This is an automatically translated article.
The principle of using antibiotics should be strictly followed, otherwise it will cause antibiotic resistance and some other side effects that change the effectiveness of the drug. Especially, when antibiotic resistance has no alternative treatment, it will affect the patient's life.
1. Principles of antibiotic selection and dosage
When using antibiotics, the principle to keep in mind is the choice of antibiotic and dosage. Specifically:
Selection of antibiotics: This is the principle of antibiotic use recommended by the Ministry of Health. This principle also depends on 2 factors: the patient and the bacteria causing the disease. Regarding the patient's factors, it is necessary to consider the age, the functional status of the liver - kidneys, the history of drug allergies, the degree of the disease as well as the accompanying diseases... As for the bacterial factor, it is necessary to see Consider what type of bacteria it is, how sensitive it is to antibiotics to choose the right antibiotic. In some cases, a combination of antibiotics is required to reduce the bacterial density and increase the concentration of antibiotics at the site of infection. Dosage of antibiotics: The dose of antibiotics will depend on many factors such as liver and kidney function, the extent of the disease or age and weight. The cause of concern about antibiotic dosage is due to differences in pharmacokinetics or dosage for children. Inadequate antibiotic prescribing will lead to unsuccessful treatment, thereby increasing the rate of bacteria resistant to antibiotics. At the same time with antibiotics with narrow therapeutic range and strong toxicity, it is necessary to ensure drug concentrations in the blood to avoid toxicity.
2. Principles of antibiotic prophylaxis
According to the principles of antibiotic use of the Ministry of Health, antibiotic prophylaxis means using antibiotics before bacterial infection occurs. The purpose of prophylactic antibiotics is to prevent infection and reduce the frequency of infections at the surgical site, but it should be noted that antibiotics are not used to prevent systemic or distant infections. far from the surgery site. The principles of antibiotic prophylaxis are as follows:
Indications for the use of prophylactic antibiotics: Prophylactic antibiotics are indicated for all surgical interventions in the form of clean-contaminated surgery. In clean surgery, prophylactic antibiotics are applied with some serious surgical interventions, this intervention can be life-threatening. Antibiotics play a therapeutic role in infectious and dirty surgery. Prophylactic antibiotics only prevent bacterial infections that have already occurred from developing. Prophylactic antibiotic selection: Prophylactic antibiotic selection is one of the principles of antibiotic use. Usually, in the selection of antibiotics, antibiotics have a spectrum of activity suitable for the main strains of bacteria that often cause infection at the surgical site. In addition, antibiotics should be selected that do not cause side effects or have few side effects and toxicity; antibiotics with unpredictable toxicity or those with dose-independent toxicity should not be used; selection of antibiotics that do not interact with drugs used for anesthesia and selection of antibiotics are less likely to alter the resident flora and select for antibiotic-resistant bacteria; Antibiotics should be selected with the ability to diffuse in the cell tissue to allow drug concentrations higher than the minimum antibacterial concentration of the bacteria causing the infection, and it is best to give preference to antibiotic therapy. reasonable cost backup. Prophylactic dose of antibiotic: The dose of prophylactic antibiotic is equivalent to the strongest therapeutic dose of that antibiotic. Prophylactic antibiotic route: Using intravenous antibiotics is often the most preferred method because this method achieves drug concentrations in blood and tissues rapidly. In some cases, the intramuscular route is used, but the rate of absorption of the drug is not guaranteed and is often unstable. Take orally only when preparing for rectal or colon surgery and use topical antibiotics according to the type of surgery. Time to use prophylactic antibiotics: Prophylactic antibiotics are best used within 60 minutes before surgery and near the time of skin incision. If cephalosporins are given intravenously, they should be given 3 to 5 minutes immediately before the procedure, and vancomycin and ciprofloxacin should be given 1 hour before and complete the infusion before the skin incision is started. In the case of cesarean section, prophylactic antibiotics can be used before skin incision or after clamping the umbilical cord in order to limit infection complications in pregnant women. If heart surgery lasts more than 4 hours, then an additional dose of antibiotic prophylaxis and blood loss with a volume of more than 1500ml in adults and over 25ml/kg in children is required. prophylactic dose of antibiotic after replacement fluid addition. Note when using prophylactic antibiotics: Do not use antibiotics to prevent infections related to postoperative care and infections that occur during surgery. The risks of using prophylactic antibiotics can include drug allergy, anaphylaxis, diarrhea, infection or antibiotic-resistant bacteria as well as the transmission of multi-resistant bacteria.
