ISPN Review Antibiotic Therapy Across the Lifespan 各年龄段的抗生素疗法
CHILDREN 儿童
Children are very sensitive to the gastrointestinal and central nervous system (CNS) effects of most antibiotics, and more severe reactions can be expected when these drugs are used in children. It is important to monitor the hydration and nutritional status of children who are adversely affected by drug-induced diarrhea, anorexia, nausea, and vomiting. Superinfections can be a problem for small children as well. For example, thrush (oral candidiasis) is a common superinfection that makes eating and drinking difficult.
Many antibiotics do not have proven safety and efficacy in pediatric use, and extreme caution should be used when giving them to children. The fluoroquinolones, for instance, are associated with damage to developing cartilage and are not recommended for growing children. Pediatric dosages of antibiotics should be double-checked to make sure that the child is receiving the correct dose, thereby improving the chance of eradicating the infection and decreasing the risk of adverse effects.
Antibiotic treatment of ear infections, a common pediatric problem, is controversial. Ongoing research suggests that judicious use of decongestants and anti-inflammatories may be just as successful as the use of antibiotics without the risk of development of resistant bacterial strains. Parents, not wanting to see their child sick, may demand antibiotics as a cure-all whenever their child is fussy or feverish. Parent education is very important in helping to cut down the unnecessary use of antibiotics in children.
Many adults believe that antibiotics are a cure-all for any discomfort and fever. It is very important to explain that antibiotics are useful against only specific bacteria and actually can cause problems when used unnecessarily for viral infections, such as the common cold.
Adults need to be cautioned to take the entire course of the medication as prescribed and not to store unused pills for future infections or share antibiotics with symptomatic friends. Pregnant and breast-feeding women should not take antibiotics unless the benefit clearly outweighs the potential risk to the fetus or neonate. Tetracyclines, for example, are associated with pitting of enamel in developing teeth and with calcium deposits in growing bones. These drugs can cause serious problems for neonates. Women of childbearing age should be advised to use barrier contraceptives if any of these drugs are used.
Many antibiotics interfere with the effectiveness of oral contraceptives, and unplanned pregnancies can occur.
很多抗生素影响口服避孕药效果,可能出现意外妊娠。
OLDER ADULTS 老年人
In many instances, older adults do not present with the same signs and symptoms of infections as other patients. Therefore, assessing the problem and obtaining appropriate specimens for culture is especially important with this population. Older patients may be more susceptible to the adverse effects associated with antibiotic therapy. Their hydration and nutritional status should be monitored closely, as should the need for safety precautions if CNS effects occur. If hepatic or renal dysfunction is expected (particularly in very old patients, those who may depend on alcohol, and those who are taking other hepatotoxic or nephrotoxic drugs), the dose may need to be lowered and the patient should be monitored more frequently.
Elderly patients also need to be cautioned to complete the full course of drug therapy, even when they feel better, and not to save pills for self-medication at a future time.
还应提醒老年人完成整个用药疗程,即使是他们感觉好转时;不要保存药物预备下次自我给药。
Vocabulary for Today
superinfection – n. 二重感染,重复感染
thrush – n. 鹅口疮
oral candidiasis – 口腔念珠菌病
cartilage – n. 软骨
controversial – a. 有争议的
cure-all – n. 万灵药
enamel – n. 牙釉质
calcium deposits – 钙沉着
Test 1. An antimicrobial medication that has selective toxicity has which characteristic?
A. Ability to transfer DNA coding
B. Ability to suppress bacterial resistance
C. Ability to avoid injuring host cells
D. Ability to act against a specific microbe 2. The development of a new infection as a result of the elimination of normal flora by an antibiotic is referred to as what?
A. Resistant infection
B. Superinfection
C. Nosocomial infection
D. Allergic reaction
本期ISPN Review答案:
1. C. Ability to avoid injuring host cells.
Selective toxicity refers to an antibiotic that has the ability to injure only invading microbes, not the host. Conjugation is the process through which DNA coding for drug resistance is transferred from one bacterium to another. Antibiotics do not suppress bacterial resistance, but rather promote the emergence of drug-resistant microbes. Antibiotics that are narrow spectrum are active against only a few microbes.
2. B. Superinfection
Antibiotic therapy can destroy the normal flora of the body, which normally would inhibit the overgrowth of fungi and yeast. When the normal flora is decreased, these organisms can overgrow and cause a new infection, or superinfection.