感染科医生建议人们不要在家里储备抗菌药 Infectious disease the doctor advised people not to at home reserve antibacterial

老百姓要抛弃对抗菌药物的错误观念，提高科学用药意识，生病要到医院及时检查，遵照医嘱用药 Common people want to abandon the antimicrobial wrong idea，Improve science drug consciousness，Ill will in time to the hospital inspection，Medicine follow the doctor's order

　　8月1日，卫生部出台《抗菌药物临床应用管理办法》(以下简称《管理办法》)，对抗菌药物的使用做出各种具体限制，这也被称为“史上最严限抗令”。抗菌药物一般是指具有杀菌或抑菌活性的药物，包括各种抗生素以及磺胺类、喹诺酮类等化学合成药物，是临床最广泛应用的药物之一。

August 1,，The ministry of health issued《Measures for the administration of antimicrobial drugs for clinical use》(Hereinafter referred to as《Management measures》)，The antimicrobial use to make all kinds of specific restrictions，This is also called“History the most strict limit resistance to make”。Antibacterial drugs generally is refers has the sterilization or bacteriostatic activity of the drug，Including all kinds of antibiotics and sulfa、Quinolones and chemical synthetic drug，Is the most widely used drugs clinical one。

　　“我国确实是抗菌药不合理使用情况比较严重的国家之一。”浙江大学医学院附属邵逸夫医院副院长、感染科主任俞云松在接受中国青年报记者专访时说，抗菌药的不合理使用，导致了细菌耐药性迅速增强。“这种情况再发展下去，很多细菌感染性疾病将无药可医，一旦患者感染了这种细菌只能等待死亡。”

“Our country is indeed unreasonable drug use one of the countries the situation is more serious。”Zhejiang university medical school affiliated hospital, vice President of the field、Infection of director of division of YuYunSong China youth daily reporter in an interview said，Antibacterial unreasonable use，Led to the bacterial resistance increase rapidly。“This kind of situation to develop，A lot of bacterial infectious diseases will be no known cure，Once the patient infected with the bacteria can only waiting for death。”

这种情况再发展下去，很多细菌感染性疾病将无药可医 This kind of situation to develop，A lot of bacterial infectious diseases will be no known cure

　　中国青年报：这次出台的《管理办法》为什么被称为“史上最严限抗令”？

The China youth daily：This time on the introduction of the《Management measures》Why is called“History the most strict limit resistance to make”？

　　俞云松：2004年，卫生部曾颁布过《抗菌药物临床应用指导原则》，更多是从技术上进行指导。这次颁布的《管理办法》则更多地从管理角度做出规定，明确指出了医院、监管部门的管理责任，必须达到的管理目标，以及有关机构和人员的法律责任。《管理办法》明确将抗菌药物分为“非限制使用”、“限制使用”和“特殊使用”三个级别。以前从青霉素到各种“高档”抗菌药物，无论什么级别的医生都可以开。而根据这次《管理办法》，只有通过考核的、具有高级专业技术职务任职资格的医师，才有权限使用三线抗菌药物(指特殊类抗菌药，即疗效独特但毒性较大、价格昂贵、新研制上市的抗菌药物以及一旦发生耐药即会产生严重后果的品种——编者注)。同时，《管理办法》对抗菌药物的采购、临床使用、定期公示报告等方面，都进行了详细规定。我国从来没有一部法规，对抗菌药物的应用进行过这么多的规定。

YuYunSong：In 2004,，The ministry of health has issued a《Antibacterial drug clinical application guiding principle》，More from technological guidance。Issued by the《Management measures》From the management Angle is more make the regulation，Explicitly pointed out that the hospital、Regulatory management responsibility，Must achieve management objectives，And the relevant agencies and personnel's legal liability。《Management measures》Clear antimicrobial drugs will be divided into“Not restrict the use of”、“Restrict the use of”and“Special use”Three levels。Ago from penicillin to all kinds of“high-grade”Antibacterial drugs，No matter what level of the doctors can open。According to the《Management measures》，Only through the appraisal、With senior professional technical position qualifications physician，Have authority to use three line of antimicrobial agents(Refers to the special kind of antibacterial，Namely clinical unique but bigger toxicity、expensive、The new development of the listed antimicrobial drugs and drug resistance is the event will have serious consequences varieties - editor's note)。At the same time，《Management measures》The antimicrobial procurement、Clinical use、Regular publicity report, etc，Has carried on the detailed regulations。Our country has never a regulations，The application of antibacterial drugs to have so many regulations。

