1. What are antibacterials, anti-inflammatory drugs and antibiotics?
Moderator: Good morning, netizens of the Capital Window. This is the interview site of the series of medical ethics Zhao jointly launched by the Beijing Municipal Health Bureau and the Capital Window. Today, we are going to talk to you about the rational use of antibacterial drugs, and we have invited three guests for you:
Welcome, Yue Xiaolin, Director of Pharmaceutical Machinery Division of Beijing Municipal Health Bureau.
Yue Xiaolin: Good morning, netizens.
Moderator: Ma Xiaojun, chief physician of Peking Union Medical College Hospital, director of hospital infection management office and executive deputy director of scientific research department, welcome.
Ma Xiaojun: Good morning, netizens.
Moderator: Li Yuzhen, chief pharmacist, professor and director of pharmacy department of Peking University People’s Hospital, welcome.
Li Yuzhen: Hello, everyone.
Moderator: Can you tell the netizens about whether antibacterial drugs, anti-inflammatory drugs and antibiotics are the same thing? At the same time, we have a survey result here. One question is whether you usually pay attention to medical and health knowledge. 86.4% people pay attention to medical knowledge. What is the understanding of antibacterial drugs? 40.9% of the respondents thought it was a chemical synthetic drug with strong professionalism. 37.9% of the respondents thought it was an anti-inflammatory drug, and 21.2% thought it was an ordinary bactericidal and bacteriostatic drug, so can you tell us what an antibacterial drug is, and whether it is the same as anti-inflammatory drugs and antibiotics?
Li Yuzhen: Let me give you a brief introduction. I think the netizen answered very well, but it was not very comprehensive. Antibacterial drugs should include antibiotics from our clinical point of view and scientific point of view, as well as synthetic or semi-synthetic antibacterial drugs. Belong to two categories. According to its production source, antibiotics are produced from the metabolites of microorganisms, animals and plants in some life processes. Antibacterials that are chemically synthesized or semi-synthetic are called synthetic antibiotics, such as quinolones or sulfonamides. We call them synthetic or semi-synthetic. Just now I mentioned some antibiotics from microorganisms, such as penicillin and erythromycin, and tetracycline used a long time ago. Some drugs like this are antibiotics, and antibacterial drugs include these two categories. This is a comprehensive concept.
Moderator: What about anti-inflammatory drugs?
Li Yuzhen: The anti-inflammatory drugs that people often say actually refer to antibacterial drugs. The concept of anti-inflammatory drugs we refer to in clinic is completely different, including antipyretic and analgesic drugs and hormones. However, the anti-inflammatory drugs mentioned by ordinary people are antibacterial drugs, which can treat infectious diseases caused by bacteria or mycoplasma, chlamydia and germs, and are called anti-inflammatory drugs by ordinary people.
Moderator: I can give you such an example. Do you think this understanding is correct? The concept of antibacterial drugs contains the concept of antibiotics, and then, as we usually eat, for example, Baifuning and Fenbid are analgesic, not antibacterial drugs in a strict sense.
Li Yuzhen: It’s not an antibacterial drug, and it’s totally different from antibacterial drugs. It belongs to antipyretic and analgesic, and it belongs to non-carrier anti-inflammatory drugs.
Ma Xiaojun: From the different appellations, it is still said that wisdom is among the general public. Because infection will definitely bring inflammation, but inflammation is not necessarily infection. Another clinical point of view, our medical professionals don’t use the name of anti-inflammatory drugs.
Moderator: Thank you. Let’s tell you a phenomenon. Let’s analyze why. People often say that the more they take anti-inflammatory drugs, the less they care, and they seek doctors to prescribe anti-inflammatory drugs that are more in charge. So everyone asks, does this mean the drug resistance of bacteria? Is this an understanding?
Ma Xiaojun: Let me try to answer this question. This topic is a topic that the majority of netizens, including the public, are more concerned about. In fact, it can be divided into two aspects: whether the drug is effective or not, whether it is symptomatic, and whether it should be symptomatic but ineffective may be a problem of drug resistance. It doesn’t work either, but both meanings should be included. Let me give you an example. It is rare now, but it used to be an important infectious disease in China, such as meningitis. At that time, the best drug was penicillin, and it is still the same now. Penicillin is very good, very symptomatic and has no drug resistance. But if you use penicillin to treat some negative bacilli infections, such as urinary tract infections, it must be ineffective, because most bacteria are resistant to penicillin. In addition, drug resistance also includes the gradual emergence of antibiotic selective resistance during treatment, which leads to treatment failure, so treatment failure is not necessarily drug resistance, but may be symptomatic.
Second, how to use antibiotics rationally?
1. What do patients know about antibiotics?
Moderator: In your daily diagnosis and treatment, as far as you know, what do our patients know about this kind of drug resistance, including antibiotics and antibacterial drugs?
