中国人滥用了多少抗生素？
2009年03月25日10:50 中国新闻网
中国抗生素滥用的根本原因，是制度缺陷、监管不力。按照目前的态势发展，“新的‘超级细菌’还会陆续出现，10～20年内，现在所有的抗生素对它们都将失去效力”
内文导读：
抗生素的中国式滥用 抗生素如何催生超级细菌
抗生素80年 一个研究所的坚持
被滥用的抗生素
黄小洁的相亲再次宣告失败。对方是一个军官，回复介绍人的理由是“她的牙齿不健康”。
这已经是黄小洁的第N次相亲失败了，并且依然是同一个失败原因。作为护士的黄小洁拥有清秀的相貌和苗条的身材；影响她相亲结果的，是她一口灰黑色的牙齿——典型的“四环素牙”。
黄小洁只是千千万万个因小时候过多使用四环素来治病而导致“四环素牙”的受害者之一。从上世纪60年代到80年代，四环素在中国一度被当成了“万金油”在使用。
然而，随后更多种类抗生素的全民式滥用，留下的就不再只是如同“四环素牙”一样的简单印记，而是催生了具有强耐药能力、医生对它几乎束手无策的“超级细菌”——今天，具有强耐药能力的金黄色葡萄球菌在医院内感染的分离率已高达60%以上；抗生素滥用的结果是我们不得不付出生命的代价。
如果从弗莱明1929年发表《论青霉菌培养物的抗菌作用》论文算起，抗生素与人类疾病的作战已历80年。然而，当第14个世界防治结核病日(3月24日)来临之际，我们却得到了这样一组数据：目前全世界每年新增将近1000万个结核病病例，每年约有300万人死于结核病；单在中国，目前就有活动性肺结核病人450万。
曾经因为抗生素的杀菌威力而一度近乎绝迹的结核病卷土重来。更要命的是，今天的结核病病菌多数是具有强耐药能力的所谓“超级细菌”，我们仿佛又回到了无抗生素时代。
导致这一结果，我们每一个人都有责任——正是因为我们每一个人对抗生素的滥用，促使细菌进化至耐药；同时，曾经遥远的“超级细菌”现在已经与我们每一个人都极度接近。
2009年世界防治结核病日的宣传口号仍为“我来控制结核病”。作为一个普通人，我们针对这一主题切实的做法就是：从现在开始，珍惜仅存的抗生素资源，停止对抗生素的滥用。
抗生素的中国式滥用
中国抗生素滥用的根本原因，是制度缺陷、监管不力。按照目前的态势发展，“新的‘超级细菌’还会陆续出现，10～20年内，现在所有的抗生素对它们都将失去效力”
本刊记者/蔡如鹏 严冬雪 文/李赫然
2009年春节后不久，北京协和医院感染内科的主任医师刘正印碰到了一个棘手的病人。
患者是重症监护病房一名年仅21岁的女孩，刚刚接受了肺移植，但医生就在她的胸水和痰液中发现了高度耐药的鲍曼不动杆菌。
“它能抵抗我们手头的几乎所有抗生素。”刘正印对《中国新闻周刊》说，这种微生物仅对一种名叫多粘菌素的药物敏感。多粘菌素是一种很老的抗生素，“但由于对肾脏有严重的损伤，早已退出市场”。
事实上，即使能找到多粘菌素，刘正印也不敢用，因为病人恰巧患有肾功能衰竭。“拿到化验报告后，我边看边问自己，还有什么办法能对付这种‘超级细菌’呢？”这位传染病专家回忆说。
所谓“超级细菌”，是指那些几乎对所有抗生素都有抵抗能力的细菌，它们的出现恰恰是因为抗生素的使用。
刘正印说，这名携带“超级细菌”的患者，在13岁时就被诊断出肺部囊性纤维化——这是一种极易受到细菌感染的疾病。因此，在过去的8年，“她一直在反反复复地使用各种抗生素”。大量的抗生素虽然杀死了无数试图侵蚀女孩的细菌，但也“锤炼”出了不再害怕它们的“超级细菌”。
“超级细菌”的诞生
这已不是刘正印第一次遇到“超级细菌”了。
他告诉《中国新闻周刊》，如今“超级细菌”的名单越来越长，包括产超广谱酶大肠埃希菌、多重耐药铜绿假单胞菌、多重耐药结核杆菌。其中，最著名的一种是耐甲氧西林金黄色葡萄球菌(简称MRSA)。
