1, indication of antibiotic use in children 1. Clinically, if there is purulent nasal discharge, yellow thick sputum, white secretion oozing from tonsils, pustules on skin, and skin infection with purulent secretion, bacterial infection is often indicated.
2. From the time limit of fever, the virus body temperature tends to drop or return to normal in about 5 days. If the body temperature drops and rises again, or if the fever is accompanied by obvious chills for more than a week, the possibility of bacterial infection is greater.
3. From the simple blood routine of children, the white blood cells are obviously increased, especially10.5 million, mainly neutrophils.
4. The detection of high-sensitivity CRP (C-reactive protein) above 30 often indicates that it may be a bacterial infection.
5. SAA (serum amyloid A) combined with CRP index is more significant, and CRP and SAA are increased in different degrees, suggesting bacterial infection.
6. If the PCT (calcitonin) index is greater than 0.5 ng/ml, there is a great possibility of bacterial infection, which is greater than 2 ng/ml, suggesting that bacterial infection is serious.
7, combined with other, such as imaging, such as chest X-ray, CT and other inspection results.
8, combined with clinical experience and guidelines, such as acute sinusitis or otitis media is often caused by acute upper respiratory tract infection combined with bacterial infection and urinary tract infection.
Antibiotics commonly used in children are divided into 1 and penicillin, including penicillin needle, amoxicillin, amoxicillin potassium clavulanate and ampicillin.
2. Cephalosporins are generally divided into three generations.
The first generation cephalosporins: including cefalexin and cefazolin.
The second generation cephalosporins: including cefuroxime, cefaclor, cefotiam, cefoxitin, etc.
The third generation cephalosporins: including ceftazidime, ceftriaxone, cefotaxime, cefoperazone, cefodizime, cefixime, etc.
3. Macrolide antibiotics include erythromycin, azithromycin and clarithromycin.
4. Others are rarely used for children.
In a word, whether to use antibiotics in clinic and how to choose antibiotics should be decided by combining clinical manifestations, laboratory results, clinical experience and disease guidelines. But sometimes it's hard to judge. This time can also be judged from the child's usual immunity. Children with low immunity may use antibiotics more actively than children with normal immunity.
Dr. Ke is the chief physician of pediatrics and has rich clinical experience. Specializing in children's digestive system diseases, respiratory diseases, chronic cough, Helicobacter pylori infection, chronic gastritis, functional constipation, abnormal liver function, chronic diarrhea, milk protein allergy and other intractable diseases, as well as infant nutrition development and feeding consultation. To be friends with health and doctors, welcome to forward your likes, comments and concerns. Sharing is a virtue. If you have any questions, you can leave a message, and Dr. Ke will answer typical questions in a targeted manner during recess. Antibiotics are an effective means to help people fight bacteria, but if taken improperly, they will not only fail to treat diseases, but also cause hidden dangers to our health. Therefore, if it is diagnosed as bacterial infection by doctors, it is very necessary to take antibiotics correctly and effectively, which will help us shorten the course of disease, relieve symptoms and restore health.
It is worth parents' attention that antibiotics must be used for a full course of treatment, and take 1-3 days after recovery to avoid recurrent diseases. Don't stop taking medicine when you feel that your condition has eased, and it is not recommended to change your medicine yourself. Pharmacological mechanism of antibiotics
1, which is not recommended because the drug will be absorbed by the blood when it enters the body. The concentration of the drug in the blood is called the blood drug concentration. As long as the blood concentration reaches the effective concentration, the condition will get better. When the drug is not taken, the drug concentration in the body is zero. When taking medicine for the first time, the blood concentration will reach the first rising period, but it will not reach the effective concentration. The second time you take the medicine, it will be higher than the first time. By analogy, after taking it several times, it reaches the peak of blood drug concentration, that is, the effective concentration, which needs to be continuously consolidated to play a better role.
2. If the drug is stopped when the condition is relieved, the blood drug concentration will drop when it does not reach the effective level, which will lead to prolonged attack time and repeated attacks.
3. When taking the same antibiotic continuously, the blood drug concentration can be maintained at an effective level for a long time, and pathogenic bacteria in the body can be eliminated.
4. If you change the medicine without the doctor's permission, because the antibacterial spectrum of each antibiotic (the type of bacteria treated) is different, you need to reach the effective blood concentration again after changing the medicine, which is what many psychologists find to be the so-called "uselessness" of some drugs. In fact, it didn't reach the blood concentration.
5. If you don't know clearly, you can't use antibiotics at will, so as not to cause drug resistance. More seriously, it will cause super bacteria, which is more dangerous to health.
To sum up, taking antibiotics needs to meet the course of treatment, and you can't stop taking drugs without authorization. In order to avoid the recurrence of the disease and prolong the course of the disease, it will cause drug resistance of bacteria and have a more serious impact on children. It is normal for parents to be wary of "abuse of antibiotics", but they should also be careful not to talk about the discoloration of antibiotics and feel that "antibiotics are as fierce as tigers".
