The rational application of antibiotics
Antibiotics are commonly used in the clinic, in recent years the problem of indiscriminate use of antibiotics is serious, the health planning commission on the rational application of antibiotics to do 3 years of planning, to rational use of antibiotics, the purpose of one to reduce medical costs, the second is to prevent and control dysbiosis, once the culture of refractory bacteria, no drug available refractory bacteria will be a global disaster.
The following is a summary of the clinical work is a guide and specification for the future.
At present, the Ministry of Health has drastically reduced the types of antibiotics according to the size of the hospital. 50 kinds of antibiotics are used in level 3 hospitals, 30 kinds of antibiotics in level 2 hospitals, and even less in community hospitals. Liu Xige, Department of Otolaryngology, Beijing Electric Power Hospital
How to choose antibiotics? It is not right to give antibiotics to patients with fever, and it is not in line with the principles of medication, because fever may be a bacterial infection in addition to viral infection, mycoplasma, rickettsial infection, but also may be a blood disease, rheumatic immune disease, if the first consultation according to the results of the blood routine need antibiotics, the use of empirical drugs to choose the side effects, less adverse reactions, the most common site of infection The pathogenic bacteria to choose the drug.
In addition, the clinical selection of antibiotics should be based on the results of sputum culture, urine culture, puncture fluid, and even blood culture of pathogenic bacteria, but the current rate of sputum culture is very low, only accounting for about 40%, which indicates that the operation should be strictly standardized, such as taking sputum is early morning saline gargle, cough up the deep sputum, take urine to clean the vulva, take the middle urine, to prevent contamination of the specimen, to distinguish whether it is colonized or pathogenic bacteria.
Because of the different sites of action of antibiotics and thus different types of antibiotics, some antibiotics act on the cell wall, some antibiotics act on the cell membrane, and some act on DNA.
Principles of combination drug use.
Only when one antibiotic fails to solve the problem should another antibiotic be chosen:
Most clinical infections are no longer combined when one antibiotic is effective.
If you can choose two antibiotics, do not choose three or four.
Avoid combining antibiotics of the same class. Avoid using the same antibiotics at the same time if they have the same toxicity.
The purpose of the combination is to
Synergy
Avoid antagonism
Four types of regimens when combining drugs.
Reproductive fungicides + quiescent fungicides
Reproductive fungicides + rapid bactericides
Resting phase fungicides + rapid bactericides
Resting phase bactericides + resting phase bacteriostatic agents
Medication specification for surgical patients.
Clean wound principle without antibiotics, or preoperative administration of a full dose of drugs at a time.
Prevention of infection
Treatment of acute infections or uncomplicated infections should be continued until 72 hours after the patient’s fever has subsided or has significantly improved.
The interval between dosing should be based on the time-dependent principle (absorption, distribution, and metabolic processes determine)
Penicillin and β-lactams, and carbapenems to be administered at regular intervals, concentration-dependent such as quinolone aminoglycosides, with antibiotic after-effects are macrolides such as azithromycin, aminoglycosides, and after-degradation effects are those where the metabolites still have a bactericidal effect.
Common antibiotics.
Penicillin (broad-spectrum penicillin)
Ampicillin + potassium clavulanate Piperacillin + sulbactam
Cephalosporins
There are 4 generations; each generation of antibiotics has a different antibacterial spectrum.
First generation cephalosporins: Pioneer 1,4,5,6 (low nephrotoxicity)
Effective against Gram-positive, effective against Gram-negative part of the site
Second generation cephalosporins: cefuroxime, cefotiam, cefaclor, cefprozil second generation broad spectrum is not the strongest, cocci and streptococci preferred second generation cephalosporins.
Third generation cephalosporin: effective against gram-negative bacilli, effective against some cocci. Really effective against intestinal and biliary tract infections. For respiratory medicine most preferred second generation cephalosporin.
Fourth generation cephalosporin: Cefpodoxime
Other β-lactams
Mainly cephalosporins such as cefmetazole, this part of antibiotics are effective against anaerobic bacteria, cefoxitin, cefmetazole, pioneer methadol
Oxycephalenes: cephalexin, cephalexin, cephalexin, cephalexin, cephalexin
Carbapenems: Tylenol, Imipenem, Cistatina, Meropenem, effective against Mycobacterium bovis, but Mycobacterium bovis is not necessarily tuberculosis
Sulbactam is effective against Mycobacterium avium and potassium clavulanate is effective against Mycobacterium tuberculosis and other branching bacteria.
Aminoglycosides are now commonly used in this class of drugs, such as etimesine and netilmicin, which have shown a significant reduction in ototoxicity and nephrotoxicity through phase IV clinical results. Effective against gram-positive bacilli and effective against gram-negative bacilli.
Subdivision.
Macrolide antibiotics rapid bacterial inhibition with film-breaking effect, Clara is effective against Haemophilus influenzae, quinolone antibiotics are effective against Gram-negative part of Gram-positive bacteria, anaerobic bacteria, mycoplasma, chlamydia, mupirocin is more effective against pneumonia.
Chloramphenicol is effective against Gram-negative bacilli.
Polypeptide antibiotics: resistant Staphylococcus aureus is effective against vancomycin.
Tetracycline antibiotics.
Minomycin is damaging to Gram-positive bacteria and Gram-negative to liver and teeth.
Antifungal: Factors of fungal infections are
Low immune function
Indiscriminate use of antibiotics related to
Amphotericin.
Ketoconazole Daflucan Itraconazole (effective against aflatoxin) Voriconazole
Other antibacterial drugs
Lincomycin such as clindamycin effective against gram-positive and anaerobic bacteria
Metronidazole
Sulfonamide antimicrobials are chronic bacteriostatic agents, for first after renal transplantation
Fosfomycin