Ma Xiaojun: The first thing I contact with in the outpatient clinic is to seek medical treatment, not to diagnose. In the case of definite or ambiguous diagnosis, an experienced infectious doctor can’t wait, and should give him a definite treatment in a relatively early time. This treatment is called empirical treatment before we get the corresponding pathogenic microorganisms, which is very important in our daily clinical practice, even the most important and most clinical prescription behavior. Most of the patients I met in the outpatient clinic didn’t come to prescribe drugs directly. They had a fever or diarrhea or a clear infection in other places. Let’s diagnose them first. In this case, doctors recommend antibacterial drugs or anti-infective drugs, which is usually the mode. However, after some patients come to the clinic, you prescribe a drug, and he will ask a lot about the adverse reactions of special drugs, and when they will take effect, he will pay attention. But after all, drugs are very professional, and medical professionals have more detailed information, so he is more concerned about the efficacy and adverse reactions.
Moderator: One of the options set in the survey is which of the following do you think should be followed in the rational use of antibacterial drugs? 75.8% people think they are familiar with the indications, antibacterial activity, pharmacokinetics and adverse reactions of selected drugs. 72.7% people think that drugs should be used rationally according to physiological, pathological and immune conditions. 63.6% people think that the appropriate dosage, dosage and course of treatment should be chosen. 56.1% people think that the etiological diagnosis of infectious diseases should be established as soon as possible. I would like to ask the guests how they feel about the results of this survey, and what is the public’s opinion on the preference of the options?
Li Yuzhen: I think these options are quite comprehensive. If they are all included, the rational use of antibiotics has basically been achieved. To sum up, the rational use of antibiotics mainly considers three aspects. One must first consider the patient’s condition, what kind of infection he has, and this drug should be symptomatic. Second, we should consider the characteristics of the drug itself, that is, the pharmacokinetics, efficacy and safety, that is, adverse reactions and effectiveness that netizens just answered. The third is to consider the patient’s own condition, such as poor liver and kidney or other immune diseases. At the same time, drug resistance, for example, we always think that drugs are effective for this bacterium, but because of the long time of use, drug resistance occurs, so we should pay special attention to the selection of indications at this time. The items that netizens answered just now are scattered choices. In fact, when we consider the rational use of antibiotics, we should consider all of them, not just one of them.
2. Is it necessary to diagnose the etiology in clinic?
Moderator: 56.1% of netizens mentioned the patient’s diagnosis, and your introduction, and some of his experience in the diagnosis and treatment process. Do we have any regulations now? Do doctors have to make etiological diagnosis? Because I understand that the diagnosis of pathogens has a process, for example, sputum has a seven-day process, and patients may not be able to wait for seven days. On the one hand, from the perspective of the Municipal Health Bureau, on the other hand, as a clinical doctor, they encounter it in the diagnosis and treatment practice.
Yue Xiaolin: In fact, we have been emphasizing that all qualified medical institutions should build corresponding laboratories to meet the requirements of culture and drug sensitivity experiments. Therefore, special indicators have also been set up in the special rectification activities of antibiotics, and patients with certain infections should be trained accordingly and get certain results. This has several advantages. The first is to guide clinical medication. I got sick a few days later and got better after taking the corresponding antibiotics, but there is also a possibility that it is ineffective. We have to determine and guide clinicians through the results of sputum and blood, and how to use more effective antibiotics better. Secondly, we can get some epidemiological results by doing experiments and screening out the results. What strains are most infected recently, which drugs are sensitive to these strains and which drugs are resistant to these strains? We will guide clinicians to give more scientific guidance when choosing drugs when dealing with influenza or related diseases this season, which is also of clinical significance.
Ma Xiaojun: In fact, we always face such a contradiction in clinic. First, netizens are very high-level and put forward very high expectations for us, but whether this expectation is realistic in clinic, we can give an example. For example, a very serious infected patient, accompanied by his family, has severe fever, headache, nausea and vomiting. From our experience, it is basically diagnosed as a central nervous system infection at the first time. In this case, is it possible for the doctor to make such a choice and advise the patient? You haven’t made a definite diagnosis yet, but I think you are like a central infection. Since there is no definite result of pathogenic microorganisms, I won’t treat you first. All microorganisms have a period of growth, which can only be recognized by us after a certain period of time. Can we wait for this period of time? Sometimes we can’t wait. I’ll give you a data. In some seriously infected patients, the survival rate of patients will be reduced by eight percentage points for every hour of delay in correct treatment. So if we wait for an important patient for six hours, the survival rate of this patient will be less than 50%. Together with the process of my treatment, this patient basically has no room for treatment. What should we do? Just now, Yuechu emphasized that we have some good technical specifications. I have a data that is particularly interesting. I participated in the compilation of data in the previous stage. I checked the documents in the United States. Almost all the guidelines I can read in the United States for simple urinary tract infection do not recommend you to do urine test and bacterial culture.This may be strange to everyone, why Americans don’t recommend you to do routine urine culture in such an important infection, especially for young women. Because most studies have proved that most of this type of infection is caused by Escherichia coli, I can treat you without doing it, but if it doesn’t work after three to five days, you should do an appropriate bacterial analysis of the etiology at this time. Therefore, in view of the background of medical reform, it may be necessary to gradually move towards a very scientific medical norm that balances health economics, because after all, we are a developing country. Therefore, doctors are needed for pathogen diagnosis. What should we do? Experience treatment, is the doctor patting the forehead? Director Li is a very experienced expert. Director Li looks well, and I am young. Am I in a fog? In fact, we all follow a basic principle, which is based on past, past and similar patients’ sensitivity when they are infected. On the basis of such a large amount of past experience, we take an empirical treatment model recognized by everyone. Therefore, empirical treatment is not blind, but is actually the result of a larger survey.
