Levin S, Trenholme G M
Prim Care. 1979 Mar;6(1):3-12.
Antibiotics with small but definable mortality, such as chloramphenicol, should not be used when safer drugs will suffice. Antibiotics with a low (1 to 5 per cent) morbidity should not be used when safer drugs are available. Therefore, cleocin, minocycline, or oral erythromycin estolate should rarely be used and regular erythromycin base is almost always preferable. Fever should not be treated with antibiotics since they are not antipyretics. "Colds" should not be treated with antibiotics, but antibiotics should be administered to patients with a history of chronic bronchitis, sinusitis, and recurrent otitis as soon as any symptoms begin. Intramuscular antibiotics should not be given except for benzathine penicillin. Use placebos instead of antibiotics when the patient's psyche demands an intramuscular injection. Make certain that the needle, syringe, and solution are sterile. Agents other than penicillin or cephalosporins should be used in patients with a definite history of penicillin allergy. Combination antibiotics or broad spectrum antibiotics like cephelosporins or tetracyclines should not be used when narrow spectrum antibiotics of known efficacy are available for specific syndromes such as streptococcal pharyngitis.
对于死亡率虽低但可明确的抗生素，如氯霉素，在有更安全的药物可用时不应使用。当有更安全的药物时，发病率低（1%至5%）的抗生素也不应使用。因此，氯林可霉素、米诺环素或口服无味红霉素应很少使用，常规的红霉素碱几乎总是更可取的。发热不应使用抗生素治疗，因为它们不是退烧药。“感冒”不应使用抗生素治疗，但对于有慢性支气管炎、鼻窦炎和复发性中耳炎病史的患者，一旦出现任何症状就应给予抗生素治疗。除苄星青霉素外，不应给予肌肉注射抗生素。当患者心理上要求进行肌肉注射时，可用安慰剂代替抗生素。确保针头、注射器和溶液无菌。有明确青霉素过敏史的患者应使用除青霉素或头孢菌素以外的药物。当针对特定综合征（如链球菌性咽炎）有已知疗效的窄谱抗生素可用时，不应使用联合抗生素或广谱抗生素（如头孢菌素或四环素）。
