The American Journal of Medicine
April， 2007
How Children Use of Antibiotics?
Andrew Lobo
The American Journal of Medicine
Abuse of antibiotics in the medical profession is already a concern and is often called the topic of long discussions, the experts have even warned: overuse of antibiotics will return to the no antibiotic era in human, epidemiological survey found that 60% of inpatients -80 antibiotic usage %, 100% utilization rate of childhood diseases. Growth and development of children, especially due to physiological and sound immature organs, lead to serious disorder in children body micro flora, intestinal flora, the production of resistant bacteria and adverse reactions that are not reversible. Childhood diseases are on the unreasonable application of antibiotics to make the reasons for review, how the process of clinical application of antibiotics to make safe, controllable and make recommendations. 1 Children's unreasonable application of antibiotics in disease 1.1 The misuse of antibiotics in viral infections As the
most common pediatric outpatient respiratory tract infections, more than 90% of infection is viral infection. Some viral infections without antibiotic use indications, but clinical widespread abuse of antibiotics. As we all know, antibiotics are ineffective against viral infections, and antibiotics at this time, over time, can damage the local soft mucosa in children the integrity of the body, so that the body's immune system weakened, defensive mechanism is damage, to provide for certain conditions, pathogen infection possible. Normal children there or to the body of the symbiotic bacteria or other pathogens trigger the invasion of opportunistic infections and secondary infections may be, resulting in the disease complex, increased. 1.2 The drug of choice for adverse drug reactions caused by improper Growth and development of children, tolerance for the drug less toxic or even more sensitive, such as the slightest mistake can easily cause drug toxicity. Common such as: amino sugar antibiotic celecoxib renal function can lead to drug-induced permanent ear damage and poison damage, hearing loss and even caused the disappearance of such drugs in the inner ear is much
The American Journal of Medicine
April， 2007
higher than the concentration of lymph in the body 670 times more other organizations, longer than the
serum half-life of more than 15 times, causing damage to the inner ear hair cells. 1.3 Sense of responsibility is not strong Before the application of antibiotics to children without making pathogenic examination and drug susceptibility testing, some doctors antimicrobial spectrum of antibiotics, pharmacodynamics and pharmacokinetics is not a solid grasp of knowledge, so that the selected spectrum antimicrobial drugs incompatible with the microbial infection adaptation, pertinence, inappropriate treatment, medication alone experience, repeated replacement, resulting in the formation of double infection and other adverse reactions. 1.4 The use of antibiotics is novelty, expensive, seeking broad-spectrum Some family members of patients and doctors mistakenly believe that the more antibiotics, a new, more expensive price, and the broader spectrum antimicrobial efficacy sure it’s possible. They lack of etiology, course, treatment, understanding the basic concepts of disease and drug beneath the basic attitude of science. So that all infections are required to antibiotics; family standing antibiotics; preventive medicine; by "chronic illness into a good doctor" of his purchase, use of antibiotics, etc.; requirements for physician use antibiotics, and Innovation, volume, seeking broad-spectrum, blind superstition antibiotics. Pharmaceutical advertising and the name of mixed mind misled consumers. 1.5 Inappropriate administration time Dosing interval is too short, the bactericidal effect of drug in blood and tissue fluid depends on the concentration of the drug, and its role depends on the length of time in the drug when administered according to the half-life and its role in the mainten
ance of time to considering the administration time interval and the amount of administration. As poor children with their physiological function in the short time interval one-time grant. High concentrations of such a large dose of antibiotics will lead to increased sexual arousal reflects the central nervous system of people, and induce pediatric epilepsy, encephalopathy and so on. This renal dysfunction in patients without a corresponding reduction in dose is more likely the case. Dosing interval is too long, less than the plasma concentration in the blood concentration of
The American Journal of Medicine
April， 2007
tissue fluid, Drug short time in contact with the bacteria, effects are reduced accordingly, is not conducive to infection control, and easy to produce bacterial resistance, is not conducive to pediatric rehabilitation. Replacement of inappropriate drugs to enhance or increase the frequency of dose administration can not achieve an effective steady state plasma concentration, and can only change the total amount of drugs in vivo in patients, so the frequent exchange of antimicrobial agents or antimicrobial agents before the interruption will not achieve its original .Effect or by some less effective. Medication for too long, the long-term application of large doses of tetracycline to children and other dr
