研究：美國(guó)43%的抗生素處方是不必要的

研究：美國(guó)43%的抗生素處方是不必要的

So-called “superbugs” — bacteria that are resistant to drugs — aren’t something to worry about for the future. They’re already here.

所謂的“超級(jí)細(xì)菌”——一種對(duì)藥物有抗藥性的細(xì)菌——在未來(lái)是不用擔(dān)心的。他們已經(jīng)在這里。

Thanks to decades of unmitigated use of antibiotics and antibacterial products, 35,000 people in the US die each year from infections that are immune to treatment, according to the Centers for Disease Control and Prevention (CDC). And while that number has actually declined by 28% since 2012, a new study published in the BMJ found that up to 43% of antibiotic prescriptions in the US are either unnecessary or “inappropriate.”

美國(guó)疾病控制與預(yù)防中心(CDC)的數(shù)據(jù)顯示，由于數(shù)十年來(lái)抗生素和抗菌產(chǎn)品的大量使用，美國(guó)每年有3.5萬(wàn)人死于對(duì)治療免疫的感染。雖然這個(gè)數(shù)字自2012年以來(lái)已經(jīng)下降了28%，但發(fā)表在《英國(guó)醫(yī)學(xué)雜志》(BMJ)上的一項(xiàng)新研究發(fā)現(xiàn)，美國(guó)高達(dá)43%的抗生素處方要么是不必要的，要么是“不合適的”。

Antibiotics are antibacterial agents designed to eradicate bacterial infections or, at least, prevent multiplying — a fact that hasn’t stopped many doctors from prescribing the drugs even for viral illnesses, such as the flu, which antibiotics do not treat. As a result, the viral pathogen remains untouched. Meanwhile, bacteria already present in the body become exposed to the drugs, giving them another opportunity to evolve and strengthen their defenses against medicine.

抗生素是用來(lái)消滅細(xì)菌感染的抗菌劑，或者至少是用來(lái)防止細(xì)菌繁殖的——這一事實(shí)并沒(méi)有阻止許多醫(yī)生開(kāi)出抗生素處方，即使是對(duì)于病毒性疾病，比如流感，抗生素也不能治療。結(jié)果，病毒病原體保持原樣。與此同時(shí)，已經(jīng)存在于體內(nèi)的細(xì)菌開(kāi)始接觸藥物，這給了它們另一個(gè)進(jìn)化的機(jī)會(huì)，并增強(qiáng)了它們對(duì)藥物的抵抗力。

Study authors analyzed notes from more than 28,000 outpatient appointments during 2015 using data from the National Ambulatory Medical Care Survey, which asks physicians to describe their patients’ visits and treatments during a specific period of time. They found that antibiotics were provided during 13.2% of these visits, and concluded that just 57% of those prescriptions were given correctly. However, another 25% of those patients were given antibiotics under false pretense, while doctors’ notes for the remaining 18% of cases were not clear enough to determine the effectiveness of the treatment. Doctors find this particularly worrisome.

研究作者分析了2015年超過(guò)28000個(gè)門(mén)診預(yù)約的記錄，數(shù)據(jù)來(lái)自全國(guó)門(mén)診醫(yī)療調(diào)查，該調(diào)查要求醫(yī)生描述他們的病人在特定時(shí)期的就診和治療情況。他們發(fā)現(xiàn)有13.2%的患者在就診期間服用了抗生素，最后得出的結(jié)論是只有57%的處方是正確的。然而，另外25%的患者在虛假的借口下服用了抗生素，而剩下18%的患者的醫(yī)生記錄不夠清楚，無(wú)法確定治療的有效性。醫(yī)生們發(fā)現(xiàn)這尤其令人擔(dān)憂。

“Antibiotic prescribing without making note of the indication in a patient’s medical records might be leading to a significant underestimation of the scope of unnecessary prescribing,” said Oregon State University researcher Michael Ray, who led the study. “When there’s no indication documented, it’s reasonable to think that at least some of the time, the prescription was written without an appropriate indication present.”

“沒(méi)有在病人的醫(yī)療記錄中注明適應(yīng)癥就開(kāi)抗生素處方，可能會(huì)導(dǎo)致對(duì)不必要處方范圍的嚴(yán)重低估，”俄勒岡州立大學(xué)研究員邁克爾·雷(Michael Ray)說(shuō)，他領(lǐng)導(dǎo)了這項(xiàng)研究。“當(dāng)沒(méi)有證據(jù)證明有任何癥狀時(shí)，我們有理由認(rèn)為，至少在某些情況下，處方中沒(méi)有適當(dāng)?shù)陌Y狀。”

Researchers also found that medical specialists were more often to blame for wrongfully prescribing antibacterial drugs compared with primary care physicians.

研究人員還發(fā)現(xiàn)，與初級(jí)保健醫(yī)生相比，醫(yī)療專(zhuān)家更容易因?yàn)殄e(cuò)誤地開(kāi)抗菌藥物處方而受到指責(zé)。

The CDC also reports that some 2.8 million Americans each year contract antibiotic-resistant infections, including strains of gonorrhea, tuberculosis and bacterial pneumonia, and survive. Those illnesses then go on to become stronger and spread farther, forcing doctors to turn to increasingly aggressive treatments, which may come with their own health consequences.

美國(guó)疾病控制與預(yù)防中心還報(bào)告說(shuō)，每年約有280萬(wàn)美國(guó)人感染耐抗生素的傳染病，包括淋病、結(jié)核病和細(xì)菌性肺炎，并存活下來(lái)。這些疾病隨后會(huì)變得更強(qiáng)，傳播得更遠(yuǎn)，迫使醫(yī)生轉(zhuǎn)向越來(lái)越激進(jìn)的治療，這可能會(huì)帶來(lái)自身的健康后果。