Whether in school or in society, papers are the most unfamiliar things for everyone. This paper is an article that allows us to study a problem in depth. Then the question comes, how to write an excellent paper? The following is my medical paper on the rational use of antibiotics. Welcome to reading. I hope you will like it.

On the rational use of antibiotics in medical papers 1 With the improvement of people's living standards, people's requirements for health are getting higher and higher. When choosing antibiotics, people often go into a misunderstanding that the more expensive the drug, the better, and the newer the better. However, incorrect use has accelerated the rapid growth of drug-resistant bacteria. On the other hand, due to the large dosage of antibiotics in clinic, many varieties, rapid update, complex relationship between various drugs, increasing combination drugs, and more and more preventive drugs. Therefore, the incidence of adverse reactions and drug resistance of antibacterial drugs are still increasing year by year. In this social environment, the rational use of antibiotics is particularly important.

1, the basic principles of rational use of antibiotics

The clinical pharmacological concept of rational use of antibiotics is to use antibiotics safely and effectively, that is, to ensure effectiveness under the premise of safety, which is the basic principle of rational use of antibiotics.

2. How to use antibiotics rationally

2. 1 Identification of pathogenic bacteria

As soon as possible, the pathogenic bacteria were isolated from the infected site and blood of patients, and drug sensitivity tests were carried out to select antibiotics.

2.2 Selection of antibiotics

The rational use of antibiotics is related to the success or failure of treatment. The following points must be considered when selecting drugs.

2.2. 1 First of all, we must master the antibacterial spectrum of antibiotics. The action characteristics of various antibiotics are different, so the antibacterial spectrum of the selected drugs must be adapted to the infected microorganisms, otherwise it will waste money and delay the illness.

2.2.2 Balance between antibiotic efficacy and adverse reactions: Most antibiotics have some side effects or other adverse reactions unrelated to the therapeutic purpose. Generally speaking, try to choose drugs that are beneficial to patients or do more harm than good, so we must strictly control the indications of drugs when using drugs to prevent drug abuse. For example, renal insufficiency should avoid using antibacterial drugs that are mainly excreted by the kidneys and harmful to the kidneys; In the case of hepatic insufficiency, antibacterial drugs which are mainly metabolized by the liver and harmful to the liver should be avoided; Special groups such as newborns, children, pregnant women and lactating women should use safe antibacterial drugs.

2.2.3 Combination of drugs Combination of drugs may increase the effect of the original drug, which is called synergy; It may also weaken the effect of the original drug, which is called antagonism. The purpose of combined medication is to improve the therapeutic effect and reduce the side effects. On the contrary, it reduces the therapeutic effect, increases the toxic and side effects, and will have adverse reactions to patients. At present, antibiotics are generally divided into four categories. The first category is germ-killing drugs (I), such as β -lactam antibiotics, and the second category is static germ-killing drugs (II), such as aminoglycosides and polymyxin antibiotics. The third category is fast bacteriostatic drugs (Ⅲ), such as tetracycline and macrolide, and the fourth category is slow bacteriostatic drugs (Ⅳ), such as sulfonamides. When the above antibiotics are used together, they can produce four effects: synergistic (Ⅰ+Ⅱ), antagonistic (Ⅰ+Ⅲ), additive (Ⅲ+Ⅳ), irrelevant and additive (Ⅰ+Ⅳ). In order to achieve the purpose of combined medication, appropriate compatibility should be carried out according to the nature of antibacterial drugs.

Generally speaking, when using antibiotics, we should strictly grasp the indications and try to use them with or without them. In addition to considering the pertinence of antibacterial effect of antibiotics, we should also master the relationship between adverse drug reactions, internal processes and curative effects. Antibiotics should not be used in patients with unknown fever; Virus infection does not require antibiotics; Try to avoid external use of antibiotics (such as skin). Strictly controlling the scope of preventive antibiotics can prevent rheumatic fever patients, and penicillin G should be used regularly to eliminate hemolytic streptococcus in pharynx and prevent rheumatism from recurring.

Use penicillin G or other suitable antibiotics before and after rheumatic or congenital heart disease surgery to prevent subacute bacterial endocarditis; Appropriate antibiotics should be selected according to the sensitivity of bacteria when removing infected lesions; After war injury or compound injury, use penicillin G or tetracycline to prevent gas gangrene. Neomycin is used for intestinal preparation before colon surgery. After severe burns, penicillin G was used to eliminate the infection of hemolytic streptococcus on the wound surface before skin grafting.

