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The Most Stringent Clinical Management Method For Antibiotics Will Be Implemented In History.

2011/10/14 14:03:00 37

Implementation Of Antibiotics Clinical Management

The most stringent management practices in the history of antibiotics destroyed the Chinese generation will be implemented.

Recently, Yao Jianhong, deputy director of the Ministry of public health, said in public that antibiotics destroy the Chinese generation, and the average Chinese hangs 8 bottles of water per person each year. Antibiotic The most abused countries. In addition to economic benefits, the abuse of antibiotics also comes from the pressure of patients and the habits of doctors.

Last month, the new version of the "management of antimicrobial drugs clinical application (Draft)" ended with solicitation comments, compared with the first edition of "draft for consultation" in April, and was called "the strictest" clinical management method of antibiotics. It is expected that this year Administration The method will be formally implemented.

Recently, in view of all kinds of strange phenomena of the abuse of antibiotics in China, the reporter interviewed Professor Xiao Yonghong, a member of the Expert Committee on rational drug use of the Ministry of health, and specialized in clinical pharmacology of antibiotics for many years.

"Three elements and one soup" highlights the abuse of antibiotics

In 2007, Professor Xiao Yonghong conducted a survey with his colleagues that China produces about 210 thousand tons of antibiotics annually, exports about 30 thousand tons, and uses 180 thousand tons (including medical and agricultural use) in the country, with an average annual consumption of about 138 grams - 10 times that of the Americans. Among the top ten drugs consumption, Cefradine and ceftriaxone accounted for half of the total consumption.

Xiao Yonghong said that the annual consumption of 138 grams per person is the result of comprehensive data, not that 138 grams are eaten by people, including raw materials and preparations, raw materials, including human and animal uses. China has become one of the most severely abused antibiotics in the world.

Statistics show that China has an average of 8 bottles of water per person per year, far higher than the international level of 2.5 to 3.3 bottles. Xiao Yonghong said, "water" is nothing more than sugar water, salt water, plus some medicine, plus the most medicine is antibiotics. Overseas outpatient service is basically without infusion. Chinese people have a misunderstanding that fever and cold are quicker and better to hang a bottle in hospital. In fact, there is no difference between the drugs eaten and the drugs that are put into the body. People who can give fluids in the outpatient department can eat by themselves, and they can also take their own medicine.

As far as the degree of abuse of antibiotics is concerned, Xiao Yonghong describes that even if you go to the smallest clinic, you will use antibiotics as long as the patient comes, no matter what the disease is. "Especially in the grass-roots hospitals, no matter what patients come, anyway, they are vitamins, hormones, antibiotics and a bottle of water, which we often describe as" three elements and one soup ".

In China, the utilization rate of antibiotics is 70%, which is two times that of the European and American countries. Almost all surgical patients use antibiotics, up to 97%. In fact, less than 20% of patients actually need antibiotics.

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Children use antibiotics more than adults.

Xiao Yonghong said that the common people also have a wrong view, that is, mix up the anti-inflammatory drugs and antibiotics, and "eat" a lot of antibiotics.

In many Chinese households, antibiotics have become a permanent drug. If you have a cold, you should have some anti-inflammatory drugs. What is called anti-inflammatory drugs is often cephalosporins and amoxicillin. The reason why out-patient doctors have a large number of antibiotics is also under pressure from patients. "If a patient caught a cold, he asked for some antiphlogistic drugs. If the doctor did not give him a fight, he would have to explain it for a long time and even lead to a doctor patient dispute."

Xiao Yonghong said that children are more likely to have fever because of viral infection and no need for antibiotics. In fact, the proportion of antibiotics used by children in China is higher than that of adults. "Children's bacterial infections account for a small proportion, and more are viral infections, but the proportion of antibiotics used in children's hospitals is high. There are reasons for them. They say, first, children are behaved the same after having a fever. It is difficult to tell whether they are bacterial infection or viral infection. Second, first children are ill, followed by four or five parents, a slight loss, which may lead to medical disputes, and doctors can not afford this responsibility."