As we all know, antibiotics are drugs that inhibit and kill bacteria, but they can't kill viruses. Only severe bacterial infections can be used.
Under normal circumstances, we are born to live in harmony with bacteria, but once the bacteria are in the wrong place, our body will react. Phagocytosis begins to devour bacteria, and the human immune system begins to work.
If this is the first invasion of a bacterium, the memory cells of the immune system will remember the bacterium first, and then the antibody or lymphatic factor will destroy the bacterium.
This process takes at least 3 days, which is why I suggest that you don't rush to see a doctor within 3 days when your condition is not too serious, and it is also a process to start and play a role in your own immune system.
Once this process is successfully completed, the immune system can start and work quickly when the same bacteria invade for the second time.
Therefore, antibiotics should be an external force and only used when the human immune system is insufficient.
In other words, don't rush to take medicine after the child is sick. Observe for 2~3 days first. If the mental state and symptoms are not very good, take your child to see a doctor as soon as possible. Moreover, antibiotics should only be considered if bacterial infection is confirmed.
The so-called "abuse of antibiotics" refers to the use of antibiotics before the human immune system starts. In this case, it seems that the disease can be cured soon, but in fact, the autoimmune process that should have been stimulated has not appeared, so the immune system still can't respond quickly when bacteria invade next time.
In the long run, people's immune system will never get exercise. This is why children who are used to using drugs to control their illness are more likely to get sick.
In addition, once it is determined that antibiotics are needed, it is necessary to follow the doctor's advice for full treatment.
This is because it is necessary to ensure that bacteria are completely killed and not dormant. Resting bacteria can easily become drug-resistant bacteria after waking up, and these drug-resistant bacteria will be immune to this antibiotic.
There are more and more drug-resistant bacteria in the body and fewer and fewer effective antibiotics. Once bacteria can tolerate all antibiotics, they will become super bacteria, which makes people helpless.
To sum up, for parents facing such problems, the suggestions are as follows:
Generally speaking, the quality of antibiotics is meaningless. Because there is no absolute good or bad in this world. In the era without antibiotics, a large number of patients died of bacterial infection or infection, among which children were frequent visitors on the death list. With the change of public health and the use of vaccines, antibiotics and other drugs, mankind has entered an unprecedented golden age of health in history. You know, in the not-too-distant past, as many as 50% of children will not live to be five years old. If you don't know this background, then talk about the advantages and disadvantages of vaccines and antibiotics, that is, you don't know if you die. However, the endless pursuit of safety and health has led to two things:
However, I stress again that these are young children. However, if your child happens to fall into this part, it will become quite troublesome, because for almost all doctors, using broad-spectrum antibiotics is the simplest and most economical way to treat diseases caused by bacterial infections. Otherwise, it will take a lot of time and cost to trace the specific pathogenic microorganisms, and it is also necessary to find out whether there are specific antibiotics to kill these vitamins, which will undoubtedly lead to prolonged treatment time, and the disease may become more serious, and so on. However, under the mode of seeking quick and saving money in China, this kind of treatment will not be favored at all, and neither doctors nor parents of children will favor this mode, so the final result depends on luck. If your child has little or no antibiotic diarrhea, there are many taboos in treating the disease, otherwise you should communicate with your doctor in more detail. Especially now, you can consult a real doctor online. Usually, we should pay attention to collecting reliable information of pediatricians on the consultation platform for major diseases. Pediatricians who do not prescribe traditional Chinese medicine and use antibiotics with caution are usually trustworthy.
It is very common for babies to have infectious diseases such as respiratory tract and gastrointestinal tract. When a baby's disease is diagnosed as caused by bacterial infection, the doctor will give the baby antibiotics to control the symptoms of the disease. At this time, some treasure mothers are very worried, and there will be many questions accordingly, such as how the baby should use antibiotics safely and is it necessary for the baby to use antibiotics for a long time? Wait a series of questions.
Many treasure mothers have a wise attitude towards antibiotics. Some treasure moms know that antibiotics will promote the growth of drug-resistant strains (strains that are resistant to corresponding antibiotics after long-term antibiotic selection), which is a problem faced by the whole society. For doctors, they are well aware of this risk and know that antibiotics cannot be used easily.
For babies, especially premature babies, the probability of bacterial or fungal infection is very high (about 40% of babies born within 28 weeks of pregnancy will be infected). For example, some premature infants in intensive care will be routinely given antibiotics through central venous catheter, which can reduce the risk of blood infection. However, in medical practice, after judging the infection probability of pathogens in intensive care and the benefits of preventive use of antibiotics.