金黄色葡萄球菌是一种常见的病菌，可引起皮肤、肺部、血液、关节感染。当年，弗莱明偶然发现青霉素时，用来对付的正是这种病菌。
在抗生素发现之前，金黄色葡萄球菌是医院的主要杀手之一，医生拿它根本没有办法。青霉素的问世，使它的猖獗有所收敛。但随着青霉素的广泛使用，某些金黄色葡萄球菌开始出现了抵抗力，能产生青霉素酶，破坏青霉素。
为了对付耐药的金黄色葡萄球菌，科学家又研制出一种半合成青霉素，即甲氧西林。1959年应用于临床后，取得了很好的疗效。然而，道高一尺魔高一丈，仅仅时隔两年，在英国又出现了耐甲氧西林的金黄色葡萄球菌——MRSA。
MRSA对许多抗生素都有耐药性，进化出来后，以惊人的速度在世界范围内蔓延。据估计，每年大约有数十万人因此而住院治疗。
中国尽管到了20世纪70年代才发现MRSA，但这种“超级细菌”蔓延的速度却十分惊人。1978年，医务人员在上海抽检了200株金黄色葡萄球菌，分离出的MRSA还不到5%。“而现在，MRSA在医院内感染的分离率已高达60%以上。”北京大学临床药理研究所肖永红教授告诉《中国新闻周刊》。他刚刚完成了一份针对中国抗生素滥用问题的研究报告。这意味着，在医院的病人体内，有超过六成的金黄色葡萄球菌，是难以杀灭的MRSA。
与MRSA同样具有强耐药性的泛耐药肺炎杆菌、泛耐药绿脓杆菌，则对所有已知的抗生素耐药，它们被称为“超级细菌”。
2006年10月，肖永红承担了中国科学技术协会的重大政策性研究课题“抗生素滥用的公共安全问题研究”。课题组对北京、湖北、四川、山东、宁夏五省市区的调查显示，目前国际医学界公认的“超级细菌”在中国已十分普遍，它们已经成为医院内感染的重要病原菌。
事实上，医院正是“超级细菌”产生的温床。美国传染病学会前主席罗伯特·莫勒林说，MRSA最早就出现在重症监护病房中。10年以前，有关它的所有病例，都发生在医院或者疗养院里。
“它们之所以在医院里流行，是因为那里使用抗生素频率与强度最大。”肖永红说。他们调查发现，在中国住院患者中，抗生素的使用率达到70%，外科患者更是几乎人人使用，比例高达97%。
“由于缺乏相关知识，人们常认为抗生素就是退烧药、消炎药。能用高档的就不用低档的，能合用几种抗生素就不单用一种，能静脉滴注就不口服。这些做法无不助推了‘超级细菌’的肆虐。”卫生部抗菌药物临床应用监测中心顾问专家、来自复旦大学附属华山医院抗生素研究所的张永信教授惋惜地说。
与此同时，不论是医生还是患者都乐意使用新型、广谱抗生素，而这些本来是应该用于严重感染、挽救患者生命的。肖永红说，医院使用最多的10种抗生素中，超过一半都是新型抗生素。
耐药性越强，意味着感染率和死亡率越高。肖永红等专家调查发现，在住院的感染病患者中，耐药菌感染的病死率(11.7%)比普通感染的病死率(5.4%)高出一倍多。也就是说，如果你感染上耐药菌，病死的几率就增大了一倍。
据此推算，2005年全国因抗生素耐药细菌感染导致数十万人死亡。
抗生素无处不在
抗生素，中国人习惯叫“消炎药”，作为家庭的最常备药，人们只要有点儿头痛发热，都会习惯性地吃上几片。
肖永红等人调查推算，中国每年生产抗生素原料大约21万吨，除去原料出口(约3万吨)外，其余18万吨在国内使用(包括医疗与农业使用)，人均年消费量在138克左右——这一数字是美国人的10倍。
“可以说，当今几乎没有一个人一辈子未曾用过抗菌药。”张永信教授这样介绍抗菌药物。以拥有1600万人口的上海市为例，近五年的抽查发现，40多家样本医院使用的各类药物中，抗菌药物的费用高居首位，年消耗5亿～9亿，约占全部药品费用的1/3。
在所有药品里，消费前十位中，抗生素占去半壁江山，如头孢拉定、头孢曲松、环丙沙星、左氧氟沙星等。
“由这些数据可见，抗菌药是何等常用。感染虽然仍在威胁着我们的健康与生命，但毕竟已不是国人死亡的首要病因，其药费却仍占首位，那就难以解释了。”张永信说，对于当今抗菌药物，尤其是抗生素，人们需要有正确的认识。