Moderator: There is a better balance and rationality.
Ma Xiaojun: There is another big problem. The bacteria we find are not necessarily pathogenic bacteria. For example, it is not normal to find bacteria in sputum and urine. The more extreme example is that there must be bacteria in stool. Everyone knows this. Therefore, some of the bacteria we found may be meaningless and need doctors to judge. However, the specimens of sterile parts, such as blood and cerebrospinal fluid, including tissue culture and so on, are really important to find in these places. Therefore, in the professional field, we also appeal, and also use this platform to appeal to the majority of netizens not to worry too much. When doctors suggest that you do some even invasive tests, it is very important to help, especially when the infection is serious. Have a good cooperation with the doctor.
3. Are anti-inflammatory drugs prescription drugs? Can they be bought in pharmacies?
Moderator: Here, I will access the questions of several netizens first. Some netizens asked, are anti-inflammatory drugs prescription drugs, and can they usually be bought in pharmacies? This is also a common problem we usually have?
Yue Xiaolin: Anti-inflammatory drugs are prescription drugs. Let me explain again that anti-inflammatory drugs are commonly known. For example, antipyretic and analgesic products are OTC products and can be bought directly in pharmacies, so what we are talking about is generally within the scope of antibacterial drugs and antibiotics. These drugs are basically prescription drugs and can only be bought in pharmacies with a doctor’s prescription. Of course, the Baifuning you mentioned just now are antipyretic and analgesic drugs, and most of the products are listed as over-the-counter drugs. People can buy related products in pharmacies with their own experience in drug therapy.
4. What problems should be paid attention to in antibacterial drugs used by infants?
Moderator: It seems that it will take a long time to reverse everyone’s change of heart. It is still very difficult to completely change it within at least one hour. It is necessary to constantly popularize knowledge, let everyone know what is going on, and put this concept into the hearts of the people. The netizen asked, what problems should be paid attention to in antibacterial drugs used by infants?
Ma Xiaojun: I’m an infectious disease doctor. I’m supposed to be a general practitioner, but because of the professional development, we do more in adult infection. But in fact, the anti-infection model of adults is not necessarily unavailable in children, but some drugs are definitely unavailable in pediatrics. For example, children under the age of 16 cannot use quinolones, which we all know very well. The treatment ideas and modes of diagnosis are exactly the same. One thing I want to emphasize with you is that although the infection of infants and young children is the same part as that of adults, for example, they are all central infections, but their immune mechanisms are different. When the immunity is different, the pathogenic microorganisms that may be infected are different. Therefore, the initial empirical treatment scheme for children’s infection is very different from that of adults. Therefore, this matter has the special infection characteristics of children of special age. In addition, most of the treatment modes, including the operation of dealing with similar infections, are the same, such as blood culture and corresponding specimens, but the child’s body is relatively small. If there are some special infections in the body, the blood drawn is actually much less than that of adults, which may meet our needs. There is no big difference in the principle.
Moderator: I saw the parents’ empirical therapy, especially at home. He didn’t go to the hospital. He thought it would be enough for adults to give their children half or a quarter of the medicine.
