Guangzhou hospitals antibiotic use limit Yin Zhengyi

Dr. , the common cold should not be quick to use antibiotics CFP for map

public rebellion: the former flood of antibiotics, is now actually a drug is hard to find “

to the doctor: hospital order strict limit on the” hard control the amount of “Yin Zhengyi

Yangcheng Evening News (microblogging) reporter Chun Wei

to

alleged misuse of antibiotics, antibiotics sometimes become the industry “sensitive words” the drug resistance survey after another burst. Recently, the top three hospitals of Guangdong Province, a famous medical workers to the Yangcheng Evening News, rebellion, said the executive public authority formally respond to community concerns, a considerable number of hospitals in the city has completed antibiotic proportional control regulations in the formulation. In the future, the patient they may face the antibiotics a drug is hard to find “the situation.

this measure is well-established charity? Or 好心办坏事? Stimulate discussion among medical workers. Administrative intervention in the areas of expertise across the board to control the amount is overkill? Definition of rewards and punishments of the dose will give rise to other problems? A number of core issues that must be multi-stakeholder discussion.

patients with complaints

burning three days without antibiotics

onto the fifth day into pneumonia

“No matter how we negotiate with the doctors, he would not prescribe antibiotics.” members of the Ms. Huang reflect their own children in a treatment experienced.

the beginning, she

the fever to the city of a hospital to take the kids to see Western medicine outpatient visits, the doctor did not prescribe antibiotics, and only two kinds of proprietary Chinese medicines. Because resistance to antibiotics that may arise, she was also prescribed quite satisfactory.

children but after taking the fever, fever three days, she and her lover to take the kids to the hospital, “checked blood indicators show that in the normal range, the results of a doctor for the other two proprietary Chinese medicine “. She was afraid the child accident, strongly demanded to prescribe antibiotics, but the doctor refused. “As a result the child or repeated burning, the fifth day, visit to check the chest radiograph, lung infection that can only be sent to hospital, fluids and hanging a few days to cure”.

after the Spring Festival, the Yangcheng Evening News rebellion hotline began to receive complaints on the doctor refused to prescribe antibiotics, a similar situation occurs more in ENT and pediatrician who. Users reflect the antibiotics in the hospital when, how outpatient doctor refused to open, there are parents anxious that their own children due to lack of doctors in a timely manner out of antibiotics, the sicker.

network above, people began to feel the little signs: “antibiotics” of the past prescription regulars, like a bit of a drug is hard to find the taste.

doctors the Baoliao

hospital issued regulations strictly controlling antibiotic

outpatient utilization 10% -20%

Recently, a province famous three hospital doctors to the Yangcheng Evening rebellion, the rumors are true, the city quite a number of hospitals has been to formulate their own about the use of antibiotics guidelines, the wording is quite severe, antibiotics, the mere mention of the original neighbors heard to the doctor dreaded “.

he introduced last year, the antimicrobial agents management approach developed by the Ministry of Health has entered to file an amendment procedure. “Approach” made it clear management indicators can be said that the history of the most stringent management.

According to reports, supervision and inspection of the Ministry of Health is the country’s medical quality of Miles and antimicrobial agents special governance found that three-point indicator in the special treatment of antibiotics and some have been realized, for example, requires three integrated the type of hospital antibiotics in principle, more than 50 kinds of two general types of hospital antibiotics in principle more than 35 kinds of; outpatient antibiotic usage control in less than 20%, inpatient antibiotic usage to be controlled within 60%. Both medical institutions is almost achieved. Now trying to do is to control the intensity of use of antibiotics, the ideal is about 40% or 40%.

In this backdrop, the city’s many large hospitals, according to the superiors regulations in the October to November last year on the 2012 annual work out the internal regulations, the provisions of the proportion of outpatient doctor antibiotic medication. some 20%, some even as low as 10%, if there are doctors or departments exceeded, there may be internal punishment.

According to reports, the relevant rules is not the final introduction of the internal punishment is likely the doctor’s wages shall be deducted, the end of the year award, as well as the level of their professional assessment of a negative impact.

dialogue parties

three hospital doctors L — with no antibiotics is very professional

Yangcheng Evening News: Why thinking to the media reflect this?

L: Hospital guidelines issued for some time, but I do not see the discussion in the community, this problem is not only the industry, it should be left to the community, so that we reach a consensus.

Yangcheng Evening News: Can you explain your hospital?

L: Recently, the flu season in January, our department of antibiotic usage has been exceeded. The more unreasonable, we are now a general practitioner’s computer privileges can not be opened antibiotics. The patient insisted on open, we can only suggest that the hanging of experts or the director number.

Of course, we can use the previous pharmacy and the production of prescription template “to get rid of this electronic management, hospital leaders know this. But the problem is that the electronic operations have traces of possible shall be deducted, even if the leadership is to understand what the doctor will adventure to open it?

