc. The rate of bacterial infection is 80% in adults and 70% in children. The rate of fungal infections is significantly higher in immunosuppressed states, in old age, and in cases of heavy use of hormones and antibiotics. It is now accepted that Gram-positive cocci (mainly pneumococci) and Gram-negative bacilli (most commonly Klebsiella pneumoniae) predominate in out-of-hospital acquired lower whistle tract infections. About 60% of hospital-acquired infections were Gram-negative bacilli, the most common of which was Pseudomonas aeruginosa. Out-of-hospital lower whistle infections used to be treated with penicillin as the first choice, but in recent years there has been a significant change in bacterial resistance. For example, the resistance rate of pneumococci to benzocillin and ampicillin reached 50%, and the resistance rate to erythromycin and clindamycin reached 50%-70%. The resistance rate of Staphylococcus aureus and Staphylococcus epidermidis to penicillin is more than 97%, and the resistance rate to erythromycin and clindamycin is about 70%, and vancomycin-resistant staphylococci have also been reported abroad. However, the resistance rate to cotrimoxazole and quinolones is low, especially the new generation of quinolones. Therefore, the combination of cotrimoxazole and quinolones can often obtain the desired effect. In-hospital lower whistle infection treatment preferred ampicillin, hydroxyampicillin or second generation cephalosporins. Metronidazole or clindamycin may be added in the presence of anaerobic infections. The total effective time can be increased by splitting the dose. β-lactam antibiotics are recommended for splitting the dose. For mild and moderate infections can be given orally, for serious lower whistle infection or combined with other diseases, intravenous administration is recommended, and can be combined with antibiotics, generally duplex can achieve satisfactory results. The quinolone antibiotics are important drugs for the treatment of lower whistle infection in recent years. It has the characteristics of high tissue concentration and low minimum bacterial inhibitory concentration. The concentration of the drug in the bronchial mucosa is two times higher than in the blood, in the alveolar epithelium is two to three times higher than in the blood, and in the alveolar macrophages is nine to 15 times higher than in the blood. β-lactam antibiotics are most widely used in the treatment of whistle tract infections. They mainly include penicillins, cephalosporins and atypical β-lactam antibiotics. β-lactam antibiotics combined with β-lactamase inhibitors (rotenone, sulbactam) can significantly increase antibacterial activity and reduce the emergence of drug-resistant strains. Tylenol, Temetin and Maspine have potent bactericidal activity against Gram-positive cocci, Gram-negative bacilli and anaerobic bacilli. Macrolide antibiotics are most commonly used in the treatment of out-of-hospital bacterial whistle tract infections, and have powerful antibacterial activity against Gram-positive cocci (Streptococcus pneumoniae, Staphylococcus aureus), and against Gram-negative bacilli (such as Haemophilus influenzae) and various anaerobic bacteria other than Clostridium difficile, and have positive efficacy against atypical pneumonia (Mycoplasma, Chlamydia, Legionella). Its new generation drugs (such as roxithromycin, azithromycin, clarithromycin) are stable to gastric acid, high bioavailability, high tissue cell concentration and blood concentration, long-lasting maintenance, and few adverse reactions. Aminoglycoside antibiotics have strong antibacterial activity against Gram-negative bacilli, and their main adverse effects are ototoxicity and nephrotoxicity. Adverse reactions are closely related to blood concentration. These antibiotics have a long antibiotic follow-up effect. This phenomenon is concentration- and time-dependent, so a short, high-dose, once-daily regimen is advocated. These drugs enter the cells through cellular uptake, which is slow, and can be administered locally at good concentrations. Infections of the digestive system and the application of antibiotics Biliary infections are acute and chronic inflammatory lesions of the entire biliary system, mostly secondary to stones and tumors, and inflammation promotes the formation and increase of stones, and has a high mortality rate (11.8%). Under normal conditions, bile is sterile. Due to the anatomical and physiological characteristics of the biliary tract and intestine, the route of infection of the biliary system is either upstream infection of the intestine or infection of the portal venous system and lymphatic system. Most of the bacteria infecting the biliary system flow directly from the intestine to the bile duct through the sphincter of Oddi, so the pathogenic bacteria are basically the same as the intestinal