Goldfarb J
Department of Infectious Diseases, Cleveland Clinic Foundation, Ohio, USA.
Pediatr Clin North Am. 1995 Jun;42(3):717-35. doi: 10.1016/s0031-3955(16)38987-8.
In any discussion of new antimicrobial agents in the 1990s, a warning and a plea are necessary. The spreading emergence of resistance among bacteria raises concerns for the effectiveness of antimicrobial therapy. Penicillin-resistant pneumococci are probably of most significance in pediatrics and are increasing in frequency, in part related to the use of antimicrobial therapy in young children to treat such infections as otitis media. New practice guidelines have suggested the more limited use of antimicrobial agents in treating serious otitis media. When pediatricians do treat, they should select effective agents. Limiting therapy to brief courses with effective and narrow-spectrum agents may be helpful also. Treating long enough to ensure eradication in serious infections is equally important. Methicillin-resistant S aureus are also increasing and are increasingly a concern in community-acquired infections and nosocomial infections. Using topical agents, such as mupirocin, to treat impetigo and other superficial skin infections can limit exposure to systemic agents and may delay the spread of resistance. Vancomycin-resistant enterococcal infections, an infrequent pediatric problem, are most frightening because no alternative therapies are available. Their occurrence is directly related to use of vancomycin in the communities that are affected. Containing the spread of drug-resistant bacteria will likely require a concerted effort by both physicians and the public. The indiscriminate use of antimicrobial agents to treat non-bacterial infections should be contained. The public must be educated to understand that antimicrobial agents are ineffective against viral infections. In the setting of managed care, educating administrators who make practice decisions that cheaper is not always better will be crucial. The issues of day-care infections and spread of potential pathogens must take on increasing attention and methods to decrease infection sought. Curbing inappropriate use of antimicrobial agents will be as important as learning the nuances between new agents.
在讨论20世纪90年代的新型抗菌药物时，有必要发出一个警告并提出一项呼吁。细菌耐药性的不断出现引发了人们对抗菌治疗效果的担忧。耐青霉素肺炎球菌在儿科可能最为重要，其发生率正在上升，部分原因与幼儿使用抗菌药物治疗中耳炎等感染有关。新的实践指南建议在治疗严重中耳炎时更有限地使用抗菌药物。当儿科医生进行治疗时，他们应选择有效的药物。使用有效且窄谱的药物进行短疗程治疗可能也有帮助。对于严重感染，进行足够长时间的治疗以确保根除同样重要。耐甲氧西林金黄色葡萄球菌也在增加，并且在社区获得性感染和医院感染中越来越令人担忧。使用外用药物，如莫匹罗星，治疗脓疱病和其他浅表皮肤感染，可以减少全身用药的暴露，并可能延缓耐药性的传播。耐万古霉素肠球菌感染是一个罕见的儿科问题，最为可怕，因为没有其他替代疗法。它们的出现与受影响社区中万古霉素的使用直接相关。控制耐药菌的传播可能需要医生和公众共同努力。应遏制滥用抗菌药物治疗非细菌性感染的现象。必须教育公众明白抗菌药物对病毒感染无效。在管理式医疗环境中，教育那些做出实践决策的管理人员，让他们明白便宜并不总是更好，这将至关重要。日托机构感染和潜在病原体传播的问题必须得到更多关注，并寻求减少感染的方法。遏制抗菌药物的不当使用与了解新型药物之间的细微差别同样重要。