Khi sử dụng kháng sinh, nguyên tắc cần phải lưu ý đó chính là việc lựa chọn thuốc kháng sinh và liều lượng
3. Principles of empiric antibiotic use
In principle, empiric antibiotic treatment is when there is no bacteriological basis because bacteria cannot be cultured or cannot be detected when cultured but there is clinical evidence of infection. antibiotics should be used. Besides, the principle of empiric antibiotic use is to choose the antibiotic with the narrowest spectrum against most pathogenic or dangerous bacteria. In addition, choose empiric antibiotics when:
Antibiotics can reach the site of infection and are not toxic but effective. At the same time, before treatment, it is best to take a patient sample to isolate bacteria. Use rapid bacterial detection measures. In the event that there is no evidence of bacteria after 48 hours of treatment, a re-evaluation must be made before deciding to use more antibiotics. Follow up on the epidemiological situation as well as the sensitivity of bacteria in order to choose the right antibiotic.
4. Use antibiotics when bacteriological evidence is available
In cases where there is clear evidence of the bacteria as well as the results of the antibiogram, priority should be given to the use of the most effective antibiotic with the lowest toxicity. At the same time, it is necessary to keep in mind the principles of antibiotic use when there is bacteriological evidence as follows:
When using antibiotics with bacteriological evidence, it is best to give preference to antibiotics alone. Combination of antibiotics when there is evidence of simultaneous infection with many other bacteria for the purpose of full spectrum of action. It is also possible to combine antibiotics in the case of strong resistant bacteria to increase the effect and to combine when treating the disease for a long time to reduce the risk of antibiotic resistance.
5. Principles of drug delivery route selection
In the principles of antibiotic use, the choice of drug delivery route to treat disease should be kept in mind. There are 3 ways to give antibiotics as follows:
Oral: This is the most preferred route, because it is convenient, safe and cheap. When using oral drugs, it is recommended to choose antibiotics with high bioavailability and less affected by food, because antibiotics that are less affected by food will give better and more successful treatment results because they ensure adherence to treatment. Parenteral route: With the choice of this route of administration, it should be applied when the patient's ability to absorb from the gastrointestinal tract is affected; where high blood levels of antibiotics are needed, which are difficult to achieve orally, or in cases of severe and rapidly progressing infections. However, when possible, it is best to switch to the oral route immediately. Topical route: It is necessary to limit the use of topical antibiotics because it can cause antibiotic resistance or allergies in patients.
6. Principle of antibiotic course length
The length of treatment will often depend on the location and status of the infection as well as the patient's resistance. For mild and moderate infections, the treatment usually lasts 7-10 days, however, in severe infections and in organizations where antibiotics are difficult to penetrate, the treatment will be more difficult and prolonged. much.
Besides, the appearance of many antibiotics with long half-lives makes the number of times of antibiotic use significantly reduced. Since then, the patient's adherence to treatment is also easier and simpler. But it is important to keep in mind the principle of using antibiotics that is not recommended for long-term treatment in order to limit unwanted side effects, increase treatment costs and especially to avoid antibiotic resistance.
Khi sử dụng kháng sinh có bằng chứng vi khuẩn học thì tốt nhất ưu tiên sử dụng thuốc kháng sinh dạng đơn độc
7. Note side effects and toxicity when using antibiotics
Almost all antibiotics will cause some mild to severe side effects. Therefore, according to the principles of antibiotic use of the Ministry of Health, when prescribing antibiotics, it is necessary to weigh the benefits and risks. Most cases of antibiotic side effects go away on their own when the medication is stopped. However, many cases will cause very serious consequences that can lead to death such as anaphylaxis. Therefore, some principles should be kept in mind as follows:
Hypersensitivity reactions will often be related to a history of antibiotic use, so before prescribing antibiotics, it is necessary to obtain drug history and drug allergy in patients. At the same time, must always be ready to have shock-resistant means and tools when using antibiotics. The liver and kidney are the sites for drug elimination, so a decline in the function of these two organs will lead to a decrease in the ability to eliminate antibiotics, which means a longer time to store drugs in the body. increase the toxicity of the drug. Therefore, in the principles of antibiotic use, it is advisable to pay attention to the side effects of the drug when prescribing, especially in the elderly, patients with impaired liver - kidney function. Special attention should be paid to the adjustment of the dose of drugs taken into the body as well as the drug delivery interval according to liver - kidney function to limit toxicity on the liver or kidneys. In summary, when treating infections, successful treatment depends on many factors such as the medical condition, the location of the infection as well as the patient's resistance and especially the principles of drug use. antibiotics properly. Therefore, the problem of antibiotic classification, pharmacokinetics and pharmacokinetics will assist doctors in choosing the right antibiotic as well as determining the correct optimal dose for each antibiotic group to implement the principle of antibiotic use. rational use of antibiotics, thereby ensuring treatment effectiveness, safety for patients and reducing the rate of antibiotic resistance.
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