flora, mainly Escherichia coli, followed by Pseudomonas, Enterococcus and Aspergillus, and often a mixture of more than two kinds of infections. Anaerobic bacteria infection rate is about 51% higher than other parts. The selection of antibiotics should take into account the pathogenic species, bacterial resistance, antibiotic spectrum and its concentration in the bile, and the bile culture and drug test is an important guide. Before getting the results of drug sensitivity test, we should choose the drugs with strong antibacterial or bactericidal power, high concentration in bile and low adverse effects. Penicillin penicillin G is not highly concentrated in the bile and is generally ineffective against biliary infections. The concentration of hydroxybenzyl penicillin and carboxybenzyl penicillin in bile is lower than the blood concentration, and the effect is not satisfactory. In contrast, oxypiperazine penicillin has strong bactericidal activity against biliary pathogenic bacteria, and the biliary concentration is higher than the serum concentration. The first generation of cephalosporins is mainly effective against Gram-positive cocci, so it is available for enterococcal infection. Second generation cephalosporins are effective for some Gram-negative bacilli and Gram-positive cocci, and the biliary concentration of cefuroxime, cefadroxil and cefoperazole sodium (Pioneer) is higher than the serum concentration, which can be used for biliary infection, but not for Pseudomonas aeruginosa. The third generation cephalosporins have strong bactericidal ability against Gram-negative bacilli and Pseudomonas aeruginosa, and low nephrotoxicity, but are not as effective as the first and second generations against Gram-positive cocci. Quinolones have bactericidal activity against most Gram-positive cocci and Gram-negative bacilli, and can reach effective concentration in bile, which is suitable for patients with mixed biliary tract infections, but have certain toxicity to the central nervous system, liver, kidney and bone. The aminoglycoside antibiotics have strong bactericidal effect on Gram-negative bacilli, but their clinical application is limited by ototoxicity and nephrotoxicity. Enterococci resistant to vancomycin and aminoglycosides are sensitive to the newly developed azolidinone antibiotics Linezol2id and Oritarancin. Metronidazole has strong antibacterial activity against common anaerobic bacteria, and the concentration in bile is greater than the serum concentration, so it is often used in the treatment of biliary infections, and has better efficacy when combined with other drugs. Commonly used combination drug scheme is metronidazole plus oxypiperazine penicillin, or add two or three generations of cephalosporins (except ceftazidime, cefmetaxel), or add quinolones, all can obtain good results. Macrolide antibiotics have some antibacterial activity against Gram-positive cocci, and the concentration in bile is greater than the serum concentration, but there is a certain degree of hepatotoxicity, so use with caution in people with impaired liver function. Biliary infection antibiotics are generally administered intravenously and can be discontinued 3-4 days after the application until the body temperature is normal and the symptoms subside. For serious infections of unknown etiology, which require prolonged medication, bacterial resistance is likely to develop, so a combination of drugs should be used. Cirrhosis with abdominal infection Patients with cirrhosis have low immunity and are prone to bacterial abdominal infections, and abdominal infections are directly related to the morbidity and mortality rate. Infected bacteria are mostly Escherichia coli and Klebsiella pneumoniae. The ideal antibiotic is a third-generation cephalosporin. Quinolones are commonly used to treat abdominal infections because of their broad antibacterial spectrum and strong antibacterial activity. However, foreign data reported a 50% resistance rate to E. coli. After the occurrence of abdominal cavity infection, the patient’s condition deteriorates rapidly, so it is emphasized that early, adequate and combined application of antibiotics, the dose should be high in the first few days, and we cannot wait for the results of bacterial culture, and adjust the medication according to the response to treatment and culture results, and the medication time is not less than two weeks. Other causes of abdominal infections are often a mixture of bacteria, treatment requires the use of antibiotics effective against a variety of bacteria. Foreign experts recommend a single drug for mild to moderate infections and a combination of drugs for severe infections. If possible, intravenous drugs should be administered intravenously, and it is appropriate to discontinue the drug in 3-5 days when the blood picture is normal and the body temperature is