How Safe Is Ciprofloxacin for Children?

Safe use of anti-infective drugs for children ---- Infectious diseases are one of the most common diseases in pediatrics. The key to treatment is to select sensitive antibiotics for pathogenic bacteria and apply them reasonably. Anti-infective drugs refer to a variety of antibiotics and other chemical synthetic drugs that can be used systemically, such as oral, intramuscular, and intravenous injection, which have the effect of killing or inhibiting various pathogenic microorganisms.

Children's anti-infectives safe use

Safe use of anti-infective drugs for children ---- Infectious diseases are one of the most common diseases in pediatrics. The key to treatment is to select sensitive antibiotics for pathogenic bacteria and apply them reasonably. Anti-infective drugs refer to a variety of antibiotics and other chemical synthetic drugs that can be used systemically, such as oral, intramuscular, and intravenous injection, which have the effect of killing or inhibiting various pathogenic microorganisms.

Chinese name

Children's anti-infectives safe use

Nature

Infectious disease

Application area

medicine

The key to treatment

Reasonable use of antibiotics

The most common drugs in China's adverse drug reaction / event reports are anti-infective drugs. In 2009, the number of such drugs still accounted for the first place, reaching 55.2% of chemical drugs. The dosage forms with the most adverse drug reactions / events were 59% for injections, 37% for oral preparations, and 4% for other preparations.

Children are susceptible to infectious diseases. The commonly used anti-infective drugs are antibiotics or sulfa drugs, so-called "anti-inflammatory drugs". The current abuse of anti-infective drugs is more prominent. For non-infectious diseases such as intestinal cramps, simple diarrhea, and children with common colds and fever, antibiotics are first used without any reason. However, it should be pointed out that antibiotics can easily cause intestinal flora imbalance, cause microecological disorders, and even cause fungal or drug-resistant bacteria infection. Some antibiotics can also cause liver and kidney damage and affect the blood system. At the same time, there are reports that as many as 300,000 children under the age of 7 have been deaf due to the unreasonable use of antibiotics, accounting for 30-40% of the total deaf child population, and only 0.9% in some developed countries. The current status of pediatric anti-infective use is noteworthy.

18 out of 21 actors in "Thousands of Goddess of Mercy" deaf due to drugs

In the spring evening of 2004, the dance performed by the Chinese Disabled Art Troupe, Thousand Hands Avalokitesvara, shocked people not only because of the beauty of the dance itself, but also because all the dance participants were deaf and dumb actors. Most of the 18 deaf and dumb actors were around the age of two because of deafness caused by the use of antibiotics during fever.

At the China Rehabilitation Center for Deaf Children, the reporter learned that more than 30% of deaf children under the age of seven in China are deafness caused by toxic and side effects of drugs. There are mainly two types of commonly used antibiotics for deafness. Chen Zhensheng, deputy director of China Rehabilitation Center for the Deaf: One is called aminoglycoside antibiotics. Its main representatives are streptomycin, gentamicin and minonomycin. The second category is non-aminoglycoside antibiotics. The representative drugs are Jiemycin and erythromycin. In fact, in addition to the antibiotics that everyone is familiar with, drugs such as aspirin and diuretics can also affect hearing.

Other medical records

Lin, female, 2 years old. Due to runny nose and fever, parents took cephalosporin antibiotics, and they still had fever after one day. Parents thought that the dose was not enough. They doubled the amount given in the instructions and added azithromycin and Chinese medicine for clearing and detoxifying There are also antipyretics and runny medications. The child's condition has not been relieved after two days, and symptoms of fatigue appear. At the hospital, a blood test showed a significant decrease in white blood cells and neutrophils. The doctor ordered him to stop using all the drugs he is using, pay attention to rest and drink plenty of water, and use some drugs that raise white blood cells. The blood routine returned to normal after the day. In fact, the child was suffering from a common cold, but the parent abused the drug and increased the dosage at will, causing unnecessary harm to the child.

Must strictly follow the indications

For example, the most common disease in children is acute upper respiratory tract infection, that is, a "cold", which is caused by more than 90% of the virus. The treatment is mainly antiviral and symptomatic treatment, and generally does not require antibiotics. Antivirals can be given orally for 3 to 5 days. The drug does not recommend intravenous drips to prevent side effects such as blood system diseases.

You can also choose some proprietary Chinese medicines that have the functions of relieving wind and clearing the table, clearing heat and detoxifying, as appropriate. Such as cold granules, pediatric Qingrejiedu oral solution, Shuanghuanglian, Yanbian granules, Qingkailing granules and so on. If the child is more ill and has a secondary bacterial infection, antibiotic treatment is required under the guidance of a doctor.

In addition, diarrhea, another common disease in children, requires anti-infective treatment, and a considerable part does not require antibacterials. As for what kind of diarrhea your child belongs to, whether you need anti-infective treatment, you need to test your stools and make a final diagnosis after checking by your doctor. Do nt buy antibiotics for your children.

