" Four cases of crime " Cause antibiotic to abuse

" Four cases of crime " Cause antibiotic to abuse Antimicrobial accounts for to fifty percent of medical fee
Because will cause all bacteria to produce and are able to bear nature, at the end of October, the ones that contain NDM-1 gene are suffused with and able to bear the medicine fungus to appear in our country, having caused paying close attention of Ministry of Health at once, this means, our country " super bacterium " Family yes new member.

"It is irresistible to be able to bear the development in our country of medicine fungus, if the habit of using medicine does not change, with how long we will put into, have difficult position that medicine can cure then " ,As to the thing that clinical antibiotic unreasonable to use the current situation at present, relevant experts worry.

Reporter find patient rely on antibiotic, the intersection of buying and selling of medicines and enormous loophole, interests of hospital of market drive and not relevant to supervise the measure weak blindly through investigation, the ones that cause and able to bear the medicine situation and aggravate " Four cases of crime " .

Patient's factor

Antibiotic is considered as omnipotent medicine

As one of the key contents of the new medical reform, this city has already established the medicine thing to manage Committee of Experts formally, aim at monitoring the situation of using medicine of the medical organization of the whole city, include it to producing the monitoring able to bear the medicine pathogen because of using antibiotic too much.

Issue of news this, let general (assumed name) Feel sad as well as gratified.

In March of this year, the 22 -year-old Cheng Shuai's pneumonia because of being infected with, is sent to the first affiliated hospital in Peking University promptly.

ChengLi Que, chief physician of respiratory medicine, find, pay breathing machine and after drug therapy quickly, Cheng Shuai's condition is controlled soon, but not infected every several days. Originally, a traffic accident 10 years ago caused Cheng Shuai to swallow the obstacle, repeated hereafter because the lung was infected and travelled to and fro between many hospitals, and accepted the antibacterial treatment, though a large amount of antibiotic killed the countless germs that attempt to corrode him, but " temper " What resistance happens extremely strongly is able to bear the medicine bacterium.

There is no alternative, Que ChengLi has to be changing the variety of the antibiotic medicine constantly.

After breaking out in several conditions, have been checked Bowman able to bear medicine out and does not move the bacillus in Cheng Shuai's phlegm liquid sample - -Able to bear the medicine fungus in a ICU most common, makes the doctor have a headachely most - -Able to bear medicines to more than three types of antibiotic.

" this is the thing that we worry about most, no because the domestic very effective medicine to it yet " ,ChengLi Que say produce while being multiple to able to bear the intersection of medicine and fungus, infect, control in short time, also it is very difficult to remove completely, it will exist in the infeted's body like time bomb, when immunity low, right away will break out once again, can pass other patient to, " trouble of using antibiotic to get into for a long time " .

Last week, my aunt of over seventy years old hung the watchtower on either side of a palace gate and presented the brass-wind instrument set up, before this, because she coughed to take the antibiotic of three generations of a spore for 3 days at home, but not seen that take a favorable turn. Test checking and lung film to reveal it has not been infected with pneumonia, Que ChengLi let it stop taking this antibiotic right away, use antitussive instead. "Very beginning spore antibiotic whether one kill the intersection of bacterium and pharmaceutical, to bacterial infection such as virus invalid, as to the common pneumonia patient, a common one of ours is two generations spore, but she has used a not strong medicine to the ill directly " .

In fact, antibiotic is not that what the common people think is guaranteed to cure all ills, abuse the most cold and have a fever as the example with antibiotic in life, the expert says, 90% of the colds are all influenza, only need to take a good rest, drink more water, take the linking C slice and fully recovering of right amount of.

At the end of October, are revealed by " medical kit investigation of Chinese family of 2010 " which the Chinese nonprescription drug association, Chinese medical quality control association,etc. jointly release, 79.4% of the residents have self-provided habit against fungus medicine, 75.4% of the residents are while having inflammation or colding that have a fever oneself or family, will take the antibacterial medicine by oneself.