Li Yuzhen: Yes, I especially agree with what the host said. I quite agree with what Director Ma said just now, and it was also very good, from a clinical point of view. But I especially want to emphasize that infants and young children should pay special attention to the dosage of drugs. Parents are particularly nervous when they see their children have a fever, so they want to use some anti-inflammatory drugs at home to bring it down, but many fevers are not caused by infection or bacteria, and many are viruses, such as cold virus or influenza. So using some antibiotics is ineffective and should not be abused. Therefore, it is not advisable to use anti-infective drugs on your own and give them to children casually, so you should go to a regular hospital, consult the pediatrics, and use the drugs correctly after a correct diagnosis. In particular, I want to emphasize the dosage of children. Most of the drugs we produce now are not specially used for pediatrics, but the dosage of adults is halved. We hope to read the instructions carefully and be very careful. How old are you? We should pay special attention to this. Sometimes it is wrong, or adults love children. We also heard such a case. In order to give the child medicine, for example, some eye drops, the child was particularly uncomfortable when she ordered this eye drop. I ordered a drop myself first, and the result was very serious consequences, glaucoma, which she didn’t know. So I think we should use medicine carefully, and don’t think that medicine doesn’t matter, as if we had eaten it in the past or something. The expiration date of antibiotics is also very important. I can’t think that I have taken them all in the past.Don’t look at the expiration date, and the storage conditions are very important. Sometimes it needs to be protected from light, refrigerated, and can’t be mixed. It needs special attention. Don’t give antibiotics to children at will.
Moderator: Let’s look at this netizen’s question. He said that infants have upper respiratory tract infections and doctors have prescribed anti-inflammatory drugs, such as cephalosporins. Will there be any adverse reactions?
Ma Xiaojun: I think this topic is very representative, but I don’t know the medicine prescribed by the doctor on the first day of the course of the upper respiratory tract infection he mentioned. Let me give you an example, not to say that we should call on everyone to abuse antibacterial drugs, but one indisputable fact is very clear. In our current situation, as an infectious disease doctor, I have seen infectious diseases for many years, and rarely encounter rheumatic heart disease and rheumatic glomerulonephritis. Why are these two diseases reduced? The most important source of these two diseases is the upper respiratory tract infection of streptococcus and rheumatic fever after three or four weeks. Why are there so few such diseases now? In fact, a large part of the reason is that in the early stage of streptococcus infection, the doctor gave him drugs. So there is no absolute bad thing, and there is no absolute good thing. What is the key question? This netizen I suggested that he listen to the doctor’s advice. The doctor prescribed the medicine after consideration. Since it is prescribed, I think it must be reasonable, so I suggested that he accept the doctor’s treatment.
Third, what are the norms for doctors to use antibacterial drugs in practice?
1. What is specified in the Administrative Measures for Clinical Use of Antibiotics?
Moderator: We have been emphasizing following the doctor’s advice. We trust the doctor so much. The prescription prescribed by the doctor includes the doctor’s diagnosis and treatment behavior. His standardization may be a problem that all patients, including their families, are more concerned about. So here I want to ask Yuechu, what kind of norms does Beijing have from the perspective of the municipal government for doctors to prescribe antibacterial drugs?
Yue Xiaolin: Actually, we have been paying attention to the doctor’s diagnosis and treatment behavior, especially the doctor’s rational drug use behavior for a long time. Therefore, we have relevant laws and regulations to regulate this behavior from several systems. First, from the perspective of laws and regulations, the Ministry of Health has a "Administrative Measures for Clinical Use of Antibiotics", which is already in the stage of soliciting opinions and may be issued in the form of departmental regulations in the near future. This is also a landmark document, which includes the management of clinical rational drug use in the overall management of laws and regulations, indicating the importance attached by the government to this work. Secondly, from the perspective of hospital management. For example, this special rectification of antibacterial drugs does not only emphasize the completion and establishment of the index system, but requires all medical institutions to make important reforms or refined management from the system management mechanism to improve the level of rational drug use by doctors. For example, the importance of the administrative department, the construction of some supporting technical support I just introduced, such as the construction of some clinical laboratories, some necessary clinical laboratories and pathological laboratories, as well as the standardized training of doctors, the special training of antibacterial drugs, clinical guidance, and the follow-up prescription review. For every prescription issued by a doctor who has the right to prescribe antibiotics, we need a clinical pharmacist, and the clinicians handed down from generation to generation organize prescription review in the hospital, which has a certain period. The system construction of these things is to improve the doctor’s medication level from the internal management of the hospital and increase the doctor’s rational medication level. Of course, we are here today,It is also an education of basic medical knowledge for the public. This is all in all aspects. With the cooperation of the government, medical institutions and the public, we take antibiotics at home without authorization, because antibiotics are classified as prescription drugs and can only be used reasonably under the guidance of doctors. Therefore, the government, medical institutions, including the public, cooperate with each other to gradually put the level of rational use of antibacterial drugs in a scientific perspective.
2. How do hospitals determine the list of antibacterial drugs in our hospital?
Moderator: I checked some related documents on the Internet, and one of them said that according to the work arrangement of the Municipal Health Bureau, hospitals will comprehensively sort out the list of antibacterial drugs in our hospital according to the control indicators before the end of June, and repel the antibacterial drugs with potential safety hazards, uncertain curative effect, poor cost performance and illegal promotion. According to such relevant regulations, can we have such understandings? Does the first one mean that these retired antibacterial drugs can no longer be purchased in hospitals in the future? Second, are the varieties of antibacterial drugs kept by all hospitals the same, or do all hospitals have their own choices? In addition, does our Municipal Health Bureau also need a dynamic monitoring for these remaining varieties, for example, with the improvement of drug resistance, do we also make some dynamic adjustments?
