National Safe Medication Month丨To curb microbial resistance, we must eliminate these misunderstandings about the use of antimicrobial drugs

November 18-24

World Antimicrobial Awareness Week

theme

Working together to prevent antimicrobial resistance

I am penicillin.

A member of the famous antibacterial drug family.

Since its launch in 1928,

I and cephalosporins, erythromycin, quinolones and other antibacterial drugs,

Eliminate bacterial infections in the human body,

He saved countless lives and made outstanding military achievements.

The people trust us.

Although there are "three thousand beauties" in the small medicine box,

Our position has always been very solid.

Headaches come to me, colds come to me, diarrhea also comes to me,

They also named it "anti-inflammatory drug".

But we don't like this name.

After all, it's not self-deprecation.

We really don’t work for all inflammation!

Despite its glorious past,

But the undefeated record has changed...

Due to our frequent battles,

The cunning microbial enemy is evolving at a speed beyond imagination.

They can always quickly see through the martial arts skills of me and my companions.

It even gave rise to "super bacteria".

It seriously threatens human life and safety.

I am very annoyed by the enemy's drug resistance.

After thinking for a long time, I finally realized:

The key to defeating the enemy is to fight alongside humans!

Although we are good generals,

But unreasonable use and abuse will have the opposite adverse effects.

We also want to continue to be the guardian of everyone's life and health!

Eliminate misunderstandings, know how to use medicine properly, and protect your health.

There is no time to lose!

The above self-description of penicillin is thought-provoking. Antimicrobial drugs, once hailed as "magic drugs" for curing diseases, are now facing the problem of bacterial resistance, which poses a serious threat to human life and health. In 2022, The Lancet published a comprehensive analysis of the global impact of microbial resistance, pointing out that microbial resistance has become the leading cause of death among the global population, with more deaths than HIV infection or malaria. Studies have estimated that bacterial resistance infections directly caused 1.27 million deaths and indirectly caused 4.95 million deaths in 2019. The "2021 National Bacterial Resistance Monitoring Report (Brief Version)" released by the National Bacterial Resistance Monitoring Network shows that my country has currently seen a relatively serious phenomenon of bacterial resistance.

It is precisely because of the abuse of antibiotics by humans that we have contributed to the current severe situation of microbial resistance. Let us start by breaking down the cognitive misunderstandings and use antibiotics rationally!

Myth 1: Antibacterial drugs are anti-inflammatory drugs

In daily life, people often mistake "antibiotics" and "antibacterial drugs" as "anti-inflammatory drugs" and widely use them in various scenarios to eliminate inflammation, which can easily lead to bacterial resistance problems.

Inflammation usually manifests as redness, swelling, heat, and pain. It is a common manifestation of many diseases, not the name of certain specific diseases. It can be caused by a variety of factors such as bacterial infection, viral infection, fungal infection, allergic reaction and trauma. The real anti-inflammatory drugs mainly include non-steroidal anti-inflammatory drugs (such as aspirin, ibuprofen, etc.) and adrenocortical hormone drugs (such as dexamethasone, etc.). They can directly fight inflammation and reduce the body's inflammatory response.

Antibiotics refer to substances produced by certain microorganisms during their life activities that have anti-pathogenic microbial effects and other activities, including penicillin, cephalosporin, aminoglycosides, macrolides, tetracyclines, etc., and synthetic antibacterial drugs (quinolones, sulfonamides, etc.) are collectively referred to as antibacterial drugs. Antibacterial drugs are ineffective for inflammation caused by non-bacterial infections. When using antibacterial drugs, it is necessary to clarify whether it is a bacterial infection and use them according to the specific condition and doctor's advice.

To sum up, antibiotics ≠ anti-inflammatory drugs.

Myth 2 : Use antibiotics for headaches and fever

When you have a cold, fever, cough, or diarrhea, many people will take antibiotics on their own. This is actually not the right approach.

Common colds are mostly caused by viral infections and are mostly self-limiting. They usually heal within a week and only require medication to relieve symptoms. Antibiotics are only useful for colds accompanied by bacterial infections.

