Antibiotics used to be called antibiotics. In fact, they can not only kill bacteria, but also inhibit and kill other pathogenic microorganisms, such as mold, mycoplasma and chlamydia. In recent years, antibiotics are usually renamed antibiotics. Antibiotics can be a substance produced during the growth and reproduction of some microorganisms, and antibiotics used to treat diseases are not only extracted directly from them; There are also fully or partially synthetic. Generally speaking, antibiotics are drugs used to treat various bacterial infections or inhibit pathogenic microbial infections. Repeated use of antibiotics may make pathogenic bacteria resistant. This is also one of the reasons to put an end to the abuse of antibiotics now. Scientific use of antibiotics is targeted. It is usually recommended to do bacterial culture and drug sensitivity test, and choose extremely sensitive drugs according to the results of drug sensitivity test to avoid blindness and achieve good therapeutic effect.

Antibacterial agents such as antibiotics mainly kill people (or other higher animals and plants) according to the mechanism of "bacterial existence". There are four mechanisms of action: they hinder the synthesis of bacterial cell walls and cause bacteria to expand and rupture under low osmotic pressure. The antibiotics that play a role in this way are mainly β -lactam antibiotics. Mammalian cells have no cell wall and are not affected by such drugs. Interact with bacterial cell membrane, enhance the permeability of bacterial cell membrane, open ion channels on the membrane, and let useful substances in bacteria leak out of the cell or die due to electrolyte imbalance. Antibiotics that work in this way include polymyxin and bacitracin. Interaction with bacterial ribosomes or their reaction substrates (such as tRNA and mRNA) inhibits the synthesis of protein, which means that structural proteins and enzymes necessary for cell survival cannot be synthesized. Antibiotics that function in this way include tetracycline antibiotics, macrolide antibiotics, aminoglycoside antibiotics, chloramphenicol and so on. Obstructing the replication and transcription of bacterial DNA will hinder the division and reproduction of bacterial cells, and hindering the transcription of DNA into mRNA will hinder the subsequent process of mRNA translation and protein synthesis. The main drugs that work in this way are synthetic antibacterial quinolones (such as ofloxacin). Edit this strategic plan

Current situation of China

China is a big country that uses and produces antibiotics: the annual output of antibiotic raw materials is about 2 10000 tons, 30,000 tons are exported, and the rest are for personal use (including medical and agricultural use), and the per capita annual consumption is about 138 grams (only 13 grams in the United States). According to the national bacterial drug resistance monitoring results of the Ministry of Health in 2006-2007, the annual utilization rate of antibacterial drugs in hospitals nationwide was as high as 74%. No country in the world uses antibiotics on such a large scale. In developed countries such as the United States and Britain, the utilization rate of antibiotics in hospitals is only 22%~25%. Obstetrics and gynecology in China has long been the hardest hit area of antibiotic abuse. According to the statistics of obstetrics and gynecology in Changning District Central Hospital, the drug resistance of penicillin is almost 100%. In China, the utilization rate of antibiotics is as high as 70%, among which almost all surgical patients use antibiotics, accounting for 97%. According to 1995-2007 disease classification survey, infectious diseases account for 49% of all diseases in China, among which bacterial infection accounts for 18%~2 1% of all diseases, that is to say, more than 80% of them are antibiotic abuse, and 80,000 people die every year. These figures make China one of the countries with the most serious abuse of antibiotics in the world.

