Using of antibiotics in Patients with Tumor

【Abstract】 Antibiotics are the most widely used clinical drugs， is one of important income source of the hospital. Improper use of antibiotics not only increased drugs' adverse reactions， also the important reasons for leading to the continuous generation of drug-resistant strains. With the development of cancer therapeutics， infection has become the most common complication of cancer patients and the cause of death. Therefore， rational application of antibiotics in cancer patients has an important role for reducing cancer mortality.

【Keywords】antibioticdrug usingthe type of drug use

【中圖分類(lèi)號(hào)】 R917【文獻(xiàn)標(biāo)識(shí)碼】 B【文章編號(hào)】 1007-8231（2011） 08-0661-03

A large number of antibiotics are applied in clinical treatment. Because of its large amount ofuse and variety， a lot of problems in clinical use exist. Therefore rational use of antibiotics has become the focus of attention. To understand the use of antibiotics in patients with tumor in hospital， enhance the clinical drug safety， effectiveness and legitimacy， and provide the basis for the rational use of antibiotics， this article did a investigation on use of antibiotics in hospitalized patients in our hospital.

I．the principles of antibiotic using in the treatment of cancer patients

For cancer patients， antibiotics is effective for bacterial infections also for infections caused by mycoplasma， anti-Rickettsia， actinomycetes and fungi. Before treatment，we should understand the nature of the source of infection and drug sensitivity. Molecular biology techniques (such as polymerase chain reaction) completely changed the diagnosis of infectious diseases and is helpful to developing treatment programs.Treatment based on clinical diagnosis， laboratory diagnosis， the patient's economic status and social factors. Viral infection and fever of unknown cause should not use antibiotics， because typical clinical manifestations and pathogenic bacteria can not easily be found after the application which may delay proper diagnosis and treatment. Combination therapy should be strict in indications. Treatment should use only one antibiotic as far as possible in narrow area， antibiotics can be combined only in rare cases: pathogens of serious infections has not been clear; patients’ situation can not be controled the infection with a mixture of antibiotics; single antibiotic can not effectively control severe Pseudomonas aeruginosa infections， bacterial endocarditis， etc.; bacteria may produce long-term drug resistance， urinary tract infections such as tuberculosis. The case that the site of infection is not easy to penetrate of antibiotics is very difficult to cure， such as bacteria meningitis. Combined use of antibiotics can achieve synergy and delayed effects of the medicine.

In reducing the toxicity of effective antibiotics and effective antibiotic inactivation， such as the lactam and aminoglycoside antibiotics in combination， can produce synergy. Rational use of antibiotics must be chosen under a clear indication of appropriate drugs， use appropriate formulations and treatment in order to kill pathogenic micro-organisms and control infection. Tumor patient immune dysfunction， prone to microbial infection， particularly bacterial infection mainly， if not based on susceptibility testing use of antibiotics， it can causes the body dysbacteriosis easily， the occurrence of double infection increased disease， severe cases can lead to death. So for tumor patients， the use of antibiotics and the choice are particularly important.。At the same time take appropriate measures to increase the patient's immune system and prevent undesirable consequences.

II. The type and cost of antibiotic use

Main types of antibiotics are penicillin， cephalosporin and amino-class II. Their utilization rates are respectively 47.0%， 46.0% and 27.2%. There are other ketones and metronidazole. Use one kind of antibiotics occupies 38.2%， using the two together accounted for 57.1%， with triple accounted for 4.7%. Those with three generations of cephalosporins is the highest in the cost which is an average of 335 yuan per person per day.

III. The analysis of improper use of antibiotics

1， No indication of the use of antibiotics. In the investigation of the prescription， the use of antibiotics accounted for 90% or more. Most of them use two or more antibiotics. The abuse of antibiotics， not only had no significant effect， but also is easy to make the patient's body flora， decreased immunity， which is not conducive to diseases.

2， Unreasonable combined use of antibiotics. Generally a single drug effective in the treatment of infections do not need combination therapy， not only in the identification of serious infection， mixed aerobic and anaerobic infection， antibiotics can not effectively controlled by a single infective endocarditis or sepsis and other severe infections， need be combined with other antibiotics， and combined with only 2 generally. Combined use of antibiotics is not only irrational waste of resources， increased bacterial resistance， and increased toxicity.

3， Improper dosing interval. Appropriate dosing interval is a key factor to play the efficacy of antimicrobial agents and to reduce adverse reactions and bacterial resistance. Penicillins， third-generation cephalosporins’ half-lives are short， and are time-dependent drugs. Drug concentration was maintained at the minimum inhibitory concentration of pathogens over time is critical for pathogen clearance. The plasma concentration exceeds the minimum inhibitory concentration at least 50% of two dose intervals. These drugs should be administered several times a day. If interval is too long，it will result in increased adverse reactions， even lead to the generation of bacterial resistance.

IV. The discussion and analysis

It is believed that to patients with suspected bacterial infection， we should obtain specimensas much as possible， and deliver them for bacterial culture and antibiotic susceptibility testing timely: when there is no bacterial culture results， doctors should choose antibiotics， based on the patients’ characteristics of the disease， the site of infection， health and hospital infection reporting， etc.. Once the culture results appear positive， doctors may select to adjust antibiotics refering to pathogens and antibiotic sensitivity test， to reduce the blindness of drug selection， to improve efficacy. As the use of antibiotics spread widely， opportunities of hospital-acquired infections increase and resistant bacteria occupies a high proportion. This not only increases the difficulties of treatment， but also caused a waste of funds. Thus we should strengthen the management on rational use of antibiotics. Hospital laboratory should publish the result of detection of various pathogens and drug resistance regularly in the hospital. As new antibiotics have been developed， the Department of Pharmacy has to plan to retain part of antibiotics for the emergency.

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