There are many causes of cough. Viral infection, asthma, cold air stimulation, etc. may induce cough, and bacterial infection accounts for a smaller proportion. Therefore, it is very incorrect to blindly use antibiotics without distinguishing the cause.

Diarrhea can be caused by colds, viral infections, food allergies, etc. Only when diarrhea is caused by bacterial infection is the use of antibiotics reasonable and effective.

There are many reasons for fever. Infections with various pathogens such as bacteria, viruses, fungi, mycoplasma, rickettsia, spirochetes, parasites, etc. can cause fever symptoms. Non-infectious diseases such as connective tissue diseases, malignant tumors, and allergic diseases may also cause fever. The abuse of antibiotics when there is no bacterial infection is not only unhelpful for treatment, but also increases adverse drug reactions and leads to bacterial resistance.

In summary, colds, fevers, coughs, and diarrhea cannot be simply equated with bacterial infections. Symptom-relieving drugs can be used, but antibiotics cannot be used blindly. Before using antibiotics, please consult a doctor or pharmacist and follow the doctor's advice.

Myth 3 : High-grade drugs are good drugs

Different antibiotics have different antibacterial spectra. Choosing the right antibiotic is the key to treating infection. Doctors will consider factors such as the type of pathogen, the site of infection, the results of bacterial drug sensitivity tests, the patient's physiological and pathological conditions, and adverse drug reactions to choose the right drug.

For example, quinolones (levofloxacin, ciprofloxacin, etc.) are suitable for urogenital tract, respiratory tract, gastrointestinal tract, bone and joint soft tissue infections caused by sensitive pathogens such as Staphylococcus aureus, Pseudomonas aeruginosa, enteric Gram-negative bacilli, Campylobacter and gonococci, but are contraindicated for children under 18 years old, adolescents and pregnant women due to adverse reactions of joint lesions. During the use of aminoglycosides (streptomycin, gentamicin, etc.), renal function should be monitored, and the patient's hearing, vestibular function, and neuromuscular blockade symptoms should be closely observed and treated in time. Macrolides (erythromycin, azithromycin, etc.) can be used for mycoplasma infection. Cephalosporins are more stable against β-lactamases and their nephrotoxicity decreases with each generation. The first three generations have a weakened antibacterial ability against Gram-positive bacteria and a stronger antibacterial ability against Gram-negative bacteria. The fourth generation has a strong antibacterial ability against both Gram-positive and Gram-negative bacteria.

The combined use of antibiotics is sometimes not as safe and effective as their single use. The more drugs used in combination, the greater the possibility of adverse reactions, and even drug interactions. Therefore, narrow-spectrum antibiotics should be used as much as possible instead of broad-spectrum antibiotics, and the indications for combined use should be strictly followed. Do not use antibiotics in combination without authorization due to poor efficacy at the moment.

Myth 4: Stop taking the medicine once it works

When using antibiotics, some people often change the medicine frequently because of the slow effect, do not follow the instructions for use and dosage, or stop taking the medicine as soon as the condition improves. These practices are incorrect.

Frequent replacement of antibiotics is not only unhelpful for treatment, but may also lead to dysbiosis of the human flora, induce the production of drug-resistant bacteria, and lay hidden dangers for later treatment. Most β-lactams such as penicillins, cephalosporins, carbapenems, as well as erythromycin and lincomycin are time-dependent antibiotics. The efficacy is closely related to the length of time that the drug concentration is maintained above the minimum inhibitory concentration, and should be administered multiple times a day. The bactericidal effect of concentration-dependent antibiotics such as quinolones and aminoglycosides on pathogenic bacteria depends on the peak concentration of the drug, and can be administered once a day. The course of antibiotic treatment varies depending on the infection status. It is generally recommended to use it until the body temperature returns to normal and symptoms subside 72 to 96 hours later. Special infections require a specific course of treatment. If the drug is stopped as soon as it is effective, it will not only easily cause the disease to recur, but it is also more likely to lead to drug resistance.

Eliminating misunderstandings about the use of antibiotics should start with changing one's own medication habits. Only by using them rationally can we effectively deal with the crisis of microbial resistance, including bacterial resistance!