ugs, because the new bone and teeth formation in the deposition of calcium binding, resulting in permanent teeth brown pigmentation or permanent quality enamel hyperplasia, and even serious Sinai inhibit the development of pediatric bone marrow. 1.6 Inappropriate choice of solvent Intravenous antibiotics properly chosen will directly affect the treatment of solvent effects, such as erythromycin lactobionate the most stable pH value of 6.0-8.0, and 10% glucose, pH = 3.2-5.5 or in salt water as solvent are all so erythromycin down effect. 1.7 Unreasonable compatibility Prevent the use of antibiotics as resistance strains, so the joint use of two or more antibiotics. However, combination therapy may also result in an unreasonable or speed up drug resistance strains. Sand Star class and the joint use of amino glycosides, the mechanism of these two drugs the same combination did not enhance the effect of the drug will only increase 2 childhood diseases rational clinical use of antibiotics recommended 2.1 strengthen the individual patient pathology and strengthen inspection of pathogenic microorganisms ① the proper and timely collection of specimens: specimens collected as far as possible before treatment, or after administration of the antibiotic susceptibility testing positive rate is certainly not ideal; attention to specimen collection time, location, manner, method, to avoid contamination of normal flora; necessary for special training or special tests. ② Note the specific sample treatment: such as: feces and urine culture: both to do and do not collect mixed; urine sample to take urine and, if necessary for catheter or
The American Journal of Medicine
documented翻译April， 2007
suprapubic needle puncture, and timely vaccination. ③ Select the appropriate media: According to the type and goal culture samples to select the best medium. ④ standardized susceptibility test: To determine the culture result is a pathogen or a contaminating bacteria or normal bacteria; the establishment of quality control strains; to adjust sensitivity / resistance standards; necessary for the combined sensitivity of enzyme determination, etc.; create a variety of special pathogens diagnostic techniques, such as anaerobic bacteria, fungal culture; for intracellular infections, parasites, viruses and other detection technology. Local hospital laboratories should provide regular pathogen distribution and drug resistance test results as a basis for clinicians to initial treatment, followed by drug susceptibility results and then verify or modify the treatment program. 2.2 The uses of antibiotics in patients are reasonable arrangements for the time After the effects of antibiotics has its own (PAE) and the characteristics of resistance weakened over time, reasonable arrangements for the use of antibiotics time to arrange the optimal dosing interval for the drug concentration exceeded the minimum inhibitory concentration (MIC) of the time with PAE time. The clinical use of Chinese medicine hospital ward in the selection of antibiotic resistant dropout phenomenon, such as gentamicin,
erythromycin and kanamycin in 1 species, disable the other 2, alternating every 3 months, 1 can significantly reduce drug-resistant infection and the development of the park. 2.3 The clinical use of antibiotics shorten the process time In the course of the clinical use of antibiotics, such as surgery reasonable period of time in patients with antibiotics reduces the length of hospital stay, reduced from an average of 14.48d to 14.06d, plus fewer adverse drug reactions, reduce or extend the drug resistant strains, to avoid the flora. 2.4 understand the rational use of antimicrobial spectrum and reduce the use of broad-spectrum antibiotics Accurate understanding of the mechanism and antibacterial spectrum antibiotics can reduce the broad-spectrum antimicrobial agent produced by strains resistant to multiple, accurate, safe, the smallest dose of antibiotics. 2.5 To establish and improve monitoring and recording system of antibiotic use
The American Journal of Medicine
April， 2007
Clinicians should meet with the pharmacy staff's drug supply from the previous model to the clinical service model changes. Strengthen supervision and management of medication for the experience; establish and improve the rational use of drugs database, including physician records, preoperative an
d postoperative adverse drug records, hospital records of blood concentration, the results of rational drug records, medical records system for a set, so that drugs are well documented, there are patterns Key; from the case of large-scale mining of clinical information on general trends and individual differences in drug use, drug use and make for the future guidance.

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