Market factor

Manage and store the loophole in buying and selling of medicines

On last Friday, the reporter came to a community hygiene service in the southern city to " go to a doctor " inside the station . Have low fever to listen to reporter, diarrhoea and after symptom with coughing, the inquiries test doctor has looked over the throat only with the flashlight, having opened a head of spore drawing definitely, Thai promise and a pair of the rhizome of Chinese goldthread of quantity for three days, the former two are antibacterialing medicines. But in fact, reporters do not have any bacterial infection symptom including red swelling of throat.

Meanwhile, in locating adjacent roundabout of Fangzhuang of dispensary much, antibiotic medicines buy, stand up too without lifting an eyebrow. Curing cold in the prefecture in Western medicine, the reporter sees, the antibacterialing medicines of manufacturers of all kinds of difference such as one,etc. are being put antibacterial sulfathiazole, brought down a fever to stop aching on the shelve, it used in cloth that brings down a fever to be Lip river fragrant to release capsules, have the amount of kind of Forth Five-Year Plan Period slowly only, though it mostly mark " please read the operation instruction or use under the guidance of doctor " ,But selling medicine personnel still promote actively, should " not merely use bringing down a fever if generating heat, it is antiphlogistic to also use, it would be better in a few days if ate, it is unnecessary to go to the hospital " .

The expert says, though the antibiotic medicine is prescribed medicine, only hold doctor's prescription and can get, but because purchase and sell links at present and exist and supervise the loophole, doctor at the basic level to lack the reason of realizing etc. in able to bear naturing, so these medicines are very easy to buy in the dispensary of this city, community's hospital, this make citizen " Antiinflammatory agent recovers quickly " Mistake understanding very difficulty change.

Factor of the hospital

" bombard mosquitoes big " The treatment prevails

, aging population trend as the chronic disease patient increases, the antibiotic medicine has already used the widest medicine as every department of the hospital, especially is ICU, respiratory medicine, infected with in the disease department, emergency ward etc. even morely. The incomplete statistics reveal, in medicines of the top ten of consumption in the hospital, it is basically all antibiotic to rank the first 4 to 5 location, such as very beginning spore drawing definitely, left oxygen Fluorine sand star,etc..

An anonymous expert says, make a comment to use antibiotic medicines with the west differently according to the condition strictly, of our country doctor write a prescription it is experience that have priority mostly, use dosage, duration, use at the classification there are unreasonable situationsing in the intersection of antibiotic and medicine.

Seeing that samples such as the phlegm liquid,etc. train needing three four days, the out patient often can't wait, so, if the patient has yellow phlegm, higher situation of the leucocyte, doctors will select the antibiotic medicine for use according to one's own experience; For that in hospital the patient, even train the result to come out, in order to guarantee the therapeutic effect, " even in order to guarantee the therapeutic effect that the doctor knows antibiotic with stronger result of use too, some doctors come up by resisting antibiotic of many kinds of bacteria, but totally unnecessary actually, this is equivalent to ' greatly bombard mosquitoes ' " .

In addition for prevent, infect with while being postoperative, including surgery of dept. of orthopedics, hematology,etc. to need, prevent from, use medicine, will spend one or enough one day according to situation, doctor infect while being postoperative often and anxiously, will strengthen the dosage and course of treatment " Jocularescort the Emperor " .

Expert this show doctor want, accomplish, suit the remedy to the case, want, familiar with the intersection of patient and condition and each characteristic of germ not merely still, clear on the heart to various efficiency and operation method against fungus medicine.

Antimicrobial accounts for to 50% of medical fee

At present, antibiotic of our country medicines reach several hundred more than already, between 130 kinds and 140 kinds a commonly used one among them, so in order to raise the sales amount of own medicines, the pharmacists are competing through various ways.

Treating national key laboratory professor Xiao YongHong in infectious disease says, except because " the experience goes ahead of the rest " Result in using medicine no as outside, it is one of the unreasonable reasons to use of antibiotic too that the doctor depends on selling medicines commercially, "in the tertiary hospital, antibiotic accounts for about 30% of all medicines incomes, and second hospital may be up to 40%, in case of that in hospital the patient, its expenses on the antibacterial medicine of flower account for over half of the all-inclusive cost especially " .

