抗生素和激素课件.pptVIP

儿童喘息性疾病治疗中抗生素、激素使用现状 1、合理使用抗生素 ? 理论易讲 ? 执行困难 ? “讲”与“做”相差甚远，适应征“过松” 2、合理使用糖皮质激素 ? 一线用药 ? 接受困难 ? 实际难以规范，“不足”与“过度”并存 √ 儿童喘息性疾病中抗生素的使用 儿童喘息性疾病中糖皮质激素的使用 一、抗生素使用现状 抗生素使用是儿童喘息性疾病中普遍存在的现象 1、认识、诊断？ ? “喘息”≈“呼吸道感染、炎症”≈“消炎” 2、“不得已”行为？ ? 求“太平、保险”，免“投诉、纠纷” 3、经济利益驱动？ 4、抗生素获取方便? 二、不合理使用抗生素的危害 1、危害 — 已有共识，是否认识？接受？ ? 增加：药物不良反应的发生率 ? 阻碍：病原微生物及其敏感性的鉴定 ? 增加：社区获得性耐药菌感染的危险性 ? 促进：耐药菌株的发生 ? 导致：临床治疗的失败 ? 浪费：卫生、医疗资源 ? ?????? 婴幼儿期不合理使用抗生素，增加儿童哮喘发病率？ Wickens K, et al.(New Zealand ) Antibiotic use in early childhood and the development of asthma. Clin Exp Allergy. 1999,29(6):766-771. ? Antibiotic use in infancy may be associated with an increased risk of developing asthma. Further study is required to determine the reasons for this association. Wjst M, et al. (Germany) Early antibiotic treatment and later asthma. Eur J Med Res,2001,6(6):263-671. ? The most likely possible explanation is reverse causation indicating that frequent upper respiratory infections, an early symptom of asthma, are treated with antibiotics. Antibiotic therapy could also be a proxy of another closely associated genetic or environmental factor. The high dose effect, the time dependency of the administration and the effect by non-pulmonary indications raises the possibility that early antibiotic treatment could itself be related to later asthma. Celedón JC, et al. (USA ) Lack of association between antibiotic use in the first year of life and asthma, allergic rhinitis, or eczema at age 5 years. Am J Respir Crit Care Med. 2002,166(1):72-75. ? Our findings do not support the hypothesis that antibiotic use in early life is associated with the subsequent development of asthma and atopy in childhood. Celedón JC, et al. (USA ) Antibiotic use in the first year of life and asthma in early childhood. Clin Exp Allergy. 2004,34(7):1011-1016. ? Our findings do not support the hypothesis that an