Children use antibiotics all their life, and the direct result is that they have long been carrying drug-resistant bacteria. Once they get sick, they may not be able to use drugs.

The world will face no drugs available.

In August, when the US government continued to trace the source of the Salmonella epidemic to dozens of people in 26 states, the latest scientific discoveries showed that a super resistant Salmonella known as "Kentucky" would spread around the world.

In October last year, two children in Ningxia were tested with superbacteria NDM - 1, which could resist most antibiotics.

Superbug threatens the world. This April 7th World Health Day, the first rational drug conference convened, coincides with the theme of World Health Day, "resistance to drug resistance: no action today, no medicine available tomorrow." Xiao Yonghong said that the use of no drugs is not sensational and has already appeared in clinical practice.

The terrible thing about superbugs is that they are super resistant, and no antibiotics can work. Xiao Yonghong said that it was resistant to all drugs. It was first discovered in foreign countries and began to appear in China. In the past few years, superbugs have been found in hospitals. Moreover, the resistance genes of bacteria can be transmitted between different bacteria. If the drug resistance genes are transmitted to highly pathogenic bacteria, such as Salmonella and Shigella, not only infected patients, but also normal people will be seriously threatened.

Xiao Yonghong said that if we go to the post antibiotic era, more and more bacteria will become resistant to antibiotics, and the whole world will be faced with drug inefficacy, which seems to be back to the era without antibiotics.

In addition, there is an indisputable fact that there are more antibiotics in the environment. According to the customs inspection report, the products rejected outside the customs because of antibiotic residues account for 20% of the export products. "Even export products can detect 20% residues. It can be deduced that if it were not for export, the number would be even higher. "

What makes Xiao Yonghong even more upset is: "milk, eggs, meat..." The amount of antibiotics used in animal husbandry is also large, and bacteria in our environment have developed resistance. The human body passively accepted antibiotics, once infected by drug-resistant bacteria, it will increase the difficulty of treatment.

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The government should be responsible for the development of antibacterial drugs.

Xiao Yonghong said that the abuse of antibiotics not only affects individual users, but also affects people who do not use drugs and even the whole population. This is a serious public health problem, just like the harm of smoking.

Some countries have suggested that it is best to take some measures in the research and development of antibiotics, such as the development of new drugs, and encourage enterprises to do drugs for the treatment of drug-resistant bacteria, rather than imitation. It has even been suggested that the use of antibiotics should be taxed. If the original new drug is used, the tax revenue is borne by the users. If the use of generic drugs, the tax is borne by the enterprises to avoid excessive imitation. But the proposal is only at the level of institutional research.

"We are now calling for original new drugs, especially for super bacteria, but many large enterprises are not interested because they are not profitable. The cost of antibiotic research and development is high, the patent period is short, the life expectancy is limited due to bacterial resistance, and then the use of antibiotics is limited. Unlike other drugs for chronic diseases such as hypertension, patients need long-term application, and the course of antibiotic treatment is generally only 1~2 weeks. Xiao Yonghong said.

From the angle of public health, it is very necessary for enterprises to invest, but enterprises will only take their own consideration, and the government should bear the responsibility of research and development.

Management indicators of new antibiotics

* the rate of antibiotic use dropped from 70%~80% to 60%

Three hospitals can not exceed 50 antibiotics, two hospitals can not exceed 35 varieties, compared with the existing situation compressed by 1/3

Surgical incision surgery should be applied to antibiotics below 30%. "

dialogue

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Can the most stringent management measures in history curb abuse?

Reporter: why do we say that the new version of the management method for the clinical application of antibiotics is "the most stringent in history"?

