At present, antibiotics, as the main drugs to treat bacterial infectious diseases, are the most widely used, fastest developing and most varied drugs in the world.
1978, mankind confidently put forward the optimistic slogan of "eliminating infectious diseases within a time limit", and all member States of the United Nations signed the agreement of "Health for all mankind in 2000", solemnly announcing to the world that mankind will completely eliminate infectious diseases before the arrival of 2 1 century. However, less than 20 years after the signing of the agreement, more and more viruses and bacteria have launched a severe challenge to mankind. Some infectious diseases have made a comeback.
Current situation of antimicrobial abuse
From 65438 to 0997, American scholar Pete Brooksmith wrote in the book Future Disasters-Plague Resurrection and Human Survival: The rapid development of vaccines, antibiotics and medical technology in recent years has created an illusion that we are almost unaffected by diseases. However, almost at the same time, many terrible and devastating new diseases are appearing in every corner of the world.
At present, there are 654.38+700 million people infected with Mycobacterium tuberculosis worldwide, and about 20 million people suffer from tuberculosis. Now there are 8 million new cases every year, and 3 million people die of tuberculosis, ranking first in the number of deaths from infectious diseases. Secondly, the spread of Ebola virus in the African continent; With the help of anthrax, mad cow disease, AIDS and SARS, even bird flu, a disease that used to spread only among poultry, began to ravage mankind.
The resurgence of infectious diseases is, in the final analysis, the failure of human immune system, and the chief culprit of this failure turned out to be antibiotics invented by human beings to resist bacterial and viral attacks. This is the merciless revenge of nature on mankind.
In recent years, due to human abuse of antibiotics, cunning bacteria began to launch a deadly counterattack against human beings. According to WHO's international multi-center survey, about 30% of inpatients use antibacterial drugs, and the cost of antibacterial drugs accounts for 15% ~ 30% of the total drug cost.
Researchers at Harvard University in the United States made a survey, and in two years, they investigated the medical records of 46,477 children. They found that antibiotics are used very frequently, three times a year per child on average. American doctors seem to like to use antibiotics very much. Half of them are normally used to treat otitis media and other problems, and 65,438+02% are used for colds, upper respiratory tract infections and tracheitis ... These diseases do not necessarily need to use these antibiotics. In the United States, 654.38+0.5 billion prescriptions made by doctors every day are antibacterial drugs, of which 50% are unnecessary.
Between 1982 and 1992, the number of people who died of infectious diseases increased by 40%, and the number of people who died of septicemia increased by 89%. The main reason is the treatment difficulty caused by drug-resistant bacteria. According to the statistics of Newsweek, in 1992 alone,13,300 patients in the United States died of drug-resistant bacterial infections.
In France, about 9-65,438+million people suffer from pharyngitis every year, and 90% of them take antibiotics during their illness, but in fact, only about 22.2% of pharyngitis belongs to bacterial infection, others are viral infections, and taking antibiotics has no effect at all. In addition, doctors often mistakenly use antibiotics to treat rhinitis, bronchitis and other diseases that are mostly viral infections.
Professor Wodtke, a British asthma expert, said that a study conducted in Britain, New Zealand and Northern Europe proved that antibiotics are related to asthma. Taking the study in Oxford, England as an example, it is found that children who use antibiotics for less than 6 months are three times more likely to develop asthma after 5 years old than children of the same age.
Application Status of Antibiotics in China
China is one of the countries with the most serious abuse of antibiotics in the world, and the resulting problem of bacterial drug resistance is particularly prominent. The drug resistance of some bacteria isolated from clinic has ranked first in the world. People in the industry believe that China people will probably eat their own fruit and take the lead in entering the "post-antibiotic era", that is, returning to the dark age before the discovery of antibiotics, which is definitely a catastrophe.
1999 ~ 2002, although the proportion of sales of anti-infective drugs in the total sales of the pharmaceutical market continued to decline, its sales still increased at a high speed. In 2002, the market scale of anti-infective drugs for hospital use in China reached 34.5 billion yuan, ranking first among hospital drugs with a market share of 26.5% (worldwide, the market sales of anti-infective drugs accounted for about 15% of drug sales, ranking second in the global drug market sales).
In 2000, a hospital in China investigated the use of antibiotics among inpatients in this hospital. Among them, 80.2% used antibiotics, and 58% used broad-spectrum antibiotics or a combination of two or more antibiotics, which greatly exceeded the international average.
According to incomplete statistics in recent five years, antibiotics account for about 30% ~ 40% of the total annual drug consumption in Shanghai, Wuhan, Hangzhou, Chongqing, Chengdu and other big cities, always ranking first among all drugs. The cost of using antibiotics in the above cities ranges from 654.38+0.4 billion yuan to 654.38+0.7 billion yuan. 80% of Staphylococcus aureus infected people in Shanghai have developed resistance to penicillin G ... The application of third-generation cephalosporin antibiotics such as ceftriaxone and ceftriaxone is becoming more and more common, and the choice of antibiotic varieties is obviously ahead of schedule. If the abuse of antibiotics is not stopped, Shanghai will become the next hardest hit area with strong drug resistance after Beijing and Guangzhou.