Outside the consulting room of clinic expert in the hospital, often put up " decline medical representatives and enter " Suggestion,but sneaking rule is to turning on more antibiotic and meaning whether there are getting more tacit on fact where income increase in doctors as trade. One hospital personage in the know in this city reveals, " delicate " among medicine enterprise and hospital, pharmacy Relation,on the premise of guaranteeing the drug effect, it is on the senior level in hospital it will choose " fine in relation " Brand,meanwhile, because it value on clinic and ward the prescriptions of the doctor right, medicine be can give doctor certain advantaged to enterprise, as the one that write a prescription more " Encourage " .

" often domestic medicines will pay attention to this kind of marketing even more, the more and the more expensive medicine deduct a percentage " ,It says, in order to sell antiinflammatory agent of a price of 30 yuan as the example to deserve and know the facts of the case personages, there is 5 yuan to deduct a percentage in the hospital or department, use No. 4 Branch to calculate each time, there is deducting a percentage of 20 yuan in the school, "but the doctor has too great working pressure, in a situation that medical price at present and the value twists, only only really a little difficult to live on salary bonus " .

The medicines manual is upgraded too slowly

Clinical Deputy Director of institute of pharmacology Lu Yuan seems in Peking University, what medical knowledge is updated is very fast now, probably the scientific research result has been briefed on such as according to the administration of the existing manual, can't meet the clinical need, but should go through a complicated and long course because of the modification of the medicine operation instruction, doctor can't ultra the intersection of manual and administration, this may influence the doctor more reasonable antibacterial medicine of use too.

Lu Yuan says, the increase used with clinical antibiotic, the bacterium's own defence ability is strengthening constantly too, such as the Escherichia coli infection. A lot of antibacterial medicines can all be treated effectively originally, but because Escherichia coli has been produced and able to bear nature a lot of medicines now, for example 60% Escherichia coli can destroy the intersection of we and commonly used the intersection of one and antibacterial the intersection of medicine and the intersection of very beginning and the intersection of spore and the intersection of fungus and plain kind at being clinical by a enzyme through produce, make this kind of medicine fail, and cause the clinical alternative medicine to reduce, cause clinic and treat the difficulty.

"The bacterium already able to bear medicine to a certain medicine, if it is still used that the doctor has not known, not only invalid, but also will aggravate the patient's condition and be able to bear the medicine situation " . Lu Yuan says.

Manage the factor

Administrative supervision waits to strengthen

In order to standardize doctor's administration, our country is in " antibacterial medicine clinical practice guideline " issued and implemented formally in 2004, already to Chinese bacterium's state, antibacterial medicine situation, the principle (take orally, inject, intravenous for different situations such as medicines) of using medicine rationally Make an overall instruction, the purpose is to standardize a doctor and use medicine.

But because this " guideline " does not require, the relevant department can't oppose the use of the fungus medicine to supervise effectively by force.

This leads to the fact independence when the doctor is using antibiotic is very great, or can't suit the remedy to the case because of experience, or is limited to the present tense relationship between doctors and patients, worry not needing the antibacterial medicine to cause the patient to be badly sick.

Antibiotic use much, able to bear nature to be bettering in the human body, this means, the higher infection rate and mortality are. Press spokesman of Beijing Municipal Health Bureau Mao Yu says, all overtime, ultra quantity, using to the ill or not strict norm use the antibacterial medicine, antibacterial drug abuse all, abuse antibacterial medicine, at first can cause to able to bear nature bacterium. Medical department of national authority statistics show, some patients improperly use because of the antibacterial medicine every year in our country, cause the bad reaction to cause a disease in hospital, some patients cause the death because of abusing the antibacterial medicine too.

This city the intersection of medicine and thing manage the relevant committee member of Committee of Experts, say, this city has planned in all public medical organization, collect 100 prescriptions at random each month, is commented on the expert of group to examine proportions accounted for such as the quantity of medicines, total amount of money, antibiotic among them by the prescription, if the auxiliary antibiotic administration that treats ranks the top ten, namely prove the medical organization has unreasonable problem of using medicine, will be intervened and adjusted.


" Four cases of crime " Cause antibiotic to abuse Antimicrobial accounts for to fifty percent of medical fee