policy advice

2065438+01April 7 is World Health Day, and the first conference on rational drug use was held on this day, which coincides with the theme of World Health Day-"Resist drug resistance: if you don't take action today, there will be no drugs available tomorrow". It is learned from relevant departments that the first batch of 20 tertiary and secondary hospitals, including Peking Union Medical College Hospital, Jishuitan Hospital, xuanwu hospital, People's Hospital and Third Hospital of Beijing Medical University, are participating in centralized prescription review. The key monitoring content is the use of antibiotics. Last year, the Municipal Health Bureau set up an expert committee on pharmaceutical affairs management of medical institutions in Beijing. The Committee consists of eight working groups: prescription review group, pharmacy management group, antibacterial drugs and bacterial resistance monitoring group, rational drug use and adverse drug reactions monitoring group, Chinese medicine group, drug quality management group, clinical pharmacy group and discipline construction and pharmacy research group. Among them, the expert members of the prescription review group will collect the prescription review data of secondary and tertiary hospitals and community health service institutions every month. Every month, 0/00 prescriptions were randomly selected from second-and third-class hospitals/KLOC, and the data were analyzed, including the proportion of injections in outpatient prescriptions, the proportion of antibiotics in outpatient prescriptions, the average drug consumption of each prescription and the average drug consumption of each prescription. These data need to be reported to the expert Committee. The key monitoring objects of this centralized prescription review are antibiotics, especially special management antibiotics restricted by the Ministry of Health, such as vancomycin. According to national regulations, prescriptions need to be issued by doctors with senior titles, and hospital consultation is needed when necessary. Therefore, experts will pay close attention to this centralized prescription review. In principle, at present, the consumption of antibiotics in outpatient prescriptions of tertiary hospitals generally accounts for about 15% of the whole prescription. If the dosage of antibiotics in some medical institutions greatly exceeds the average level, publicity and intervention will be carried out. In addition, the expert committee will regularly rank all kinds of antibiotics used in the city. If antibiotics or traditional Chinese medicine injections used for adjuvant therapy rank in the top ten, it means that medical institutions have irrational drug use problems and will intervene and adjust. In order to reverse the abuse of antibiotics, WHO has launched six policy packages this year, including cooperating with all sectors of society and formulating national plans, strengthening monitoring and laboratory capabilities, ensuring the continuous supply of essential drugs with quality assurance, reducing the use of antibiotics by food animals, strengthening infection prevention and control, and supporting innovation and development of new tools. At the same time, the Ministry of Health also regards the use of antibiotics as an important indicator to assess the performance and work of hospitals, and will organize nationwide supervision and take strict measures against hospitals and doctors who violate the rules and regulations. If some medical institutions do not implement the relevant regulations of the Ministry of Health, they may be downgraded. Edit this discovery history.

A long time ago, it was found that some microorganisms inhibited the growth and reproduction of others, which is called antibacterial effect. With the development of science, people finally revealed the essence of antibiotic phenomenon, and found substances with antibiotic effect from some microorganisms, which are called antibiotics, such as penicillin produced by Penicillium and streptomycin produced by streptomyces griseus, all of which have obvious antibacterial effects. Therefore, antibiotics are called a kind of chemical substances produced by some microorganisms in the course of life, which can inhibit or kill some other pathogenic microorganisms. Because some antibiotics originally discovered mainly kill bacteria, antibiotics were once called antibiotics. However, with the continuous development of antibiotics, anti-virus, anti-chlamydia, anti-mycoplasma and even anti-tumor antibiotics have been found and applied in clinic. Obviously, it is inappropriate to call them antibiotics, but it is more practical to call them antibiotics. The emergence of anti-tumor antibiotics shows that the chemicals produced by microorganisms can not only inhibit or kill some pathogenic microorganisms, but also inhibit the proliferation or metabolism of cancer cells. Therefore, the definition of modern antibiotics should be: chemicals produced by certain microorganisms and substances that can inhibit the proliferation of microorganisms and other cells are called antibiotics.

Antibiotic molecular formula

During the period of 1929, when British bacteriologist Fleming cultivated bacteria in Petri dishes, he found that there was no bacteria growing around the colonies grown by Penicillium accidentally falling from the air on the culture medium. He believes that Penicillium produces some chemicals and secretes them into the culture medium to inhibit the growth of bacteria. This chemical is the first antibiotic found-penicillin. During the Second World War, Fleming and two other scientists worked hard to extract penicillin and make it into a medicine to inhibit bacterial infection. Because during the war, drugs to prevent war wound infection are very important strategic materials. Therefore, the United States puts the development of penicillin in the same important position as the development of the atomic bomb. 1943, the news reached China. Zhu Ye, a microbiologist who was engaged in scientific research in the anti-Japanese rear at that time, also isolated Penicillium from moldy leather and used it to produce penicillin. From 65438 to 0947, American microbiologist Wachsman discovered streptomycin in actinomycetes and used it to treat tuberculosis. More than half a century has passed, and scientists have discovered nearly ten thousand kinds of antibiotics. However, most of them are too toxic to be used as drugs to treat infectious diseases in humans or livestock. Later, it was found that not all antibiotics can inhibit the growth of microorganisms, some can inhibit parasites, some can weed, some can be used to treat cardiovascular diseases, and some can inhibit human immune response, which can be used for organ transplantation. After 1990s, scientists expanded the scope of antibiotics and gave it the name of organ newspaper, called biopharmaceuticals. Edit the usage history of this paragraph