On the other hand, in the 1920s, the main hospital infection was streptococcus, but in the 1990s, methicillin-resistant Staphylococcus aureus, enterococcus, penicillin-resistant Streptococcus pneumoniae, fungi and other drug-resistant bacteria emerged. Quinolones have only been in China for more than 20 years, and the drug resistance rate has reached 60% ~ 70%.
Penicillin-resistant Streptococcus pneumoniae used to be sensitive to penicillin, erythromycin, sulfanilamide and other drugs, but now it is almost impeccable. The resistance rate of Pseudomonas aeruginosa to 8 kinds of antibiotics such as amoxicillin and penicillin was 100%, and the resistance rate of Klebsiella pneumoniae to 6 kinds of high-grade antibiotics such as penicillin and Fudaxin was 5 1.85% ~ 100%. However, there is no cure for methicillin-resistant Staphylococcus aureus except vancomycin.
The infection caused by multi-drug resistant bacteria poses a serious threat to human health, and the abuse of antibiotics has paid a heavy price for human beings. In 1950s, methicillin-resistant Staphylococcus aureus was first infected in Europe and America, which quickly swept the world, with 50 million people infected and more than 500,000 people dying.
Experts say that it usually takes about 10 years to develop a new antibiotic, while the first generation of drug-resistant bacteria only takes two years, so the speed of antibiotic development can't keep up with the reproduction speed of drug-resistant bacteria. At present, many seriously infected people die in clinic, mostly because of drug-resistant bacteria infection, and antibiotics are ineffective. "Abuse of antibiotics will mean the end of the era of antibiotics." People have to worry that in the near future, there will be a kind of bacteria resistant to all antibiotics, and mankind will return to the era without penicillin in the last century.
Long-term use of antibiotics is harmful.
There are about 50 million to 80 million disabled people in China, 1/3 is hearing disability, and 60% to 80% of them are caused by aminoglycoside antibiotics.
About 75% of outpatient cold patients in China use antibiotics; The use of antibiotics in surgery is as high as 95%; The utilization rate of antibiotics in inpatients in China is 79%, which is much higher than the average level in Britain (22%) and other countries (30%).
American researchers conducted a long-term follow-up study, comparing the antibiotic use of 2 266 breast cancer patients and 8 000 controls. The results showed that 17 used antibiotics for more than 500 days or more than 25 times, and the risk of breast cancer increased by 2 times.
One of the researchers, Dr. Roberta Ness from the School of Public Health of the University of Pittsburgh in the United States, pointed out that this risk is very large, far exceeding the level of 30% ~ 40% increase in breast cancer risk caused by estrogen use. And this problem is not the first time. As early as 1999, a follow-up study on Finland 1 000 women also got similar results.
The widespread abuse of antibiotics
Example 1: give patients lincomycin 1. Prevention of infection by intravenous injection of 2g/500ml after acute appendicitis operation. After the infusion, he died of respiratory failure and shock.
Lincomycin has neuromuscular junction blocking effect, so it should be reduced when combined with anesthetics and muscle relaxants, otherwise it may cause respiratory depression and even death due to synergistic effect. In this case, lincomycin 1.2g is used once, and the dose is too high, so 0.6g should be used repeatedly every 8 ~ 12 hours. It is suggested that the death of the patient may be related to the overdose of lincomycin and the adverse interaction between lincomycin and anesthetics and muscle relaxants.
Case 2, a 44-year-old male, was admitted to hospital with acute pancreatitis. Gentamicin 240,000 units, one day 1 time, died of renal failure in 29 days.
To sum up, among the many phenomena of antibiotic abuse, the lack of correct understanding of the use of antibiotics by medical staff can not be ignored, including poor mastery of indications; More broad-spectrum antibacterial drugs were used; Excessive combination of drugs; Preventive medication time is too long; Do not pay attention to pathogenic examination, too few drug sensitivity tests; Do not understand the pharmacokinetic characteristics, such as irregular dosage, route and interval operation.
Seek countermeasures
Facing the global problem of antibiotic resistance, the World Health Organization sent an initiative to scientists to seek countermeasures. This organization, founded in 198 1, is an alliance for the prudent use of antibiotics, with members in more than 90 countries. More and more countries take legislative measures to ban the use of antibiotics.
The European Commission has issued a ban on the use of four antibiotics within the EU. These four antibiotics, including bacitracin zinc, spiramycin, virginiamycin and tylosin phosphate, account for 80% of the total market share of antibiotics, and should not be used for raising livestock and poultry from 1 July 9991.
At present, the Department of Medical Administration of the Ministry of Health is drafting the Guidelines for the Rational Use of Antibiotics, which is expected to be released in the first half of next year. This is the first guideline for certain drugs in China, and it is also the first time that the Ministry of Health has used administrative orders to control the use of certain drugs by doctors. Since July 1 this year, the state has stipulated that all kinds of antibacterial drugs that are not listed in the over-the-counter drug list must be sold by medical practitioners in all retail pharmacies across the country in order to better strengthen the management of antibiotic use.