Rational use of antibiotics in medical papers. Rational use of antibiotics, in the concept of clinical pharmacology, rational use of antibiotics and effective use of antibiotics are the basic principles to ensure effectiveness under the premise of safety. This basic principle is rational use of antibiotics.

2. How to use antibiotics rationally

2. 1 Identify the pathogenic bacteria from the infected site as soon as possible, conduct isolation and culture of the patient's blood samples, conduct pathogenic bacteria and drug sensitivity tests, and select antibiotics.

2.2 The use of antibiotics and the reasonable choice of antibiotics are related to the success or failure of treatment. When choosing drugs, the following points must be considered.

2.2. 1 first of all, we should know that broad-spectrum antibiotics have different characteristics, so the antibacterial spectrum of drugs must be consistent with microbial infection, otherwise it is aimless, wasting money and delaying illness.

The role of antibiotics

2.2.2 Key points and adverse reactions: Most antibiotics have some side effects or other adverse reactions that have nothing to do with the therapeutic purpose. Generally speaking, try to choose drugs that are less harmful or harmless to patients. Worldwide, the indications of drugs must be strictly controlled to prevent drug abuse. If renal function is damaged, antibiotics should be avoided, mainly through renal excretion, renal function damage, liver dysfunction, primary liver metabolism and antibiotic damage to the liver. Antibiotics should be avoided, and special groups such as newborns, children, pregnant women and lactating women should choose safety.

2.2.3 Combination therapy drugs may increase the synergistic effect of the original drugs or weaken the effect of the original drugs, which is called antagonism. The purpose of improving curative effect and reducing adverse reactions is not to reduce curative effect and increase toxicity and side effects of patients with adverse reactions.

At present, there are four kinds of antibiotics.

The first kind of sterilization drugs are reproductive period (I period), such as β -lactam antibiotics.

The second category of static fungicides (category II), such as aminoglycosides and polymyxin antibiotics.

Third (third) four-membered ring, macrolide

The fourth kind of slow bacteriostatic drugs (Ⅳ), such as sulfonamides and fast bacteriostatic drugs. The combined use of antibiotics can produce four effects: synergistic effect (I+II), antagonistic effect (I+III), and (III+IV), independent effect and additive effect (I+IV). In order to achieve the purpose of combined medication, it is necessary to make appropriate compatibility according to the "medicinal properties" of antibacterial drugs.

Generally speaking, the use of antibiotics should strictly control the indications, and all of them should be as bad as possible. In addition to considering the antibacterial effect of targeted antibiotics, we should also grasp the relationship and effectiveness of adverse drug reactions and pharmacokinetics. Antibiotics should not be used for unexplained fever, and antibiotics should not be used for virus infection. Try to avoid external use of antibiotics (such as skin).

The scope of preventive antibiotic prevention and control is strictly controlled in the following situations: patients with rheumatic fever often use penicillin G to eliminate hemolytic streptococcus in throat and prevent rheumatism from recurring; For rheumatic or congenital heart disease, penicillin G or other suitable antibiotics should be used before and after operation to prevent the excision of subacute bacterial endocarditis infection focus, and the sensitivity of suitable antibiotics to bacteria should be selected; Wound or compound trauma, penicillin G or tetracycline to prevent gas gangrene; Intestinal preparation of neomycin before colon surgery: after severe burns, penicillin G is used to eliminate skin wounds infected by hemolytic streptococcus.

Discussion on Rational Use of Antibiotics in Medical Papers (Ⅲ) Symptomatic medication

The use of antibiotics should be selected according to the indications of antibiotics. The main selection principles are as follows:

① Choose appropriate antibiotics according to the types of pathogenic bacteria, clinical symptoms of infectious diseases and antibacterial spectrum of drugs.

② Antibiotics were selected according to the site of infection and pharmacokinetics. In order to play a bactericidal or bacteriostatic role in the body, antibiotics must reach an effective drug concentration in the target tissue, so they should be selected according to the concentration and maintenance time of antibiotics in the infected site.

③ Choose drugs according to the patient's physiology, pathology and immune status, because all the above factors will affect the effect of drugs. Different patients use different antibiotics. During pregnancy and lactation, women should avoid using drugs that cause malformation and affect the development of newborns.

Dosage and course of treatment

The dosage and frequency of administration of antibacterial drugs should be appropriate and the course of treatment should be sufficient; Too small a dose or too short a course of treatment will affect the curative effect and make bacteria prone to drug resistance. Excessive dosage or course of treatment will not only cause waste, but also cause adverse reactions.