Yue Xiaolin: First of all, the establishment of this indicator has gone through a process of scientific argumentation, and Professor Ma also participated in the process of argumentation. First of all, correct a possible misunderstanding. The whole selection process is organized by medical institutions to organize their own pharmacists, managers and clinicians. According to their own whole diagnosis and treatment tasks, for example, we have some specialized hospitals, comprehensive hospitals, secondary and more basic health institutions. When all drugs are required to enter the hospital, they must be demonstrated by the Pharmaceutical Affairs Management Committee before they can enter the drug use list of this hospital. Our clinical pharmacists will consider pharmacology, toxicology, adverse reactions, including cost-effective factors, and give some reference from the perspective of pharmacoeconomics. Clinicians in various departments, such as infectious diseases and surgery-related departments, will also put forward his drug demand. After demonstration, each hospital selected 50 drugs with common names for its drug list. However, the drug list of each hospital is different because of the different tasks undertaken. For example, infection is the main factor, and there may be some specialized departments, so the drugs selected by each hospital can be different. You mentioned it very well just now, and now we have established a dynamic monitoring system, which of course has a lot of technical support. For example, there is a bacterial resistance network, and 50 medical institutions are selected to submit some results of clinical experiments and the basic situation of drug-resistant bacteria to this network. We have a regular information feedback to guide clinical medication.Secondly, all drugs are purchased through the government’s online platform, and the information of drug use in various medical institutions is dynamically monitored from the government’s point of view. Specifically, it will arrive on June 30th, and the People’s Hospital is also doing these things. What we emphasize is to get rid of some drugs that are not suitable for clinical use and prevent drug abuse. This is our goal.
Li Yuzhen: According to the guiding principles and plans of the clinical management of antibiotics of the Ministry of Health, all our hospitals have actually done their work, and the Beijing Municipal Health Bureau has also attached great importance to it and set a timetable. This timetable calls for the selection of 50 antibiotics by the end of June. I quite agree with some principles mentioned by Director Yue. When selecting, we should first consider the safety of this drug, its economy, effectiveness and drug resistance in our hospital. For example, if you are completely 70% resistant to some bacteria, such drugs should definitely be withdrawn. There are some similar drugs, because there are many manufacturers of the same drug in our country, so we will choose the one with the best quality and the best cost performance to stay. There are many ways and means in the selection process. First, according to the guiding principles of antibacterial drugs in the country, a management team is set up. Under the guidance of our Pharmaceutical Administration and Drug Treatment Committee, the management team is composed of experts from infectious diseases, respiratory diseases, medical services and pharmacy. It is also necessary to formulate the principles of selection, which are also based on the requirements of the Ministry of Health, such as the clinical use of drugs. I quite agree with Yue Chu that the 50 varieties selected by each family are different, because they undertake different tasks. For example, the blood in our hospital is famous, and the infection in hematology department is critical, because after bone marrow transplantation, the immune function declines, and some immune drugs are needed, so the infection is heavier, so some advanced antibiotics,In the third and fourth generations, very effective anti-infective drugs were carefully selected. These 50 kinds, the people think it will not be enough, the original so many, some can not buy. In fact, before we sorted it out, there were more than 50 kinds. After selection, 50 kinds should meet the clinical needs. There is also a document of the Ministry of Health that allows you to make one-time purchases for some special needs. It is entirely from a clinical point of view. From the interests of patients, it is not impossible to use more than 50 kinds across the board, but you have to apply for approval and put on record. There are such regulations.
Ma Xiaojun: We need to take a look at the current management of antibiotics or the requirements for rational drug use. What’s the purpose? Our purpose is definitely not to remove antibiotics from our medical institutions. The problem we have to solve is that the drug resistance of bacteria is becoming more and more rampant. I think a topic that netizens should pay attention to is that even if antibiotics are used reasonably, the drug resistance of bacteria will definitely increase. This is certain, and this is the first thing to pay attention to. The second thing to pay attention to is my subjective speculation that although the requirements of medical institutions above the second level are different, the differences in the final selected varieties will not exceed 25%. About 70% of them are the same. With different characteristics and different tasks, there may be some emphasis. Because, after all, globally, if China compares with foreign data, we find that the common infections are in these parts, such as respiratory tract, urinary tract, digestive tract and surgical site, which are commonly used medicines. There is also a "Guiding Principles of Antibiotic Drugs" in the Ministry. Such a programmatic document provides technical guidance, so netizens don’t have to be too nervous about whether there will be many drugs. Please rest assured that effective drugs can’t get out. Another director, Li, said that we have an effective regulation, which reflects the requirements of Scientific Outlook on Development. If a drug is temporarily purchased for more than five times, it will be discussed in this hospital whether it will become a routine drug preparation in this hospital in the future. This is a very scientific management norm from the policy point of view.