Stay away from four major classes of anti-infectives

Children are in a special period of growth and development, their immunity is low, and they are susceptible to diseases such as respiratory infections. The child is ill, and some parents are used to choosing medicines for their children. However, experts remind parents that children's various organs are not fully developed and are sensitive to the toxic and side effects of the drug. Therefore, the following four categories of anti-infective drugs should be used with caution or disabled:

A) Aminoglycosides Aminoglycosides include gentamicin, amikacin, streptomycin and the like. The Ministry of Health has clearly stipulated that children under 6 years of age are prohibited from using such drugs. These drugs have strong ototoxicity and renal toxicity. Therefore, after using such drugs in children, deafness or renal failure can occur.

B) Macrolides Macrolides include erythromycin, roxithromycin, and azithromycin. These drugs have a greater toxic effect on the liver. Children using macrolides for a long time or in large doses can suffer from liver failure and other conditions, and severe cases can be life-threatening.

C) Amido alcohols Amido alcohols include chloramphenicol, sulfomycin, and the like. Such drugs are relatively toxic and have rarely been used clinically. Children using amido alcohols may develop aplastic anemia, gray infant syndrome and other conditions.

D) Quinolone drugs Quinolone drugs include norfloxacin (haloperic acid), ciprofloxacin (ciprofloxacin), ofloxacin (floxacin), levofloxacin, lomefloxacin, fleroxacin ( Polyfloxacin) and so on. These drugs can cause bone and joint disease in children. Therefore, quinolone drugs have side effects that affect children's growth and development.

Choose the right medicine

The use of anti-infective drugs in children with infectious diseases is a wise choice, but the selection of drugs must be appropriate to achieve the desired effect. The correct approach in the application of antibiotics should be to adjust the treatment plan in time after the etiology diagnosis, and choose narrow-spectrum, low-toxic drugs to complete the treatment. If combined application is required, the principle of good efficacy and small side effects should be used. In order to prevent cumulative toxic effects, the combined use of antibiotics that are toxic to the same organ is prohibited. For example, ceftizolin and amikacin have heavy kidneys. Toxic effects should be avoided as much as possible.

According to the characteristics of the drug

Reasonable application should not only consider from the sensitivity of the pathogenic bacteria, but also from the characteristics of drug efficacy, pharmacokinetics, drug stability and other aspects.

Considering the susceptibility of pathogenic bacteria: commonly used antibacterial drugs in pediatrics are generally -lactam antibiotics, aminoglycoside antibiotics, macrolide antibiotics and quinolones. Commonly used antiviral drugs are ribavirin, acyclovir, ganxi Lowe, antifungal drugs include clotrimazole, miconazole, ketoconazole, etc. In addition, there are antituberculosis drugs, antiparasitic drugs and so on.

(1) As far as antibiotics are concerned, pediatric commonly used antibacterial drugs are the most commonly used in -lactams, such as various penicillins and cephalosporins, and monocyclins such as aztreonam (juncadan) and carbapenems. For example, Metroloplast can be used less in pediatrics. Complex antibiotics with beta lactamase inhibitors such as ampicillin / clavulanic acid (ametine), ticarcillin / potassium clavulanate (temetine) and cefoperazone sodium / sulbactam sodium (supram) It can also be used in severe pediatric infectious diseases. The antibacterial spectrum is different for different kinds of penicillin and different cephalosporins.

1. If penicillin and penicillin V are used in gram-positive and gram-negative cocci, penicillin-resistant oxacillin and clozacillin are available, but the effect on sensitive bacteria is not as strong as that of penicillin. Broad-spectrum ampicillin and amoxicillin have less effect on gram-positive cocci than penicillin, but have stronger antibacterial effects on gram-negative bacilli. It can be used for various infections caused by Gram-negative bacteria (except Pseudomonas aeruginosa). Therefore, penicillin antibiotics should be selected according to different sensitive bacteria.

2. There are also one, two, three, and four generations of cephalosporins. The first generation of cephalosporins has a strong effect on Gram-positive bacteria, is resistant to Pseudomonas aeruginosa and anaerobic bacteria, and is resistant to -lactam. Enzymes are prone to drug resistance and are toxic to the kidneys, especially cefotaxime. Pediatrics are widely used in clinical cephalexin, cefazolin, and cefradine. The second-generation cephalosporins have the same antibacterial activity against Gram-positive bacteria and most Enterobacteriaceae, but they are mostly resistant to Pseudomonas aeruginosa and are resistant to Lactamase is relatively stable with low renal toxicity. Cefaclor and cefuroxime are commonly used in pediatrics, which have high tissue permeability and can penetrate into the cerebrospinal fluid. Purulent meningitis in children is the drug of choice. In addition, children with cefuroxime (nebrendazol) are suitable for oral preparations and can be used as sequential administration of cefuroxime (celixin). The third-generation cephalosporins were synthesized only 80 years later. Although its characteristics have considerable antibacterial activity against Gram-positive bacteria, but it is weaker than the first generation, but has strong antibacterial effect on some Gram-negative bacteria (including Enterobacter and Pseudomonas aeruginosa), which is superior to the first, The second generation can penetrate into the inflammatory cerebrospinal fluid, can treat central nervous system infection caused by sensitive bacteria, and is highly stable to -lactamase. Renal toxicity is low. Pediatrics often use third-generation cephalosporins in severe infections, especially long-acting preparations such as ceftriazine, to reduce the pain of venipuncture once a day. Fourth-generation broad-spectrum cephalosporins such as cefepime have also been used in pediatric severe infections.