据1995～2007年疾病分类调查，中国感染性疾病占全部疾病总发病数的49%，其中细菌感染性占全部疾病的18%～21%。也就是说，真正需要使用抗生素的病人数不到20%，80%以上属于滥用抗生素。
在肖永红看来，中国是世界上抗生素滥用最严重的国家。由于抗生素滥用，在中国，细菌整体的耐药率，要远远高于欧美国家，大约在45%左右。
上海市长宁区中心医院妇产科主任左绪磊告诉《中国新闻周刊》，因为分娩感染，妇产科长期以来都是抗生素滥用重灾区。根据他们科室多年来的监测显示：目前青霉素的耐药性几乎达到100%，在这种情况下还使用抗生素，除了浪费钱财，并无其他意义。因此，在长宁区中心医院妇产科，左绪磊对科室医生们的抗生素使用有着严格的控制。
与此同时，抗生素在养殖业中的应用突飞猛进。“在中国，每年有一半的抗生素用于养殖业。”肖永红说。然而，这些药物并非用于治疗生病的动物，而是用于预防动物生病。因为目前大规模集约化饲养，很容易爆发各种疾病。
另外，在饲料中添加抗生素，可以促进动物生长，这已是养殖业内通行的做法。有一种理论说抗生素杀死了肠内细菌，减少了它们对能量的需求，使得动物能够获得更多的食物，因此长得更快。
但这样做的后果是，在农场周围的空气和土壤中、地表水和地下水中、零售的肉和禽类中，甚至是野生动物体内到处都充斥着抗生素。这些抗生素可以通过各种途径，在人体内蓄积。它不仅会导致器官发生病变，而且能把人体变成了一个培养“超级细菌”的小环境。刘正印告诉《中国新闻周刊》，现在有许多携带“超级细菌”的患者，既没有传染病史，也没有住过医院，病因十分蹊跷，“这很可能与环境有关”。
抗生素滥用问题引起科学家和政府注意
政策：有制定，无执行
抗生素滥用问题在中国很早就引起了科学家和政府的注意。
卫生部合理用药专家委员会副主任委员吴永佩对《中国新闻周刊》回忆说，在2001年，他就受卫生部委托，开始参与编写《抗菌药物临床应用指导原则》。这一原则于2004年颁布实施，并首次在中国国内建立系统的“细菌耐药监测网络”。张永信也参与了这一条文的制定，他告诉《中国新闻周刊》，在这份《指导原则》中，全面系统地把中国细菌状况、抗菌药物情况、合理用药原则(比如什么情况要口服，什么情况要注射，什么情况要静脉给药，什么情况下要多药联合)都规定清楚，目的就是规范医生用药。
“但由于执行力度不够，问题依然很严峻。”吴永佩说。
2003年6月，SARS席卷中国期间，哈尔滨医科大学校长杨宝峰发表论文《滥用抗生素的危害与“非典”发生的启示》，文中指出：在举国上下抗击SARS的战斗中，更应充分认识到滥用抗生素带来的危害，更应加强抗生素使用管理，防止广大人民群众和医务人员为防治SARS而滥用抗生素，在短时间内出现耐药微生物的急剧增加，再次引发新的问题。
其后，新华社记者据此论文写成“内参”，被国家有关领导人阅读后作出重要批示。以致SARS期间，关于如何在中国实现抗生素科学使用的具体建议，被下发到各省有关部门。
令人惋惜的是，这并未阻止抗生素类药物在SARS期间的大量使用。在90多家医药类上市公司里，1/3的上市公司牵扯到SARS药品的生产，其中真正获益的主力即为生产抗生素的企业。华北制药、鲁抗医药、华北制药、白云山等医药公司，其一线的销售业绩和该公司的股市表现一样全面飘红。
而丽珠集团在2003年公布的一季度报表显示：该公司主营业务利润比去年同期增长0.8亿元，主要原因是罗红霉素、抗病毒颗粒等抗生素原料药销售收入增长所致。而事实上，用于杀灭细菌、立克次氏体等微生物的抗生素，并不能对SARS病毒产生抑制作用。