The value of preventive use of antibiotics for infants is controversial, but if infants are diagnosed with infection, antibiotics are the cornerstone of treatment. Especially babies with immature anti-infection ability usually need extra medical help. Of course, in the course of treatment, some babies have a long treatment time, but in order to completely eradicate the infection, antibiotics are still needed.
Routine use of antibiotics generally does not produce drug resistance unless the same drug is used intermittently for a long time. At this time, the doctor will judge which antibiotic is effective for the baby's infection through drug sensitivity test. If the baby is resistant to certain drugs, the doctor will choose other drugs with better effect.
The side effects of antibiotics (the most common are renal and liver function damage, salt and mineral loss, changes in blood cell count and hearing problems) are well known, and most antibiotics are safe for infants. Of course, the doctor will also monitor the baby's various performances during the medication. If there are complications or the blood concentration exceeds the safe level, the drug will be stopped or reduced. Under close monitoring, antibiotic treatment rarely leads to long-term damage.
Antibiotics may also temporarily change the types of bacteria in infants. Because these resident microorganisms can help the baby digest and fight against other bacteria, some babies who use antibiotics will have diarrhea or other infections, but this situation is rare, and mother Bao does not have to worry.
It should also be mentioned here that intravenous immunoglobulin is also an anti-infection treatment, which can enhance the natural antibody level in the baby. Under special circumstances, if you are infected with certain viruses, or your baby's white blood cell count is particularly low, you can use drugs to stimulate him to produce anti-infective white blood cells. However, the application of antibiotics is still the main means to combat infant infection.
On this issue, my opinion is: use it when necessary, not abuse it!
Some parents think that antibiotics are omnipotent. They have a little fever with a cold, a little cough and runny nose, a little bloating and diarrhea, and a little crying and getting angry. Some parents think that in order to avoid drug resistance, available antibiotics should not be used, so that there will be no drugs available when antibiotics are really needed in the future. Both views are wrong.
Antibiotics are drugs that can kill or inhibit the growth of bacteria, aiming at "bacteria". How to judge whether there is bacterial infection is invisible to the naked eye. It is generally necessary to go to the hospital for a blood test and judge according to the test results. If there is bacterial infection, we need to take antibiotics. In fact, in most cases, colds are caused by viruses. In this case, it is useless to take antibiotics. Influenza can usually heal itself, and severe influenza can be treated with antiviral drugs.
The choice and dosage of antibiotics should be comprehensively evaluated according to the child's age, weight, types of infected bacteria and severity of illness. It is safe to use antibiotics reasonably and standardly. Parents should not worry too much. If your child gets better, don't stop taking the medicine by yourself. Drugs that are not enough to complete the whole course of treatment are more likely to lead to bacterial resistance. Some parents want to give their children more medicine when they see that their children have not improved obviously after taking two doses of medicine, which is also wrong, because it takes time for the medicine to take effect. If the children are really uncomfortable, you can give them corresponding care, such as wet compressing their noses with warm towels, or giving them some relief drugs under the guidance of doctors or pharmacists.
Authors: Zhang, a clinical pharmacist, is a member of Pharmacy Network of Beijing Daxing District Hospital of Integrated Traditional Chinese and Western Medicine.
Authoritative interpretation of pharmaceutical affairs network, unauthorized reprint, plagiarism will be investigated. I've always wanted to talk about the use of antibiotics (to be exact, antibacterial drugs), because I really feel that there are too many antibacterial drugs abused now; I also think this topic is not suitable for discussion with non-professionals, because antibacterial drugs are prescription drugs and should be used in advance before doctors prescribe them. It should be reasonable, but the fact is that there are still many cases of using antibacterial drugs in family self-medication at present. Without a doctor's diagnosis and evaluation, antibacterial drugs are easy to be abused when they are used by themselves, especially among children.
In clinical practice, we often encounter the situation that parents give antibacterial drugs to their children when they have a fever, a cold, a cough or diarrhea. Simply put, antibacterial drugs are used as antipyretics, cold medicines, cough medicines and diarrhea medicines. This practice is wrong and seriously wrong. Antibacterials, as the name implies, are drugs against bacteria, so they only need to be used in the case of bacterial infection, and they are effective. For unexplained acute fever, children should use ibuprofen or acetaminophen to reduce fever; There is no need to use drugs for mild colds, but symptomatic drugs (compound cold medicines containing single or multiple components such as antipyretic, nasal congestion reliever, cough medicine, expectorant and antiallergic drugs) are used for severe symptoms.
Improper use of antibacterial drugs may cause many adverse reactions, which may cause bacterial resistance, that is, antibacterial drugs that could have killed bacteria have no effect on bacteria; It may also kill beneficial bacteria, cause flora imbalance, lead to diarrhea, and even cause pseudomembranous enteritis. In addition, some antibacterial drugs have special adverse reactions to children, such as the use of tetracycline in childhood will lead to yellowing of teeth (tetracycline teeth).
