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The clinical choice should pay attention to several problems of antibacterial drugs

Author: WangJianMin From: www.yourpaper.net Posted: 2010-05-15 05:37:22 Read:
[keyword] antimicrobial selection
with the wide application of antibiotics, so that a variety of bacterial infection to get effective treatment and control, but the irrational use and abuse led to the problem of adverse reaction increased and drug-resistant bacteria, such as methicillin resistant Staphylococcus aureus, vancomycin-resistant enterococci, drug resistance of gram-negative bacilli and multidrug-resistant Mycobacterium tuberculosis bacilli, some of which drug-resistant bacteria infection is currently no effective treatment.Therefore, the rational use of antimicrobial drugs may maximize the efficacy of antibacterial agents and adverse reactions to a minimum.
antibiotics for bacterial infections usually only useful, ineffective against virus infection.Not all fever were caused by infection, but not all infections are caused by bacteria, antibiotics cannot treat viral infections.The following is or should be restricted use of antibiotics: viral infection; fever of unknown cause, and no signs of bacterial infection that Salmonella; no symptoms or mild gastrointestinal infection, because can inhibit the normal intestinal bacterial antibiotic use, is beneficial to the growth and reproduction of bacteria Salmonella, longer period, and is easy to produce drug resistance; antibiotic application preventive medicine should not be classified as routine, should be strictly controlled; the local application of antibiotics should be limited, for local application is easy to produce allergic reaction, but also easily lead to the emergence of resistant strains.
used for clinical anti-infection treatment has always played an important role of antibiotics, but if the improper selection of drugs, not only can not cure, may also bring a series of adverse consequences for the patient, such as adverse reaction increases, more changes of pathogenic bacteria, cause bacterial resistance,, increasing comorbidity, extended course of disease, increase the economic burden of patients.Therefore, in the use of antibacterial drugs must strictly master the indications, should consider the following aspects.
1 bacteriological diagnosis and drug sensitivity test in vitro.
antimicrobial selection, first of all depends on the type and nature of pathogenic microorganisms, pathogens, most antimicrobial agents selectively acting on a limited range of therefore, correct choice of antibiotics must be built on the correct diagnosis of pathogens, conditional should the bacterial classification and drug sensitivity test.
2 patients.
drug allergy and allergic family history of antibacterial drugs, easy to produce allergic reaction should be banned; the body defense function is low person, should be treated with fungicides.The kidney is the main way to most antibiotics excretion.Renal insufficiency, application of the main drug renal excretion, appropriate reduction or to extend the delivery time, to prevent excessive poisoning caused by drug excretion disorder, especially for drugs, which itself is toxic to the kidney such as: amphotericin B, cefaloridine, aminoglycoside antibiotics, peptide antibiotics more attention should be paid to.The urinary excretion of less than 15% of the antibiotics can generally be renal function is not affected.Is generally believed that even in renal failure, can according to conventional drugs, but liver function is normal.As for penicillin is mostly excreted by the kidneys, renal function failure in prolonged half-life period can not use, its reason is in renal failure when the drug metabolism by the liver.Therefore, when liver dysfunction, the application must extend the dosing interval, such as carbenicillin only in severely impaired renal function, can be 2G each time, once every 12 hours, but when the liver illness medication interval should be extended by 1 times.In the liver of high concentration antibiotics or mainly through hepatic metabolism and inactivation, when liver dysfunction patients application, can cause abnormal reaction, such as: chloramphenicol in serum significantly increased, thereby increasing the toxicity of bone marrow; lincomycin half-life could be extended by 1 times, hepatitis or chronic liver dysfunction should be disabled or used with caution.
features of 3 patients with drug in the body of the site of infection.
the possibility of infection sites often can suggest the pathogenic bacteria, so as to provide reference for drug selection.Secondly, the concentration of some drugs in the tissues and drug selection basis.Staphylococcal enterocolitis or empyema of gallbladder, erythromycin, because it is absorbed by bile into the large intestine, so there are effects; sepsis or urinary tract infections caused by gram-negative bacteria, aminoglycoside antibiotics orally can not be absorbed, it must be injected.Prevention of epidemic meningitis SD should be the first choice, because it is easy to pass through blood-brain barrier, can reach effective concentration in the cerebrospinal fluid.
adverse reaction of 4 antimicrobial agents.
the doctor in the application of antimicrobial agents in the process, it is necessary to consider the effect of treatment, but also to ensure patient safety.At the same time to observe the curative effect of the pay close attention to the possible adverse reactions.These responses may and infection process continue to develop symptoms similar.Such as fever, rash, central nerve function disorder, hematopoietic system disorders and liver and kidney damage.If there is abnormal, should immediately adjust the dosage or withdrawal.
5 the price of drugs or individual patient economic burden.
the doctor to understand drug prices and the economic burden of the patients, the appropriate choice of drugs and reduce the economic burden of the patients is very necessary, in principle, should give priority to with the same therapeutic effect and low price of antibiotics, but if the increase the price of drugs with the effect of the increased, it should be based on the selection of antimicrobial agents in patients with economic burden.
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