抗生素雖好,但不要貪吃哦(2)
Charles Cutler, an internist near Philadelphia, says women with recurring urinary-tract infections frequently request broad-spectrum drugs like ciprofloxacin because it is what they know. But the overprescription of such drugs has created a lot of resistant infections, he says. It can take 48 hours for a test to determine what is causing a urinary-tract infection and 'doctors and patients don't want to wait 48 hours,' says Dr. Cutler, who is chairman of the American College of Physicians' Board of Regents.
費城附近的內科醫生卡特勒(Charles Cutler)説，反覆出現尿路感染的婦女經常要求環丙沙星之類的廣譜藥物，因為這是她們知道的藥。但過量使用這類藥物導致出現了眾多抗藥感染。卡特勒説，檢測確定尿路感染的原因需要48小時，但醫生和病人不願意等上48小時。卡特勒是美國醫師協會評議委員會(American College of Physicians' Board of Regents)主席。Bronchitis is another illness for which antibiotics are often overused, says Lauri Hicks, medical director for the CDC's 'Get Smart: Know When Antibiotics Work' program. Eighty percent of the time patients come into a doctor's office with acute bronchitis they will be prescribed an antibiotic, and usually a broad-spectrum one, she says. 'Bronchitis in someone who's otherwise healthy typically gets better on its own,' she says.
疾控中心的“常識：何時使用抗生素”(Get Smart: Know When Antibiotics Work)項目醫學總監希克斯(Lauri Hicks)説，支氣管炎是另一種常常濫用抗生素的疾病。她説，患有急性支氣管炎的患者去看醫生時，八成會被開具抗生素，而且通常是廣譜藥。她説，如果在其他方面都很健康，支氣管炎通常會自己好轉。Doctors say it can be difficult to tell a bacterial infection from a viral one. A general rule of thumb with sinus infections is to hold off on the early use of antibiotics but consider using them if symptoms persist. Infections like bronchitis, which is mostly caused by a virus, and pneumonia are usually diagnosed by listening to lungs with a stethoscope. If there is doubt, X-rays can often tell the difference.
醫生説，細菌感染和病毒感染可能很難分辨。鼻竇炎的一個簡單的經驗法則是，不要過早使用抗生素，但如果症狀持續則可以考慮使用。主要由病毒引起的支氣管炎和肺炎感染通常是用聽診器聽肺音來診斷。如果有疑問，通常可以用X光檢查來辨別。
Experts say patients should question their doctors about the use of antibiotics-both whether they are warranted and why a particular type is chosen.
專家説，患者應當向醫生追問抗生素的使用，包括是否必要以及為何選擇某種類型的抗生素。The American Academy of Pediatrics has emphasized the importance of judicious use of antibiotics. The group this year updated guidelines for treating sinusitis and ear infections to help physicians determine which illnesses will respond to antibiotics and which type of antibiotic to prescribe. Both updates recommended the narrow-spectrum amoxicillin as a first-line treatment when antibiotics are warranted.
美國兒科學會強調了明智使用抗生素的重要性。該組織今年更新了治療鼻竇炎和耳部感染的指導方針，幫助醫生確定抗生素對哪些疾病見效以及該開具何種抗生素。這些更新後的指導方針都推薦在有必要使用抗生素時將窄譜的阿莫西林作為首要治療選擇。Resistant bacteria are often present in the body in small numbers to begin with but are crowded out by other bacteria that are more susceptible to antibiotics. When a person takes an antibiotic, it kills off the susceptible bacteria, allowing the resistant bacteria to grow more easily, says Dr. Hersh.
赫什説，抗藥菌一開始只是少量存在於身體內，但受到其他對抗生素更敏感的細菌排擠。服用抗生素之後，抗生素會殺滅易感細菌，從而讓抗藥菌更容易繁殖。Jeffrey Gerber, a pediatric infectious-disease specialist at the Children's Hospital of Philadelphia, recently led a research team exploring whether doctors' prescribing habits could change. The researchers looked at 18 primary-care pediatric offices. In half of the offices, doctors received on-site education about prescribing guidelines for some common infections: pneumonia, strep throat and sinus infections. Narrow-spectrum antibiotics were recommended for all three conditions. The other offices didn't receive any guidance.
費城兒童醫院(Children's Hospital of Philadelphia)兒科感染疾病專家格伯(Jeffrey Gerber)不久前帶領一個研究小組考察能否改變醫生們開具處方的習慣。研究人員考察了18所初診兒科診所。一半診所的醫生們接受了一些常見感染處方指導方針的現場培訓，包括肺炎、膿毒性咽喉炎和鼻竇炎。這三種病症都被推薦使用窄譜抗生素。剩下的診所沒有接受任何指導。'After 12 months we saw overall a nearly 50% reduction in broad spectrum or off-guideline prescribing for these conditions' in the intervention group of offices compared with the control group, Dr. Gerber said. The study appeared in the June issue of the Journal of the American Medical Association. He said the researchers are currently examining what effect the change in prescribing habits had on illness control, cost and other outcomes.
格伯説，12個月後，我們看到相比對照組，干預組診所針對這些病症開具廣譜抗生素或脱離指導方針開藥的情況整體上減少了近50%。該研究發表在今年6月出版的《美國醫學會雜誌》(Journal of the American Medical Association)上。他説，研究人員正在考察處方習慣的變化給疾病控制、成本和其他結果帶來的影響。