Xiao Yonghong: the Ministry of health has carried out special rectification activities for antibacterial drugs this year and formulated management measures for antimicrobial agents. In other words, the utilization rate of antibiotics in the past hospitalized patients reached 70%, or even as high as 80%, and now set a target of 60%. If we can achieve this goal, it will be a great achievement.

At the same time, there are strict indicators for other aspects, such as three hospitals, antibiotics can not exceed 50 varieties, two hospitals can not exceed 35 varieties, compression 1/3 than now, require surgical clean incision surgery preventive application of antibiotics to below 30%, which is very high compared with the proportion of 95% before remediation. From a global perspective, they are the most stringent management measures. So far, no country has introduced such a way.

Reporter: why can some countries use antibiotics in a low proportion?

Xiao Yonghong: the proportion of antibiotics used in the Asia Pacific region is relatively high, including South Korea, Japan, India and Southeast Asia and South America. The utilization rate of antibiotics in American hospitalized patients is about 40%, and the lowest in Europe is the lowest in Nordic Europe, which is about 20% to 30%. In Nordic countries, there is no clear regulation or administrative management, but through education and training, doctors and patients form conscious actions to avoid the abuse of antibiotics. The management of physicians is mainly based on the evaluation of medication for doctors, and if they are found to be unreasonable, they will be interviewed.

Reporter: what degree should the utilization rate of antibiotics be controlled?

Xiao Yonghong: who recommends that antibiotics should not be used more than 30% in hospitalized patients. This is an ideal goal. From the actual situation, with the improvement of living standards and social progress, the incidence of infectious diseases is significantly reduced. Outpatients mainly are cardiovascular disease, diabetes, nervous system diseases, tumors and so on, while respiratory tract infections, urinary tract infections and skin infections are becoming less and less. The proportion of antibiotics should be reduced. In developed countries, especially in Nordic countries, the main antimicrobial agents are penicillin and sulfanilamide, while the three generation of cephalosporins and quinolones commonly used in China are limited. For example, the drug used in outpatient treatment of urinary tract infections in Sweden is the furfuroidin used by us 40 years ago. Although Gao Fuli, a Nordic country, did not use antibiotics for free medical treatment. The management objectives set by the Ministry of health this year are more in line with China's specific realities and management.

Reporter: why is it difficult to manage the abuse of antibiotics in China?

Xiao Yonghong: there are still difficulties in the administration of antibiotics by the health administration department. For example, there are more than 6000 pharmaceutical factories in our country, producing more than 1000 varieties of antibacterial drugs and tens of thousands of products. There may be hundreds of manufacturers in each drug producing, leading to irrational use of antibiotics. Therefore, it is suggested that the State Administration of drug administration should do something in this regard, control the production of drugs, set a certain number of restrictions on the quality of antimicrobial drugs, and ensure that the national demand for medicine is enough. No one will apply for it.

The results of last year's drug approval issued by the drug administration showed that among the newly approved drugs, antibiotics still account for 60%. The present method is different from the original one, and many specific indicators have been removed. The purpose is, of course, not to compromise, but to ensure the implementation of this method and to ensure the demand for clinical medication.

Reporter: what is the biggest obstacle to overcome the abuse of antibiotics?

Xiao Yonghong: system is the biggest obstacle. The basic reason for irrational use of drugs in medical institutions is the status quo of "relying on drugs to support doctors and using drugs to supplement doctors". According to the survey, China's medical institutions accounted for 40%~50% of turnover drugs, of which antibiotics accounted for about 20% of the total hospital drugs. When medical institutions do not support their operations by drug sales, rational drug use can be incorporated into the normal track. We hope to slow down the pressure of drug use through the reform of medical system.

Reporter: what better suggestions do you have for the abuse of antibiotics?

Xiao Yonghong: it is proposed to set up an antibacterial Management Committee which is higher than a single department, and organize and coordinate the relationship between each department. For example, Sweden has set up a national antibiotic management organization STRAMA, coordinating the work of drug supervision, health and agriculture departments. Antibacterial drugs The application of materials in various fields.