　　中国青年报：为什么要对抗菌药物的应用进行严格规定？

The China youth daily：Why the antimicrobial application rules strictly？

　　俞云松：我国是抗菌药不合理使用情况较严重的国家之一。过去抗菌药物的不合理使用，导致现在耐药问题十分严重。根据国内抗生素监测机构(CHINET)的调查，较常见的肺炎克雷伯菌，对目前被认为抗菌活性最强的碳青霉烯类抗生素“泰能”和“美平”的耐药率从2005年1%左右上升到了现在的9.5%。10年前，不动杆菌最多只有3%是耐药的，现在耐药率超过50%。去年只有“泰阁”一种新抗生素上市，其只解决了部分耐药菌的耐药问题。在未来3~5年内，估计没有新的对革兰阴性菌(包括肺炎克雷伯菌、大肠杆菌等——编者注)有效的药物上市。这种情况再发展下去，很多细菌感染性疾病将无药可用，患者只能等待死亡。

YuYunSong：Our country is antibacterial unreasonable use of one of the more serious。In the past the unreasonable use of antibacterial drugs，Cause now the resistance issue is very serious。According to the domestic antibiotic monitoring mechanism(CHINET)investigation，The more common pneumonia crayresearch bacteria，The present is considered the strongest antimicrobial activity of carbon blue mould olefinic antibiotic“Thai can”and“Beautiful flat”The resistant of from 2005 1% rose to 9.5% now。Ten years ago，Most of acinetobacter only 3% is resistance，Now more than 50% respectively。Last year only“Thai pavilion”A kind of new antibiotics listed，It only has solved the partial resistance bacteria resistance problem。In the next three to five years，No new estimates of gram-negative bacteria(Including pneumonia crayresearch bacteria、Escherichia coli, etc. - editor's note)Effective drugs on the market。This kind of situation to develop，A lot of bacterial infectious diseases will have no medicine can be used，Patients can only waiting for death。

　　中国青年报：抗菌药物的不合理使用还会带来哪些问题？

The China youth daily：The unreasonable use of antimicrobial agents will also bring what problem？

　　俞云松：除造成耐药性快速增长外，毒副反应也需引起重视。在国家药品不良反应监测中心的统计结果中，抗菌药物的不良反应位居前列。很多抗菌药物的不合理使用，会导致患者肾功能、肝功能、听力等损伤。

YuYunSong：In addition to cause rapid growth resistance outside，Side reaction also need to pay attention。In the national adverse drug reaction monitoring center of the statistical results，Antibacterial drug adverse reaction of high achievers。A lot of antibacterial drugs is not reasonable use，Can lead to kidney patients、Liver function、Hearing damage。

　　要知道，病愈本身需要一个过程。比如，病毒性感冒，病愈需要3~5天，要用药也是使用抗病毒药物，吃抗菌药不会好得更快。另外，每种抗菌药不是对所有病菌都有效，没有用对路的话，最贵的抗菌药也不一定有效。

Want to know，Recover itself need a process。For example，Viral cold，Recover need 3 ~ 5 days，To use is also using anti-viral drugs，Eat antibacterial not good faster。In addition，Each antibacterial not for all bacteria are effective，No word of marketable，The most expensive antibacterial are not effective。

感冒时滥用抗菌药物的情况更严重，特别是儿童患者 When a cold antimicrobial drugs abuse of the case is more severe，Especially children patients

　　中国青年报：抗菌药物过度使用为什么在过去那么普遍？

The China youth daily：Excessive use of antibacterial drugs in the past why so popular？

　　俞云松：这跟国内长期的用药习惯有关。很多老百姓一发烧，就想到要吃抗菌药消炎，而且错误地认为，使用贵的抗菌药好得更快。药店增多也使得购买抗菌药更加方便，导致更多人生病时不看医生，选择自己服药。相对于围手术期(围绕手术的一个全过程时间约在术前5－7天至术后7－12天——编者注)抗菌药物的预防使用，人们在普通感冒时过度使用抗菌药物的情况更严重，特别是儿童患者。

YuYunSong：With the domestic long-term drug habits。A lot of people a fever，Just want to eat antibacterial diminish inflammation，And wrong to think，Use expensive antibacterial good faster。Pharmacy increase also makes the purchase of antibacterial more convenient，Lead to more people get sick from the doctor，Choose medication。Relative to the perioperative(Around the operation of a whole process time about the preoperative 5 to 7 days to postoperative 7-12 days - editor's note)Antibacterial drug prevention use，People in the common cold excessive use of antimicrobial agents when the case is more severe，Especially children patients。

　　国家从2004年就开始关注抗菌药的不合理使用，但直到最近两三年，才采取强有力的措施，进行广泛宣传，使人们科学使用抗菌药物的意识明显增加。

Countries from 2004 began to pay attention to the rational use of antibacterial，But until recently two or three years，To take strong measures，Extensive publicity，Make people scientific use of antimicrobial drugs significantly increased awareness。

　　中国青年报：现在依然有医生过度使用抗菌药物，这里面会不会有利益因素？

The China youth daily：There is still a doctor excessive use of antimicrobial agents，There will have interest factors？

　　俞云松：由于《管理办法》的规定比较严格，医生乱开抗菌药拿回扣的情况还是很少的。一些医生过度使用抗菌药，主要还是由于专业知识不够，对药物不够熟悉，做不到“个体化”用药。还有部分病人不理解医生，责怪医生没给自己开抗菌药，或者没开所谓“好”的抗菌药。因此医生在开药时，可能拗不过病人，在处方中过度使用抗菌药。