Moderator: Now many things are in line with a dynamic adjustment according to the situation at that time.
Ma Xiaojun: I would also like to add that we have to deal with drug resistance. China has discovered that it is a serious problem all over the world. Therefore, the World Health Organization will set off a World Health Day. The theme of this year is that no action will be taken, and no medicine will be available in the future. This is a topic facing the whole world.
3. Will the abuse of antibiotics lead to the consequences of no medicine in the future?
Moderator: Now some people are talking about superbugs, saying that their appearance is to retaliate against the consequences of human abuse of antibacterial drugs. If you don’t take action, there will really be no drugs available, right? Is it really revenge for people abusing antibacterial drugs?
Li Yuzhen: I think so. Director Ma put it very well. Even if we use antibiotics rationally, its resistance will inevitably occur. The fate of all antibiotics is from research and development to drug resistance to final elimination, which may go through such a process, either clinically or in the life cycle. However, the speed of drug resistance is closely related to our rational use and abuse. Because in the process of using antibacterial drugs, if they come into contact with bacteria for a long time, bacteria will constantly evolve themselves in order to survive, so it is natural to produce drug resistance. Sometimes, you don’t aim at bacteria, but you use a lot of broad and powerful antibacterial drugs, killing the normal flora of the body and slowly growing the pathogenic bacteria, so that drug resistance occurs very quickly. This superbug was discovered in Britain at that time, but its source was found in India and Pakistan, that is, its source was from this country where the management of antibiotics was not very strict. There are similar problems in our country, so the problem of antibiotic resistance is not a local problem, but a global problem. Therefore, the theme of the World Health Organization on April 7 this year is to resist antibiotics. If no action is taken today, there will be no drugs available tomorrow. Therefore, the problem of drug resistance is indeed very serious, and it is also a punishment for us. We should wake up our own medication behavior. As for no medicine available, because it takes a long period for us to develop a new drug, we can develop new antibiotics to deal with drug-resistant bacteria, but the period is very long.No bacteria grow fast in drug resistance, so we really need to be alert to our behavior and protect our environment ourselves, which is actually to protect our own interests. This drug resistance is not only a rational application in hospitals, but also an understanding with others in the society. There are also too many antibiotics used in agriculture and animal husbandry, so many fish, chickens and pigs are also using antibiotics. After eating some things left in their own bodies, we humans will also have some drug resistance. About 40% of antibacterial drugs used in our country are used in agriculture and animal husbandry, so the whole society should work together to rationally use antibacterial drugs and reduce their drug resistance.
4. Is there a long-term mechanism for bacterial resistance detection?
Moderator: Just now, several experts said that the speed of developing new drugs can’t keep up with the speed of bacterial resistance, but from the perspective of government supervision, do we have a testing center for bacterial resistance spectrum, for example, which is transmitted to our terminal through the Internet of Things, and even this terminal is not only connected to Beijing, but also to the whole country and even the whole world? Are we still in the process of continuous improvement?
Yue Xiaolin: I just told you that because the use and resistance of antibiotics is a professional subject, we need professional technical support to help us solve the problem of rational use of doctors and the whole society. The Ministry of Health attaches great importance to this work, including the Beijing Municipal Health Bureau. First of all, you mentioned the first question. There is a relatively large bacterial resistance monitoring network in China. Beijing has also set up a bacterial resistance monitoring network in Beijing on the basis of the national drug resistance network since the whole year. We have absorbed some tertiary hospitals and some secondary hospitals, because now the secondary institutions have also received many patients in infectious diseases, and we will get some regular things from the whole results to guide drug use. At present, more than 50 hospitals have been included in the scope of our bacterial resistance monitoring network. Through the construction of the basic network and the central network, relevant data, including some strains, have been submitted to the central network, and we also regularly feed back information to medical institutions. There is only one goal, to guide the rational use of antibiotics in clinic through scientific results, to reduce the emergence of drug resistance cycle in antibiotic resistance time, and to make the whole country mention that the future drugs should be used effectively and the health level should be well controlled and improved.
Moderator: Do you think it is necessary to let the public know about our drug resistance to bacteria and its data monitoring?
