Among the parents, there are always two schools regarding the use of antibiotics. One school firmly believes that it is better not to use "antibiotics" and insists on using them. The other faction firmly believes that "antibiotics" are abused, with large side effects, and should not be used. Whether to use it or not is really a question.
Cao Qing, the deputy chief physician of the Infection Department of Shanghai Children's Medical Center, pointed out that antibiotics were used more frequently in children's respiratory diseases, and most of children's respiratory diseases were viral infections, of which 80% were children under 5 years old with viral infections. Virus infections really did not require the use of antibiotics. However, it should be pointed out that in the later stage of viral infection, especially in the 3-5 days, if the fever does not subside, it is easy to cause secondary bacterial infection. At this time, antibiotics need to be used.
"Clinical evaluation is very important. Doctors usually judge whether it is viral infection, bacterial infection or atypical bacterial infection, including whooping cough and mycoplasma infection, by blood routine, clinical symptoms and signs. Similarly, it is also necessary to distinguish whether other parts of the infection need to use antibiotics or not. For example, children have more gastrointestinal infections in autumn and winter, most of which are related to viruses, including rotavirus, norovirus, and so on. This kind of infection also does not need anti infection treatment. " Dr. Cao Qing said.
It should be pointed out that many parents are worried about the toxic and side effects of antibiotics and stop taking them at will. Dr. Cao Qing reminded that excessive use at will will increase the occurrence of toxic and side effects, while random reduction will reduce the efficacy and increase the production of drug-resistant bacteria. Therefore, it is necessary to ensure the use of adequate doses of antibiotics, which is one of the keys to treatment.
"For example, patients with scarlet fever, which is actually an acute respiratory infectious disease caused by group A beta hemolytic streptococci, especially in winter and spring, is the high incidence season of the disease. The clinical symptoms are characterized by fever, angina, generalized scarlet rash and skin scaling after rash regression. After using antibiotics, they improved, but many parents stopped taking medicine as soon as they got better. In fact, we need to treat this bacterial infection for a certain period of time, about 7-10 days. If we stop taking medicine too early, it is easy to relapse. " Experts said, "For the anti infection treatment, our suggestion is to identify the pathogen; after that, we should carry out sufficient treatment."
As for the question of oral or injection administration, experts pointed out that anti infection treatment is nothing more than "oral administration, intramuscular administration and intravenous administration". Although the efficacy of intramuscular and intravenous administration is higher than oral administration, it is also due to the different routes of administration and the lack of treatment of digestive tract and defense system for intravenous or muscle tissue administration, The possibility of allergic reaction caused by it is greatly increased, and the particles that may be produced during the use of infusion increase the risk of injury to body tissues, leading to a great increase in the allergy of intravenous and intramuscular drugs, and increasing the risk of injury to body tissues. Therefore, from the perspective of safety, oral drug use>intramuscular drug use>intravenous drug use.
However, the final drug use depends on the situation. For example, patients with mild pneumonia can choose to take oral medication, while patients with severe pneumonia need to take intravenous medication first. If they get better 3-5 days later, they can switch to sequential oral treatment.
"It's not like many parents think that once pneumonia needs to be suspended for 7-10 days of saline, oral treatment can be used later. In addition, for mild pneumonia, if you first choose oral medication, if the temperature does not subside and the clinical symptoms continue to worsen, you still need intravenous drip treatment." Dr. Cao Qing said.
Doctor Cao Qing reminds that if the child has a fever for 1-2 days, he will not return; In particular, the child is in poor spirit and has severe symptoms such as headache, vomiting and cough. He needs to go to the hospital in time to let the specialist determine the infection site and severity.
"The virus infection does not mean that it is not serious. Some severe encephalitis and pneumonia caused by virus infection are life-threatening. The child's immune function is not perfect, and the disease may develop quickly, so once the above symptoms are found, we should go to the doctor in time." Dr. Cao Qing said.
So why can't we test the infection bacteria before we use drugs? Dr. Cao Qing pointed out that there is a test called "cultivation+drug sensitivity", which can determine the type of bacteria infected and which drugs are more sensitive to. However, the culture time is relatively long. Generally, bacteria can grow in aerobic conditions at 37 ℃ for 18-24 hours. Anaerobic bacteria need to grow in anaerobic environment for 2-3 days. Individual bacteria such as tubercle bacillus should be cultivated for 1 month.
In addition, antibiotics used before the examination may result in false negative results. Therefore, it is necessary to wait for the examination results to come out before taking medicine. At that time, it may be difficult to recover when the disease progresses to a certain extent. Doctors will use antibiotics first according to experience. If the empirical treatment is not effective, these examination results are the best evidence to guide further treatment, which is also commonly done abroad.
Therefore, it is very important to establish a rapid, accurate and easy to promote pathogen detection method for the accurate diagnosis and treatment of infectious diseases in children in China. "We are now trying to introduce new detection methods, improve the timeliness and accuracy of detection of infectious bacteria, and solve the problem of detection of pathogenic bacteria from the source, which can more effectively reduce the problem of inappropriate use of antibiotics," Dr. Cao Qing said. Surging journalist Tu Jun