YuYunSong：because《Management measures》The regulation is more strictly，The doctor disorderly open antibacterial take kickbacks situation or very little。Some doctors excessive use of antibacterial，The main or because professional knowledge is not enough，On the drug is not familiar with，Can't do“individualization”drug。There are some patients do not understand the doctor，Blame the doctor didn't give yourself open antibacterial，Or didn't open the so-called“good”Of antibacterial。So doctors prescribe in when，May her patients，In the prescription of excessive use of antibacterial。

我建议人们不要在家里储备抗菌药 I suggest that people don't at home reserve antibacterial

　　中国青年报：据您了解，《管理办法》颁布以后效果如何？

The China youth daily：According to you understand，《Management measures》After issued effect how？

　　俞云松：《管理办法》颁布后，抗菌药物的不合理使用得到了很大程度的遏制。就我所在的医院来说，甲状腺手术的病人围手术期预防用药比例从原来的50%左右减少到了5%左右。有人担心，抗菌药物总体使用率下降，可能导致抗菌药物生产厂家的销售减少。但我认为，以前抗菌药物被过度使用，整治措施只是让它的使用率回归正常，销售减少也是应该的。

YuYunSong：《Management measures》issued，The unreasonable use of antimicrobial drugs have a large degree of containment。As far as I in the hospital for，Thyroid surgery patients perioperative preventive medicine proportion from the original 50% down to 5%。There are fears that the，Antibacterial drug overall utilization rate decline，May cause antibacterial drug manufacturer sales decrease。But I think，Antibacterial drugs by excessive before use，Improvement measures just make it the utilization rate of return to normal，Sales reduce is also should。

　　中国青年报：为减少抗菌药的不合理使用，相关部门都采取了什么措施？

The China youth daily：In order to reduce the unreasonable use of antibacterial，Relevant departments are what measures were taken？

　　俞云松：《管理办法》的规定十分详细。目前，大多数医院都按照卫生部及当地卫生管理部门的规定，制定了完整的抗菌药物管理工作制度，成立了专门的工作组，在抗菌药物的遴选、采购、处方、调剂、临床应用等方面，严格按规定进行操作。卫生部和各地区卫生行政部门，也在按规定对医院的管理工作进行定期督促和检查，加强了对医务人员的技术指导和培训。

YuYunSong：《Management measures》Regulations is very detail。At present，Most of the hospitals are according to the health ministry and the local health management regulations of the department，Make a complete set of antibacterial drug management system，Set up a working group，In the selection of antibacterial agents、purchasing、prescription、dispensing、Clinical application, etc，Strictly in accordance with the rules of operation。The ministry of health and the administrative department of public health area，Also in the regulations on hospital's management work periodically urge and inspect，To strengthen the medical staff technical guidance and training。

　　中国青年报：如何进一步减少抗菌药物的不合理使用？

The China youth daily：How to further reduce the unreasonable use of antibacterial drugs？

　　俞云松：这需要医患双方的共同努力。医生应科学用药，对不理解的病人进行耐心解释，避免造成误会，以减少医患矛盾。同时，医生也该提高专业知识水平和业务能力，正确做出疾病诊断，合理选择抗菌药物。

YuYunSong：This requires the doctor-patient concerted efforts of both sides。The doctor should be scientific and medical treatment，To don't understand patient patient explanation，Avoid misunderstanding，In order to reduce the doctor-patient contradiction。At the same time，The doctor should also improve professional knowledge level and professional ability，To make the correct diagnosis of disease，Reasonable selection of antimicrobial agents。

　　老百姓要抛弃对抗菌药物的错误观念，提高科学用药意识，生病要到医院及时检查，遵照医嘱用药。另外，我建议人们不要在家里储备抗菌药。一方面，这可能导致人们生病时自己服药，增加过度使用的机率；另一方面，在家中并不适宜保存药品，这可能导致药品失效。

Common people want to abandon the antimicrobial wrong idea，Improve science drug consciousness，Ill will in time to the hospital inspection，Medicine follow the doctor's order。In addition，I suggest that people don't at home reserve antibacterial。On the one hand，This can lead to people get sick when I take medicine，Increase the risk of excessive use；On the other hand，In the home is not suitable for save drug，This may lead to drug failure。

　　减少抗菌药物不合理使用，关键是要提高公众意识。有关部门也应继续加大对抗菌药物科学用药的宣传力度。让大家认识到，少用药是好事，少用抗菌药物更是好事。(记者 周易 黄冲)

Reduce the unreasonable use of antimicrobial agents，The key is to raise public awareness。The relevant departments should also continue to strengthen the scientific and medical treatment of antimicrobial agents the propaganda。Let us realize the，Less medication is a good thing，Less use of antimicrobial agents is good。(Reporter HuangChong book)