Ma Xiaojun: I think it depends on how you understand it. The same data may be interpreted differently by different groups. For example, it is said that cephalosporins are highly resistant to a certain drug, and some patients will ask why they are prescribed to me after being so resistant. But it is the best choice for another kind of germs. So how do we understand antibiotics and how to understand drug resistance is a topic in a professional field. We are not only the Health Bureau, the Ministry of Health, but also the national monitoring network. As an infectious disease doctor, I understand this very well, but it is a trend thing. He tells us what the general trend is and what the drug resistance is. But from the public point of view, this is not the whole country, nor is it the whole of Beijing. For example, the most serious problem facing China now is not the drug resistance of positive cocci, but the drug resistance of negative bacilli. On the contrary, in the United States, the drug resistance of down-peptide-resistant cocci in the United States is very serious, and this is less than 5% in China, which shows that our trend-oriented things have regional characteristics, so if the trend is concerned, the monitoring network is very important, and in terms of treatment, every treatment is a case, so from this perspective, For the dissemination of drug resistance information, we can let more professionals know in the professional field. In the public field, I personally feel that the evaluation of antibiotics is a very good tool for our human self-salvation, and everyone should protect it from different angles.
Fourth, netizens ask questions
1. To what extent do you need to use antibiotics when you have a cold?
Moderator: Next, I will pay attention to a few questions of netizens. The netizen asked, to what extent do you need to use antibacterial drugs when you have a cold?
Ma Xiaojun: Let’s talk about this separately. For example, the infection of streptococcus just now started with sore throat. Maybe his symptoms will be a little bit, or even early viral infection, because viral infection may weaken our local defense ability, followed by bacterial infection, so to what extent, I’m afraid it’s difficult to give a standard. For example, antibacterial drugs are needed for a fever of 39 degrees. This is not so divided. I suggest that if necessary, you go to the hospital for a simple check-up, such as a blood routine, and look at some other laboratory indicators to roughly distinguish between bacteria and viruses. Even if you don’t treat viral diseases, you can alleviate them through symptomatic treatment for three to five days, such as drinking water and taking antipyretics.
Moderator: I also heard a saying that it is viral. Is this cold a further improvement of the autoimmune system?
Ma Xiaojun: I can’t understand it this way. Whether we will get infected depends not only on viruses or bacteria, but also on one aspect. My own ability is another aspect. In our field of infection, I will talk about three topics, one is the number of bacteria that we have been exposed to in a single time, the other is what the independence of this bacteria or pathogenic microorganisms is, and what the human immunity is at this moment. Now, when the virus hits human beings, it is often not an improvement, but a weakening. If there is a fever and infection that you can’t stand, for example, you must go to the hospital for treatment. For example, if you have a temperature of 37 degrees or 38 degrees, you can take antipyretics, so you can take some OTC medicine at home, but if you have a fever for a long time, you have to go to the hospital.
2, cardiovascular and cerebrovascular, hypertension patients need to pay attention to what problems in daily use of antibacterial drugs?
Moderator: netizens asked what problems should be paid attention to when patients with cardiovascular and cerebrovascular diseases and hypertension use antibiotics daily?
Li Yuzhen: This problem involves the drug interaction between patients suffering from multiple diseases and taking multiple diseases, which must be paid attention to. Just mentioned cardiovascular and cerebrovascular diseases, hypertension and other diseases, there are many kinds of drugs used, and there are also many anti-infective drugs, so the specific problems should be analyzed in detail. For example, this patient has a lot of blood lipids, but he has respiratory infection. At the same time, he uses some drugs such as erythromycin and simvastatin. When using them together, he should pay special attention, because they are all metabolized in the liver, and they all have to compete with the drug enzymes of the liver. If they are taking such a drug, it may cause the concentration of statins to increase, which may easily lead to statins being very safe drugs at ordinary times, but because they cannot be metabolized in the body, the concentration in the body increases. It may cause liver damage or muscle pain, and such adverse reactions will come out, so special attention should be paid to the interaction of drugs. When anti-infective drugs are combined with other drugs, specific problems should be analyzed, and the instructions should be read carefully. It is not possible to say in general that you can’t use this drug after using other drugs, or you can use two of them casually. I think it is necessary to pay special attention.
3. Is there an inquiry channel for the specific dosage for indications of various antibacterial drugs?
Moderator: In our survey, netizens also want to know the solution of drug resistance, including adverse reactions, including how to use them correctly. Some netizens said that it would be best if the specific dosage for indications of various antibacterial drugs could be found online. Is this netizen’s suggestion operable or necessary?
Ma Xiaojun: This is no longer a problem. Now he can find interesting questions in some search engines. The question I gave this netizen is what you can do after you know this information. After all, you are not a doctor. This topic is very good, that is, we should pay attention to self-health or self-treatment. But let me give you an example. You will see a very interesting detail in the media. I don’t say that foreign products are good. Many foreign patients are like this. The doctor gives him medicine and he doesn’t even know what the medicine is called. I’m surprised. They said the medicine prescribed by the doctor was edible. But he is concerned that if he has any problems after eating, he will communicate with the doctor. So from this point of view, I suggest that you can understand, but after all, medication is a very professional topic, which is not an ordinary thing. I have seen a very extreme example. I took a very simple medicine and died of explosive liver necrosis, so I can understand the medicine, but it may not be necessary to communicate with doctors too much, so it is better for everyone to live a relatively simple life.