There are so many hidden dangers in the use of antibacterial drugs, can't children use antibacterial drugs? Of course not, on the contrary, because children have low immunity, they are more susceptible to infectious diseases than adults, and antibacterial drugs are used more in children than adults.
Finally, it is repeatedly emphasized that antibacterial drugs should be used only in the case of bacterial infection.
This parent's question is too typical. Do you want to take antibiotics? The answer is to eat, but it is more important to eat, and you can't eat indiscriminately. Let's analyze it from the psychology of parents. Some parents have a fanatical superstition about antibiotics. As long as the child has a headache and brain fever, he should take some anti-inflammatory drugs first, because antibiotics and anti-inflammatory drugs are equivalent in the minds of parents. When I got to the hospital, I still insisted that the doctor prescribe antibiotics and even asked me to prescribe some anti-inflammatory drugs. The reason is that my baby knows best how many times I have been sick in the past, and the doctor is unwilling to prescribe. There is also a kind of parents who turn pale at the smell of antibiotics. As soon as doctors want to prescribe antibiotics, they will refuse with a little knowledge. The seemingly tall words such as "antibiotic abuse" and "drug resistance" are their most powerful explanatory evidence.
It must be clearly pointed out that the above two methods are not desirable. So what exactly is useful? This standard is often in the hands of doctors. Because antibiotics are not omnipotent anti-inflammatory drugs, they can only be used for infections caused by bacteria, but are useless for infections caused by viruses or aseptic inflammation. Take the most common cold as an example. More than 90% of them are caused by viruses. Isn't taking antibiotics the opposite? Other diseases with "inflammation" in their names, such as scapulohumeral periarthritis and arthritis, are not caused by any bacteria at all. However, parents can't blame all these performances. Our domestic antibiotic market is very large. Driven by interests, drugs that should be prescribed can be bought in pharmacies, and even the clerk misleads parents to buy them. Doctors who are irresponsible or afraid of taking responsibility do exist in hospitals, so parents lack trust and cannot judge. When you learn to use it yourself, you often have a little knowledge, and you don't know one thing.
So generally speaking, antibiotics are used when there is bacterial infection, and it is useless without bacterial infection. But whether there is bacterial infection is up to the doctor to judge. What antibiotics to use depends on the situation. Children are different in age and size, and they may be used differently. Different bacteria are infected and used differently. In addition, there are many kinds of antibiotics, imported and made in China, the second generation and the narrow spectrum, all of which are in the professional field of doctors. Therefore, if parents insist on a standard of antibiotic use, it is really beyond their power. How to use it? Let's end with a picture. Remember, follow the doctor's advice. millimetre
Now the word abuse of antibiotics appears frequently in our lives, but I think the phenomenon of abuse of antibiotics is not very obvious here. I think it's my parents who say I want to hang salt water, hoping the child will get better soon, not the doctor who says you'd better hang more bottles of salt water or something.
Our sister, who suffered from bronchopneumonia twice in a row, made a film and said it was quite serious, but they didn't give us an intravenous drip. They just said that if the medicine you took this time hasn't brought down the child's fever, you must hang up the water. It is simply that the child will be fine if he takes the medicine, and then he has not hung up the water so far.
Boss is in good health. He is six years old and not sick, let alone hanging water.
I feel that no matter what disease you have, you should listen to the doctor when you go to the hospital. If you should use antibiotics, don't let the doctor prescribe them for you. Follow the doctor's advice!
Drugs have dual properties, both therapeutic and side effects. When drugs must be used to treat diseases, choose the right kind of drugs, treat matching diseases, and give drugs at the right dose. For children, when the benefits of using drugs far outweigh the possible side effects of drugs, such drugs are reasonable. Antibiotics are also drugs, both for treatment and prevention. In the following, the concept of antibacterial drugs will be uniformly used instead of antibiotics, because the concept of antibacterial drugs is more rigorous and broad.
When a child is initially diagnosed with bacterial infection or is definitely diagnosed with bacterial infection through pathogen examination, antibacterial drugs will be selected for treatment. Rational use of antibacterial drugs is like this. Pediatricians need to consider the individual situation of children when choosing antibacterial drugs, such as age, basic diseases, liver and kidney function, infection severity, drug allergy history, whether they can tolerate oral drugs, etc. And the susceptibility of possible or known pathogens to antimicrobial agents. The specific principles to be followed are as follows:
Antibacterials should not be used for viral infection, but only for secondary or combined bacterial infection. Relevant clinical specimens should be sent to culture and drug sensitivity test as far as possible before treatment, especially for children with fever of unknown cause. Finally, according to the above principles, children need to use antibacterial drugs for disease treatment. Parents don't have to blindly reject all antibacterial drugs. Children's rational use of antibacterial drugs is relatively safe, and children also benefit.