Yangcheng Evening News: From your personal point of view, Are you in favor of stringent control over antibiotics?

L: with antibiotics, in fact, is a professional problem. Healing is a complex process, with individual differences. Unlike repair the machine, as each patient according to the template to deal with. Pathogens are epidemic, regional, such as fever of one hundred patients, pathogens spring 50% is a virus, summer, fall, it is impossible or that kind of ratio. May be caused by bacterial infection may increase even more than 20 percent of drug use indicators, this indicator to perform, many patients will be affected. I hope the relevant departments to seriously consider. Patients’ lives should not be attached to the care of one or several indicators above.

such a rigid use of indicators, the impact is really great.

Yangcheng Evening News: Prior to social misuse of antibiotics for the hospital is really offensive, what is your view?

L: The current situation is part of the pharmaceutical production of corporate marketing behavior is not standardized, combined with a very few medical personnel to medical ethics problem exists, leading to antibiotic use unreasonable. In addition, there are some deep-seated problems, such as imperfect compensation mechanism of public hospitals, drugs fill medicine “mechanism is still in the hospital plays a very important role. I believe that to solve this problem, start from here, and not simply by administrative power to the areas of expertise to regulate.

Reporter survey

doctor said the problem has appeared

face mandatory The dilemma in the treatment process

administrative public authority take concrete actions to respond to the community for the abuse of antibiotics, their motivation is undoubtedly good. However, medical staff said that under the strict control problem has been gradually emerging.

senior doctors briefed reporters on antibiotics on an outpatient basis commonly used drugs, involved inside and outside, women, children, nose, throat, skin, and even orthopedics, oncology and other departments. 20% of the indicators means that the doctor in the admissions of patients, 10 patients only two of the use of antibiotics, “As a result, there will be this case, drug indications, there is a need to use antibiotics patients, because of this provision and not the antibiotics. ”

ENT doctors to reflect this provision seriously affect the treatment effect. Sinusitis in children, for example, which states in the diagnosis and treatment guidelines, antibiotic treatment should last three months, “this medication, many parents can not accept, the original can not be such a specification to adhere to medication, and now we even did not dare prescribe medication. ” He introduced some time ago in sinusitis patients for more than half of patient admissions, treatment guidelines prescribe that every month I have certainly ‘excessive’, then my salary be deducted, I mean white dry “.

doctors, therefore, does not exceed the index, so are rarely prescribe antibiotics, or tell the patient to the pharmacy to buy medicine. Some doctors encounter patients strongly requested to prescribe antibiotics, after the interpretation is no way to indicate in the medical records patients require oral antibiotics.

in some sections of the doctors for this indicator, according to diagnostic and treatment practices, patients with fever, a priori blood reflect bacterial infection before the use of antibiotics for patients, but the doctor , often three main types of infection, viruses, bacteria, Mycoplasma pneumoniae, normal blood do not reflect the three types of infection, such as blood normal range, but the patient may be infected with Mycoplasma pneumoniae. Drug targets failure to make timely use of antibiotics, the victim more patients, the Hospital under pressure, many things are pressed to the doctor, the doctor’s work has become very hopeless and helpless.

the Kaifong said do not do mice

relevant standards of scientific proof

” mixed feelings, mixed feelings. “Mr. Choi’s children of the public because of infirmity, from the age of two, almost a frequent visitor to the hospital had also a large number of receiving antibiotic injections. He admitted that the antibiotic hated, but now doctors binding the hands, allowing him to cast further doubt on the ability of hospitals.

public interview with reporters, said to a certain extent understand, if such a system is not scientific evidence, only the hospital under pressure, gave up his professional responsibility, areas of expertise, originally should be brave voice, a hundred schools of thought contend “.

During the interview, the reporter found that doctors were also the victims. They were wronged the seam maternal anus “, or” eighty door, have been confirmed with the fact that there is some discrepancy, but intensify the doctors greater distrust of the community, “Now a lot of people in order to prescribe antibiotics have been angry. we are worried that once again the intensification of doctor-patient conflicts.

Chun Wei

restricted terrible treatment does not affect many doctors limit the use of antibiotics is a good thing, and look forward to greater public understanding of

Yangcheng Evening News reporter Xia Yang Liu Weining

party accustomed to the citizens of antibiotics, the other doctors can not prescribe antibiotics. The often-criticized people excessive antibiotic dosage finally be curbed, however, lead to a lot of puzzled. To this end, the Yangcheng Evening News reporter interviewed a number of provincial-level three hospital doctors to talk about the reason why. The

, the overuse of antibiotics

out his post

Provincial Health Department and the major hospitals The president signed the application of antimicrobial agents of Duty

survey showed that Guangdong hospital antibiotic usage has generally in more than 60%, some small hospitals and community hospitals up to 70%; the U.S. and Europe developed countries the proportion is only about 30%. Some of the medical institutions, medical personnel, there is still a wrong concept of medication, drug use behavior and drug habits, the clinical use of antibiotics and bacterial resistance situation is still very grim. According to the 1995 to 2007 Classification of Diseases Survey, infectious diseases accounted for 49% of the total incidence of all diseases, in which bacterial infections accounted for 18% -21% of all disease, that is more than 80% belong to the misuse of antibiotics each year 80,000 people died. Children under 7 years in China due to irrational use of antibiotics caused deafness up to 30 million, accounting for 30-40% of the overall deaf children, while some developed countries is only 0.9%. China can be described as the world’s most serious problem of overuse of antibiotics, one of the countries.