1877, Pasteur and Joubert first realized that microbial products might be therapeutic drugs, and they published the experimental observation that ordinary microorganisms could inhibit the growth of Bacillus anthracis in urine. 1928, Sir Fleming discovered Penicillium which can kill deadly bacteria. Penicillin cured syphilis and gonorrhea without any obvious side effects at that time. From 65438 to 0936, the clinical application of sulfanilamide initiated a new era of modern antibacterial chemotherapy. Streptomycin, the second antibiotic, 1944 was isolated from the University of New Jersey, which effectively cured another terrible infectious disease: tuberculosis. Chloramphenicol appeared in 1947, and it was mainly used to treat mild infections for dysentery and anthrax. Tetracycline appears in 1948, which is the earliest broad-spectrum antibiotic. At that time, it seemed that it could be used effectively without diagnosis. Nowadays, tetracycline is basically only used in livestock breeding. 1956 Lilly invented vancomycin, which is called the last weapon of antibiotics. Because of the triple sterilization mechanism on cell wall, cell membrane and RNA of G+ bacteria, it is not easy to induce drug resistance of bacteria. Quinolones appeared in1980s. Unlike other antibacterial drugs, they destroy bacterial chromosomes and are not affected by gene exchange resistance. In 1992, a variant of this drug was banned in the United States because it caused liver and kidney dysfunction, but it is still used in developing countries. The purpose of editing this paragraph is introduced.

Antibiotics used to be called antibiotics. In fact, they can not only kill bacteria, but also inhibit and kill other pathogenic microorganisms, such as mold, mycoplasma and chlamydia. In recent years, antibiotics are usually renamed antibiotics. Antibiotics can be a substance produced during the growth and reproduction of some microorganisms, and antibiotics used to treat diseases are not only extracted directly from them; There are also fully or partially synthetic. Generally speaking, antibiotics are drugs used to treat various bacterial infections or inhibit pathogenic microbial infections. Repeated use of antibiotics may make pathogenic bacteria resistant. This is also one of the reasons to put an end to the abuse of antibiotics now. Scientific use of antibiotics is targeted. It is usually recommended to do bacterial culture and drug sensitivity test, and choose extremely sensitive drugs according to the results of drug sensitivity test to avoid blindness and achieve good therapeutic effect. Edit the sterilization of this paragraph.

Mechanism of action

Antibiotics have four main bactericidal mechanisms: inhibiting the synthesis of bacterial cell wall, interacting with cell membrane, interfering with the synthesis of protein, and inhibiting the transcription and replication of nucleic acid.

Sterilization process

Inhibition of cell wall synthesis will lead to the rupture and death of bacterial cells. Antibacterials that work in this way include penicillin and cephalosporins. Mammalian cells have no cell walls and are not affected by these drugs. The cell wall of bacteria is mainly peptidoglycan, and the organelle of peptide chain synthesis is ribosome, which is the only organelle of bacteria. However, frequent use will lead to an increase in bacterial drug resistance. 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. Interaction with the cell membrane Some antibiotics interact with the cell membrane, affecting the permeability of the cell membrane and having fatal effects on cells. Antibiotics that work in this way are polymyxin and Brevibacterium. Interfering with the synthesis of protein and protein means that the enzymes necessary for cell survival cannot be synthesized. Antibiotics that interfere with the synthesis of protein include fosfomycin (actinomycin), aminoglycosides, tetracyclines and chloramphenicol. Inhibition of transcription and replication of nucleic acids will inhibit the function of nucleic acids, thus preventing cell division and/or synthesis of desired enzymes. Antibiotics that work in this way include nalidixic acid and dichloroacridine. Edit the description of this paragraph.

Principle of use

The following basic principles must be considered in the clinical application of antibiotics: (1) Strictly grasp the indications and try not to use them; In addition to considering the pertinence of antibacterial effect of antibiotics, we should also master the adverse reactions of drugs and the relationship between in vivo process and curative effect. (2) People with fever of unknown cause should not use antibiotics, except those who are critically ill and highly suspected of being infected with bacteria. People with fever of unknown cause should not use antibiotics, because the use of antibiotics often makes it difficult to detect pathogenic microorganisms, and makes clinical manifestations atypical, affecting clinical diagnosis and delaying treatment.