时间:2019年02月22日 10:40:33

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 #39;doctors and patients don#39;t want to wait 48 hours,#39; says Dr. Cutler, who is chairman of the American College of Physicians#39; Board of Regents. 费城附近的内科医生卡特勒(Charles Cutler)说,反复出现尿路感染的妇女经常要求环丙沙星之类的广谱药物,因为这是她们知道的药。但过量使用这类药物导致出现了众多抗药感染。卡特勒说,检测确定尿路感染的原因需要48小时,但医生和病人不愿意等上48小时。卡特勒是美国医师协会评议委员会(American College of Physicians#39; Board of Regents)主席。 Bronchitis is another illness for which antibiotics are often overused, says Lauri Hicks, medical director for the CDC#39;s #39;Get Smart: Know When Antibiotics Work#39; program. Eighty percent of the time patients come into a doctor#39;s office with acute bronchitis they will be prescribed an antibiotic, and usually a broad-spectrum one, she says. #39;Bronchitis in someone who#39;s otherwise healthy typically gets better on its own,#39; she says. 疾控中心的“常识:何时使用抗生素”(Get Smart: Know When Antibiotics Work)项目医学总监希克斯(Lauri Hicks)说,气管炎是另一种常常滥用抗生素的疾病。她说,患有急性气管炎的患者去看医生时,八成会被开具抗生素,而且通常是广谱药。她说,如果在其他方面都很健康,气管炎通常会自己好转。 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. 医生说,细菌感染和病毒感染可能很难分辨。鼻窦炎的一个简单的经验法则是,不要过早使用抗生素,但如果症状持续则可以考虑使用。主要由病毒引起的气管炎和肺炎感染通常是用听诊器听肺音来诊断。如果有疑问,通常可以用X光检查来辨别。 Experts say patients should question their doctors about the use of antibiotics-both whether they are warranted and why a particular type is chosen. 专家说,患者应当向医生追问抗生素的使用,包括是否必要以及为何选择某种类型的抗生素。 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. 美国儿科学会强调了明智使用抗生素的重要性。该组织今年更新了治疗鼻窦炎和耳部感染的指导方针,帮助医生确定抗生素对哪些疾病见效以及该开具何种抗生素。这些更新后的指导方针都推荐在有必要使用抗生素时将窄谱的阿莫西林作为首要治疗选择。 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. 赫什说,抗药菌一开始只是少量存在于身体内,但受到其他对抗生素更敏感的细菌排挤。用抗生素之后,抗生素会杀灭易感细菌,从而让抗药菌更容易繁殖。 Jeffrey Gerber, a pediatric infectious-disease specialist at the Children#39;s Hospital of Philadelphia, recently led a research team exploring whether doctors#39; 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#39;t receive any guidance. 费城儿童医院(Children#39;s Hospital of Philadelphia)儿科感染疾病专家格伯(Jeffrey Gerber)不久前带领一个研究小组考察能否改变医生们开具处方的习惯。研究人员考察了18所初诊儿科诊所。一半诊所的医生们接受了一些常见感染处方指导方针的现场培训,包括肺炎、脓毒性咽喉炎和鼻窦炎。这三种病症都被推荐使用窄谱抗生素。剩下的诊所没有接受任何指导。 #39;After 12 months we saw overall a nearly 50% reduction in broad spectrum or off-guideline prescribing for these conditions#39; 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. 格伯说,12个月后,我们看到相比对照组,干预组诊所针对这些病症开具广谱抗生素或脱离指导方针开药的情况整体上减少了近50%。该研究发表在今年6月出版的《美国医学会杂志》(Journal of the American Medical Association)上。他说,研究人员正在考察处方习惯的变化给疾病控制、成本和其他结果带来的影响。 /201308/253355

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