Based on this situation, this year the state and the provinces have introduced stringent measures, limiting the abuse of antibiotics of hospitals and doctors. Guangdong Provincial Health Department and president of the provincial subordinates hospital signed a Duty of clinical application of antibacterial drugs, and the dean of his post linked directly. Dean again the responsibility of layers down to the implementation of doctors overuse of antibiotics, will cancel its antimicrobial drug prescribing rights. Sections on the problem of antibacterial drug clinical unreasonable application of, given a warning, a deadline for rectification, the serious problem of revocation of the administrative duties of the department director.

open drug sub permissions

to open the required signature

the

can effectively avoid the doctor habitual abuse of antibiotics

restrictions affect the treatment effect? Yangcheng Evening News reporter in the Guangzhou area a number of hospitals to do a survey to understand. First Affiliated Hospital of Sun Yat-sen, a doctor said in an interview, antibiotics really strict control, different levels of permissions to different doctors prescribe medication, the general practitioner to open the antibiotics, we must find the director of signature, otherwise it can only open the day the amount of .

“strict management for a number of general practitioners, do have some difficulties, can no longer be free to prescribe medication as before,” said the doctor, looking for director of the signature, even if eligible, it also depends time, such as outpatient middle of the night while on duty, it is impossible to admissions for each patient to find the director of the signing. Talking about this point, there are many difficulties a young hospital doctor Zhang. “If it is acute urinary tract infections caused by Gram-negative bacteria, acute appendicitis, acute gastroenteritis need to use three generations of cephalosporins, this drug to the attending physician to be able to open.” So sometimes the middle of the night, receiving the patient. they can not find the Director’s signature or the other doctors have permission to prescribe medication, they can only use the curative effect is not good common antibiotics emergency. In addition, he pointed out that the strict control of outpatient antibiotics use no more than 20% “should be floating slightly, if there is a seasonal infection, many patients, this quantitative enough, it will affect the treatment effect.

But the doctor also believes that stringent measures to control the abuse of antibiotics is necessary. “Not so severe, can not change the habits of some doctors prescribe medication in the past! Just not suited also normal, after a while to get used to certain informed sources, antibiotics, the higher the level, the more likely a black-box operation of the” commission ” . Such as hospitals, in the past at every turn there are 100-200 kinds of antibiotics breeds drug dealers to sell the Chamber of Commerce to give high economic returns. And doctors habitually prescribe antibiotics, and often test new drugs to patients, there are also income considerations. It is understood that the generic drugs is no “benefits”. The moment, limiting the types of antibiotics used in hospitals, three hospitals purchase a variety of antimicrobial agents not more than 50 kinds of two hospitals to purchase a variety of antimicrobial agents not more than 35 kinds of. “Limit the amount of doctors prescribe antibiotics and permissions, you can effective way to avoid some of the existence of selfish groups of doctors habitual abuse of antibiotics.

foreign colds

no antibiotics

timely and flexible, never would delay the diagnosis and treatment

“to impose strict restrictions on policy range of drugs prescribed by doctors can significantly narrow, but it does not mean that doctors can not cure.” Guangdong Provincial People’s Hospital of Pediatrics Director Lin Xiaoyuan physicians believe that the common cold, fever, should never have been quick to prescribe antibiotics. Guangdong a hospital Dr. Zheng said: people have a misunderstanding, ill be sure to take antibiotics before peace of mind. In fact, many diseases do not need to prescribe antibiotics, such as the common cold. “In the U.S., the flu medication is the dimension C, orange juice!” He said of the older generation of doctors to use antibiotics have a habit, they believe that antibiotics can cure, in fact, this is a wrong perception. Common colds are caused by a virus, colds are caused by inflammation is the body’s own immune system decline due to antibiotics and there is no direct correlation. Treatment abroad, a cold, definitely not the use of antibiotics! “

specification for the use of antibiotics is a good thing!” Zhang said the doctor, daily treatment, does not need to open a high-level antibiotic as long as the basic drugs can be cured, it also requires greater public understanding. Moreover, even if it is to limit a doctor’s prescription privileges, does not affect the patient’s condition. “If I do not have prescription privileges, it will recommend that patients go to other doctors to prescribe medication, or do a special application, the doctors saving lives, has always been the same.” He said, will not therefore delay diagnosis and treatment of the phenomenon.

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