3. Aminoglycoside antibiotics have a broad antibacterial spectrum and strong antibacterial activity, and are effective against most G +, G- bacteria and tuberculosis bacteria.

4. Macrolide antibiotics have a narrow antibacterial spectrum, which mainly acts on G + and G-cocci, but is effective against Mycoplasma, Chlamydia, and Legionella, and is widely used in clinical applications.

5. Quinolone has a broad antibacterial spectrum and strong antibacterial activity. At present, it has antibacterial activity against a variety of resistant strains. As for the effects of these drugs on children's articular cartilage, although basic research data are available, clinical evidence is lacking. Children are not the only victims of joint toxicity caused by quinolones, and adults are unfortunately also immune. It is safe to properly grasp the indications, doses, and treatment courses to prevent abuse.

(2) Considering the factors of pharmacodynamics: the dosage, dosage form, administration route, and medication plan of the drug can affect the efficacy. Choose a reasonable dose, administration route, and medication plan to achieve the best effect.

Antibiotics can be divided into three categories according to their bactericidal activity and sustained effects:

1. Concentration-dependent bactericidal and antibacterial effect. Such as aminoglycosides and quinolones, the higher the concentration, the bactericidal rate and bactericidal range increase correspondingly. This class of drugs has an antibacterial effect, prevents the continued growth of bacteria, and can extend the interval time when used, which is a great advantage for children. .

2. Time-dependent and extremely short after-effects, such as -lactam antibiotics, they only have a minimal concentration-dependent bactericidal effect on most bacteria. No matter how high the blood concentration is, they cannot kill bacteria more and faster. This kind of antibiotic lacks after-effect, and the antibacterial concentration decreases with time and the antibacterial effect weakens. Therefore, the interval between medications must be shortened, and the medication should be administered every 8 hours or even every 6 hours or continuous intravenous drip.

3. It is time-dependent and has after effects, such as macrolides and vancomycin. Therefore, for different drugs with different pharmacodynamics, different medication schemes should be selected.

(Three) from the perspective of pharmacokinetic factors: different drugs, different individuals, drug absorption, distribution, metabolism and excretion are not the same, clinically consider pharmacokinetics, according to the length of half-life to give different intervals to achieve continuous The blood drug concentration exceeding MIC, for example, the half-life of penicillin is 1 / 2-1h. After a large dose of 6 and a half-life, that is, 6h, the body will be basically cleared, and bacteria will start to grow again. Therefore, the effective blood drug concentration must be maintained every Dosing once every 4-6h, only 1-2 times a day for the convenience of administration, will inevitably affect the efficacy.

(D) the stability of the drug: the activity of the antibiotic after preparation is affected by temperature, sunlight, and the acidity and alkalinity of the solution, so it is not advisable to continue the drip in the clinic to maintain the blood concentration. For example, penicillin can produce penicillin enoic acid and penicillin thiazole protein after mixing. Compared with freshly mixing, the activity is weakened and the possibility of allergic reactions is increased by more than 8 times.

Personalized medicine

When choosing medicines and dosages, it is generally not appropriate to directly administer medications taken by adults to children. If administered in the manner of adult administration, accumulation poisoning is prone to occur, so the dosage of children should be considered; the individual characteristics of children should also be considered , Such as the age, strength of the body, the severity of the disease, the quality of liver function, and what medicines have been used before and whether there is a history of allergies, such as children's individual medication, but also pay attention to children's previous medication tolerance Ability, etc. in order to achieve reasonable medication and obtain the desired therapeutic effect.

However, with the completion of the Human Genome Project and the advent of the post-genomic era, it is no longer enough to conduct so-called "individualized medicine" from the perspective of age, gender, and health status. A large number of biomedical research results show that the vast majority of individual differences in drug response are caused by genetic factors, that is, the genetic type of drug metabolism of patients determines the individual differences in drug response.

The individualized medicine in the true sense is the use of advanced molecular biology technology (including DNA chip technology) to interpret the drug-related DNA (drug metabolism enzymes, transporters and receptor genes) of different individuals. The DNA is different, and the body treats specific drugs. The metabolic capacity is different, which is directly related to the efficacy and toxic side effects of the drug.

Studies have found that part of the difference in the body's response to anti-infective drugs lies in mutations in specific DNA. If these drugs are metabolized slowly in the body, the metabolites are not easy to be excreted from the body, and they are likely to accumulate and cause side effects such as dizziness, excitement, insomnia, palpitations, abdominal pain, nausea and vomiting, and severe cases may cause liver damage; therefore, clinicians can DNA type data is used to implement the administration plan, and the patients are rationally administered in a "tailor-made" manner, such as which anti-infective drugs are suitable for each child or the dosage of these drugs, in order to improve the efficacy of the drug and reduce the toxic side effects of the drug At the same time, it alleviates the pain and financial burden of children, and supports children with safe medication protection umbrellas, so that they can grow up healthy under the bright sun.