normal. Urinary tract infection is second only to the incidence of urinary tract infection after the whistling system, 85% of urinary tract infections are caused by Escherichia coli, followed by Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, anaerobic bacilli and staphylococci. Empirical treatment to give cotrimoxazole, norfloxacin and other quinolones after 3 days of treatment, if the condition does not improve, then according to the drug sensitivity results of drug replacement (before the use of drugs should be preceded by urine culture plus drug sensitivity test). As far as possible, we should use antibiotics with low nephrotoxicity, few adverse reactions, easy to take, and bacteria are not easy to produce resistance, and as far as possible, a single drug. The first is to use a combination of antibiotics after the failure of a single drug, a serious infection, a mixed infection or the emergence of drug-resistant strains, but generally the second is the main. The use of a glycoside plus a semi-synthetic broad-spectrum penicillin or three generations of cephalosporins is often used. Because of the short half-life of these drugs, 1 day dose divided to maintain the effective urinary drug concentration, to achieve the best therapeutic effect. The duration of treatment is usually 2 weeks. Central nervous system infection and the application of antibiotics Central nervous system infection is a very critical clinical condition, the early and correct application of antibiotic treatment is the key to save the patient’s life and reduce the sequelae. The common causative agents of CNS infection are meningococcus, pneumococcus, Listeria monocytogenes and Haemophilus influenzae. For adult patients, attention should be paid to the use of drugs that can easily cross the blood-brain barrier and blood-brain crestal fluid barrier in order to work in the central nervous system. Erythromycin, lincomycin, and aminoglycosides do not easily reach CNS lesions, while ampicillin, penicillin, sulfonamides, cefotaxime, ceftriaxone, and meropenem are all effective antibiotics for CNS infections. CNS infection is mostly a bacterial infection, so an effective antibiotic can be used. Try to use bactericidal drugs, intravenous administration, and high doses are appropriate. The combination of drugs must be clearly indicated. Central nervous system infection can also be intrathecal administration, but we should pay attention to small doses, low concentration, slow speed of drug administration. Orthopedic infectious diseases mainly include acute and chronic osteomyelitis, septic arthritis and sclerosing osteomyelitis. The causative agents are mainly Pseudomonas, Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus haemolyticus and Streptococcus pyogenes. In the treatment of bone and joint infections, it is advisable to use drugs that can reach effective concentrations in bone tissue and joint cavities, are less likely to produce resistance and have fewer toxic side effects. Penicillin, lincomycin, clindamycin, phosphomycin, cephalosporins, etc. can easily enter the joint cavity and are therefore suitable for use, while erythromycin, chloramphenicol, aminoglycosides, etc. do not easily penetrate into the joint cavity and are relatively more toxic, so they are not suitable for use. Since the causative organism is often Staphylococcus aureus, one drug for Gram-positive cocci and another for broad-spectrum antibiotics are usually used. After the return of bacterial culture results, the medication should be adjusted promptly, and the antibiotics should be applied continuously for 3 weeks. Soft tissue skin infections The soft tissue of the skin is in direct contact with external pathogens and has a much higher chance of being traumatized than other systems and organs. The main pathogenic bacteria are Staphylococcus aureus, Streptococcus haemolyticus and Escherichia coli. In mild cases, oral medication is given, while in moderate and severe cases, systemic medication should be given. Treatment with penicillin and cephalosporins is appropriate. The infection of abdominal cavity and perineum is mainly Gram-negative bacilli, so quinolones, aminoglycosides and metronidazole should be used. The bacteria and antibiotic susceptibility of different parts of the infection have different characteristics. Before the results of the drug sensitivity test are returned, antibiotics should be selected empirically according to the patient’s condition and the location of the infection. Individualized treatment by drug sensitivity test. The use of antibiotics should not be used blindly, abusively, in large doses for a long time or in low concentrations, otherwise it will not only cause economic waste and toxic side effects of antibiotics, but more importantly, it will lead to an increase in the resistance of pathogenic bacteria and drug-resistant bacteria.