Preventive drug therapy

Prophylactic use of antibiotics accounts for about 40% of antibiotic use, but it is of little practical value. Misuse of antibiotics in viral infection may even lead to drug resistance or secondary infection. Therefore, the application of preventive antibiotics should be strictly controlled. Antibiotics can be used in the following situations: benzathine penicillin, penicillin V, etc. Used to remove hemolytic streptococcus from throat and other parts and prevent rheumatic fever; When epidemic cerebrospinal meningitis is prevalent, sulfadiazine can be taken orally as a preventive drug; Penicillin is used to prevent infective endocarditis in patients with rheumatic or congenital heart disease before oral and urinary tract surgery; Penicillin can be used to prevent gas gangrene in patients with trauma, war injury and angiitis obliterans during amputation. Prevention of anaerobic infection by metronidazole and gentamicin before colon surgery.

Joint application

The purpose of combined medication is to improve the therapeutic effect of diseases, reduce bacterial drug resistance, reduce the occurrence of adverse reactions and expand the antibacterial scope. However, it is necessary to strictly grasp the indications of combined use of antibiotics, such as mixed infection that can not be controlled by a single antibiotic, such as peritonitis caused by abdominal organ injury; Serious infections that can't be controlled by a single antibiotic, such as septicemia, septicemia and other serious infections; Infected sites that are not easily penetrated by a single antibiotic, such as tuberculosis infection; The pathogen has not been identified as a serious infection, etc. If treated for a long time, pathogens may lead to drug resistance, so it is necessary to combine drugs. Refer to relevant books or documents or follow the doctor's advice according to the specific combination principle.

Extended data:

Main classification

According to its chemical structure, antibiotics can be divided into quinolones, β-lactams, macrolides and aminoglycosides.

Antibiotics can be divided into antibacterial antibiotics, antifungal antibiotics, antitumor antibiotics, antiviral antibiotics, veterinary antibiotics, agricultural antibiotics and other microbial drugs (such as ergotoxine produced by ergot bacteria, which has the function of contracting uterus).

According to different kinds of antibiotics, there are many production methods of antibiotics. For example, penicillin is biosynthesized by microbial fermentation, and sulfonamides and quinolones can be chemically synthesized. There are also semi-synthetic antibiotics, which are antibiotic derivatives synthesized by chemical, biological or biochemical methods.

Mechanism of action

There are four main bactericidal mechanisms of antibiotics, namely, inhibiting the synthesis of bacterial cell walls, interacting with cell membranes, interfering with the synthesis of protein and inhibiting the replication and transcription of nucleic acids.

Inhibition of cell wall synthesis

The cell wall of bacteria is mainly composed of polysaccharide, protein and lipid, which has important functions of maintaining morphology, resisting osmotic pressure changes and allowing substances to pass through. Therefore, inhibiting the synthesis of cell wall will lead to the rupture and death of bacterial cells; Mammalian cells are not affected by these drugs because they have no cell walls.

This effect depends on a kind of protein in bacterial cell wall, which is usually called PBPs (PBPs). β -lactam antibiotics can bind to this protein and inhibit the synthesis of cell wall, so PBPS is also the target of this kind of drugs. Antibacterials that work in this way include penicillins and cephalosporins, but frequent use will lead to an increase in bacterial resistance.

Interact with cell membrane

Some antibiotics interact with the cell membrane, affecting the permeability of the membrane, causing important substances such as salt ions, protein, nucleic acids and amino acids to leak out, which is fatal to cells. However, bacterial cell membranes are similar to human cell membranes, so these antibiotics are toxic to human body. Antibiotics that work in this way are polymyxin and Brevibacterium.

Interfering with protein synthesis

Interfering with the synthesis of protein means that the enzymes necessary for cell survival cannot be synthesized. Antibiotics that function in this way include fosfomycin (actinomycin), aminoglycosides, tetracyclines and chloramphenicol. Protein is synthesized on ribosomes, which are composed of 50S and 30S subunits.

Among them, aminoglycosides and tetracycline antibiotics act on the 30S subunit, while chloramphenicol, macrolides and lincomycin mainly act on the 50S subunit, which inhibits the initial reaction, peptide chain extension and termination of protein synthesis.

Inhibition of nucleic acid replication and transcription

Inhibition of transcription and replication of nucleic acids can inhibit the function of bacterial nucleic acids, thus preventing cell division and/or synthesis of desired enzymes. Antibiotics that work in this way include nalidixic acid and dichloroacridine, rifampicin, etc.

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