German-Fattal Michèle, Mösges Ralph
Faculty of Pharmacy, University of Paris-XI, France.
Curr Med Res Opin. 2004 Nov;20(11):1769-76. doi: 10.1185/030079904X5535.
Despite guidelines and educational programs, systemic antibiotics and anti-inflammatory drugs are often inappropriately prescribed in upper respiratory tract infections (URTIs), although they are most often of viral origin, generally benign, and self-limiting with spontaneous recovery in more than 80% of cases. Reduced use of systemic antibiotics is crucial in the current context of concern about emerging antibiotic resistance and reducing unnecessary costs associated both with drug over-consumption and with the management of the consequences of antibiotic resistance. Local bacterial or viral infection of the airways induces an early inflammatory reaction. Although this inflammatory reaction has a beneficial effect in the capture and destruction of the pathogens, it can be responsible for deleterious tissue damage and vascular alterations leading to a self-perpetuating cycle of events. A wide array of medicines is available for symptomatic relief of URTIs: many of them are partially effective in reducing symptoms, but none is curative. Local administration of antibiotics and anti-inflammatory drugs allows drug delivery directly to the target site of infection and inflammation, i.e., the respiratory mucosa, thus enabling a higher concentration of the drug, which results in smaller doses to be given, decreased potential for systemic toxicity, fewer side effects, protection of other flora, and rapid relief. Fusafungine is a naturally occurring peptide antibiotic with anti-inflammatory properties, which selectively targets the tissue reaction and preserves the natural antibacterial and antiviral defences. It is indicated for topical use in nose and throat infections. A recent analysis of French general practitioners' (GPs) prescribing pattern in the field of URTIs has demonstrated that prescription of fusafungine has achieved what many educational programs have failed to do: a significant reduction in the 'real life' prescription of systemic antibiotics and antiinflammatory drugs, without the side effects of corticosteroids and vasoconstrictive agents, and without impact on microbial ecology.
尽管有相关指南和教育项目，但在上呼吸道感染（URTIs）中，全身用抗生素和抗炎药的处方往往并不恰当，尽管这些感染大多由病毒引起，通常是良性的，且具有自限性，超过80%的病例可自发痊愈。在当前对抗生素耐药性不断出现的担忧以及减少与药物过度消费和抗生素耐药性后果管理相关的不必要成本的背景下，减少全身用抗生素的使用至关重要。气道局部的细菌或病毒感染会引发早期炎症反应。虽然这种炎症反应在捕获和破坏病原体方面具有有益作用，但它可能导致有害的组织损伤和血管改变，从而引发一个自我延续的事件循环。有多种药物可用于缓解URTIs的症状：其中许多药物在减轻症状方面部分有效，但没有一种是治愈性的。局部使用抗生素和抗炎药可使药物直接输送到感染和炎症的靶部位，即呼吸道黏膜，从而使药物浓度更高，进而可减少给药剂量，降低全身毒性的可能性，减少副作用，保护其他菌群，并能迅速缓解症状。夫沙芬净是一种具有抗炎特性的天然肽类抗生素，它能选择性地针对组织反应并保留天然的抗菌和抗病毒防御功能。它适用于鼻咽喉感染的局部使用。最近一项对法国全科医生（GPs）在URTIs领域处方模式的分析表明，夫沙芬净的处方达到了许多教育项目未能实现的目标：显著减少了全身用抗生素和抗炎药在“现实生活”中的处方量，没有皮质类固醇和血管收缩剂的副作用，且对微生物生态没有影响。