Moderator: This shows that foreign countries trust his doctor very much. The second point is that he doesn’t need much knowledge, but after taking it, he will pay attention to his health. This is also a problem that our health and patients, including myself, should think about, because sometimes when I get the medicine, I will study it online first. In fact, at present, our clinic time and the doctor’s clinic time don’t have much time to discuss such a topic.
Ma Xiaojun: In the information we get online, even if the incidence is one in ten thousand, as long as the research finds it, we should write it in. However, there is nothing for the patient, and you just have an adverse event that is not in the manual. Because it is a very small probability, it has occurred, so how can we balance this problem? Still, as a doctor, I suggest that the majority of netizens should be able to see a doctor. This is a science.
4. Is it necessary to take antibacterial drugs for diarrhea and dermatitis?
Moderator: Next, let’s look at such a question. There are two diseases in summer, one is diarrhea and the other is dermatitis. At this time, everyone will take some medicine by themselves, but I want to ask if it is necessary to take antibacterial drugs for diarrhea. Including dermatitis, because I sometimes have allergies, and I use an ointment called Elozon. Should I not be a doctor myself?
Ma Xiaojun: Actually, in the first topic, we saw that there are many reasons for digestive tract infections, some of which are parasites. In the conventional sense, the treatment of many parasites is also included in antibacterial drugs. The second is bacteria, which must use antibacterial drugs. There is also a virus, a gastrointestinal infection caused by a virus, which is diarrhea. Here we see that only parasites and bacteria are suitable for infection. However, in the early stage of diarrhea, it is not recommended that you do a very strong antidiarrheal treatment. If his diarrhea is very serious and dehydrated, he needs a lot of rehydration, not just simple antidiarrheal, because simple antidiarrheal first hinders the excretion of toxins, and second brings serious obstruction and paralysis, etc., so if it is diarrhea with some symptoms that you can’t stand, Beijing requires all medical institutions to have intestinal clinics at the first time, so you should go to the hospital.
Li Yuzhen: Elonson is not an anti-inflammatory drug for ordinary people, but a hormone called acid-fast allergy pine, which can treat some skin lesions such as allergic dermatitis or eczema. It is not caused by bacteria, and it is easy to cause skin discoloration or skin atrophy if used for a long time, so it is necessary to see whether your skin is allergic or other reasons. If it is an abscess caused by bacteria, some local drugs should be used. Of course, we sometimes have to use drugs all over the body in clinic, and antibiotics for external use should be used as little as possible, but local small redness and swelling can still be used, which is completely different from hormones, which are used only for allergic dermatitis and eczema.
V. Conclusion
Moderator: Finally, we used a little time to ask three guests to sum up from their own perspectives. How can we use antibacterial drugs reasonably? Director Yue talks about how to use antibiotics rationally from the perspective of government supervision. Professor Ma, how do you advise our patients to see a doctor? Professor Li talks about how to guide the public to correctly understand the rational use of antibacterial drugs, including from the perspective of pharmacology.
Yue Xiaolin: I still want to quote a theme used by two experts in this year’s World Health Assembly: No action today, no medicine available tomorrow. The government must improve the system of laws and regulations, strengthen the management, internal management and external supervision of medical institutions, and strengthen the training of doctors, so as to urge medical and health institutions to use drugs rationally and give everyone a very good and healthy environment.
Li Yuzhen: As a pharmacist, I would like to tell the netizens that any drug is a double-edged sword, including our antibacterial drugs. We use them well, which benefits us and mankind. If we don’t use them well, it will cause drug resistance and even bring us some consequences that endanger our own lives. Therefore, we should use antibacterial drugs reasonably, which is very important.
Ma Xiaojun: Our ancient philosophy in China is very good. There is nothing absolutely good or absolutely bad. I suggest that you don’t fear and hate bacteria, because we can’t live without them. We also realize that although everyone is saying that antibacterial drugs are drug-resistant, they have treated a large number of patients who were doomed to die in the past. Therefore, in the field of anti-infection, in addition to the requirements of government management, there is also a very strong academic connotation, which requires doctors to come out. You mentioned teaching netizens to see a doctor. I can’t teach this, but I want to say that what we need most is the trust between doctors and patients. This trust is very important. You have to believe that the doctor will look after you, and his subjective will will definitely look after you. Every doctor wants to treat his patients well, because the patient’s word of mouth is the biggest reward for him, not to mention a good deed for us. Therefore, if netizens want to see a doctor, they should trust the doctor. This is my most important suggestion.
Moderator: Today, I am very grateful to the three guests for being our guest to talk about medical ethics. I also thank the netizens for their participation. I hope today’s program can give you some advice and help in future medication. This program is here. Goodbye.
