新冠正在加剧印度的抗生素滥用

2021-07-11 DY MedSci原创

由美国圣路易斯华盛顿大学医学院主导的研究发现,印度在第一波新冠病毒暴发期,抗生素销量猛增。

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最近几个月,新冠大流行席卷了印度,导致其新冠死亡人数超过 400000。除了疫苗短缺和氧气供应不足之外,另一场公共卫生危机也正在逼近:抗生素耐药风险。

由美国圣路易斯华盛顿大学医学院主导的研究发现,印度在第一波新冠病毒暴发期,抗生素销量猛增,且它们可能主要被用于治疗新冠患者。但这种使用不仅无效,而且还很危险,因为不必要或过度使用抗生素会导致全世界耐药性感染风险日益增加。

https://doi.org/10.1371/journal.pmed.1003682

抗生素耐药的公共卫生威胁

抗生素耐药是当今人类面临的最重要的健康问题之一。由于细菌出现抗生素耐药性,曾经可以用抗生素有效治疗的感染越来越难以治疗,特别是在免疫力低下的患者中,如糖尿病患者或癌症患者,以及流感后继发细菌感染的老年人。乱用和过量使用抗生素是导致这种抗生素耐药性出现的重要原因之一。

没有哪个国家能幸免于这个问题。世卫组织估计,到2030年,抗微生物药物耐药性可能会使多达 2400 万人陷入极端贫困。到2050年,将有1000万人死于抗药性感染,今年公布的数字显示,抗药性感染在去年增加了约9%。

去年5月26日,WHO公布了2020年全球抗生素耐药性和使用监测系统(GLASS)报告,来自全球66个国家64000多个监测点的数据显示,抗生素耐药国家数量创下新高,越来越多的细菌感染对手头的治疗药物产生了抗药性。

参与GLASS系统的国家,https://apps.who.int/iris/bitstream/handle/10665/332081/9789240005587-eng.pdf?ua=1

如果我们不解决这个问题,我们将回到人类因诸如割伤或刮伤之类的简单事情而死亡的时代,也会产生由于风险过高,必须取消髋关节置换等常规手术的现象。

抗生素与印度

印度拥有世界第二大人口,近 14 亿人。作为世界上最大的抗生素消费国,该国“值得研究”。

印度基本上是在医疗保健实践相似的低收入和中等收入国家滥用抗生素的典型代表。这些国家在初级保健机构中过度使用抗生素,而大流行也进一步刺激抗生素使用不当的发生。

该研究的作者表示,进行这项研究是因为印度大约 75% 的医疗保健是私营的,不受监管且分散的私营部门占抗生素消费的 90%,这也是引发人们滥用抗生素治疗新冠的重要原因。

由于中低收入国家的大多数患者负担不起呼吸系统疾病的诊断测试,大多数人倾向于跳过这个步骤。因此,他们往往假设疾病是细菌感染引起的,并采取抗生素治疗。

研究估计了由新冠引起的抗生素、阿奇霉素和羟氯喹月销售额水平和趋势的变化,并在适当情况下考虑了季节性和锁定期。结果显示,在年 6 月至 9 月的大流行活动高峰期,新冠可能导致印度2.164亿剂抗生素总剂量和3800万剂阿奇霉素过量。

2018年1月至2020年12月,印度抗生素总量、阿奇霉素、强力霉素、法罗培南和羟氯喹的销售量趋势

https://doi.org/10.1371/journal.pmed.1003682

研究结果意味着什么?

该研究的作者估计,在印度发现的趋势很可能发生在其他抗生素经常被过度使用的低收入和中等收入国家。

他们表示,印度滥用抗生素导致细菌耐药性的中期和长期后果应引起高度关注,需要在全国医院采取紧急抗生素管理措施。

研究还显示,在印度羟氯喹的销售额在2020年3月出现了1110万剂量的新冠归因变化。此前,羟氯喹在大流行初期被广泛吹捧为治疗新冠的神药,但后来被相反的研究结果推翻,在印度政府对其销售实施严格限制后,该药物的使用才有所减少。

研究人员表示,印度和其他低收入和中等收入国家应该考虑对阿奇霉素采取类似的限制措施,以保留这种抗生素的价值。另外还应增加印度的新冠检测,以减少不合适的经验性治疗。

根据美国CDC数据显示,人类多达三分之一的抗生素使用是不必要或不恰当的。抗生素不能对抗病毒感染,如感冒、流感、支气管炎和大多数喉咙痛。不过,很多患者还是希望医护人员开出抗生素来 "治愈 "小病。但是现在几乎所有的细菌感染都对其对应选择的抗生素治疗产生了耐药性。同时,当抗生素在食品生产中(比如饲养牛和鸡)过度使用时,细菌也会产生耐药性。此外,抗生素会杀死人体内的 "好 "细菌,导致肠道和其他问题。

抗生素可以救命。凡是有细菌感染的人,都应该按规定服用抗生素。但当病情较轻,或者可能是病毒引起的,最好是对症下药。"记住,当医护人员说没有必要时,不要要求使用抗生素"。

世卫生组织总干事谭德塞博士说:"随着收集到更多的证据,我们更清楚、更充满担忧地看到,全世界失去至关重要的抗生素药物的速度有多快"。这些数据强调了保护我们所拥有的抗生素和开发新抗生素的重要性,以有效地治疗感染,维护上个世纪取得的健康成果,并确保未来的生命安全。

原始出处:

Sales of antibiotics and hydroxychloroquine in India during the COVID-19 epidemic: An interrupted time series analysis.https://doi.org/10.1371/journal.pmed.1003682

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    2022-03-17 zchen
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    2021-09-14 医学生要考试

    世界难题#抗生素#

    0

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    2021-09-14 医学生要考试

    学习了

    0

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    2021-07-13 carolinewy

    学习了

    0

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    2021-07-12 公卫新人

    新冠肺炎,疫情何时才能消失

    0

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    2021-07-12 土豆你个马铃薯

    哦立普妥

    0

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    2021-07-11 1209e435m98(暂无昵称)

    学习了,谢谢分享

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