2009年1月9日，吴永佩在“全国基层医疗机构抗菌药物临床合理应用培训计划”的启动仪式上说，“不合理用药最重要的原因之一，是医师用药知识的不足”。这个由卫生部开展的计划将对3万～4.5万名基层医务人员进行培训，以改善中国医疗机构抗生素滥用的现状。
60年来，中国的药品种类从400多种猛增到7000种左右，不少医生对一些抗生素使用的基本原则还都没了解，特别是在基层。
然而，有些医生过度使用抗生素并不因为是知识欠缺，而是由于各种压力。肖永红说，中国的医院50%左右的收入来自于药品，而抗生素占所有药品收入的25%左右。多开抗生素，就意味着广开财路。与此同时，老百姓把它看成“万能药”，他们甚至会主动要求医生多开一些，大部分医生都会满足患者的要求。
肖永红认为，中国抗生素滥用的根本原因，是制度缺陷、监管不力。
拉锯战进入关键时刻
在抗生素的黄金时期——20世纪60到80年代，随着越来越多抗生素的发现与使用，面对细菌，人类似乎一下子拥有了大批武器。遇到很多葡萄球菌感染病例，医生们大都不假思索地注射青霉素，效果显著。
但人们也很快发现，事情在悄悄起变化。以青霉素作为案例来说，它刚投入使用的时候，一天用100、200个单位就很有效了，后来使用剂量明显上升，再后来，即使剂量上升药效也很差。到了今天，即使是治疗普通的呼吸道炎症，一袋注射用生理盐水(250ml)中需加入青霉素剂量为1000万个单位——用量上升了数十万倍。
“不是青霉素不好了，是敌人变得越来越狡猾、强大了。”张永信说，一些青霉素产生的酶可以耐药，科学家们就研发一种酶抑制剂，使青霉素的作用继续得以发挥。这一做法，相当于清扫阻挡青霉素生效的障碍，后来这种方法被广泛应用，作用又慢慢下降。
“情况非常严重。在人跟细菌的斗争当中，抗生素产生之后，开始的那些年都是我们领先的；但是拉锯战拉到现在，人和它的距离越来越短了。”张永信说，尽管如此，今天人类仍然走在细菌的前头。“然而，五六十年代我们是远远地、大步地走在细菌前头。那时候只有几种抗菌药，但在临床做医生却潇洒得很——因为就这几种药，疗效都很好。而现在有这么多的药，就是效果不灵。”
研究抗生素的科学家还在绞尽脑汁，但要考虑到如果有一天，所有抗生素都对那些细菌产生不了作用怎么办？张永信说，不仅是医生、药师，所有的老百姓都应看到这样的局面。“大家都要珍惜现有临床中有效的抗菌药物，每一个地球上的人都要非常爱惜地使用它，该用的时候才用，该用多少用多少。”
在肖永红看来，抗生素和石油、煤炭一样，也是一种不可再生的自然资源。“新的‘超级细菌’还会陆续出现，或许10年～20年内，现在所有的抗生素对它们都将失去效力。”他的结论让人不寒而栗。
抗生素如何催生超级细菌
从长远来看，MRSA这类“超级病菌”将会在全世界流行，并对越来越多的抗生素产生抗药性。“超级细菌”的产生，究竟是因为抗生素刺激细菌产生变异，从而具有了抗药性呢，还是本来就存在着少数变异菌株，而抗生素只不过进行了筛选，使得有耐药性的突变株生存下来，占了优势？
也就是说，耐药性的产生，究竟是因为用进废退，还是自然选择？微生物学家已经用实验证明：细菌在接触抗菌药物之前，就已存在具有耐药性的突变株。而抗生素等抗菌药物的使用，实际上是对细菌进行了一次自然选择，在绝大多数普通细菌被杀死后，原先并不占数量优势的、具有耐药性的“超级细菌”存留下来开始大量繁衍，并占据主导地位，使得抗生素使用剂量越来越大，失效的抗生素也越来越多。
因为“超级细菌”的先天存在，细菌的耐药性是不可避免的。然而，这并不意味着人类对此不可控制。近年来，越来越多的微生物学家、医学家开始呼吁：阻止“超级病菌”流行的重要手段，便是立即停止滥用抗生素。
袁钟：思维习惯导致中国式滥用
缺乏科学思维方法、过分的实用主义以及追求速效的心理导致中国老百姓“自愿”滥用抗生素
本刊记者/方玄昌(整理)
全世界都存在抗生素滥用的问题。但与欧美国家相比，中国的情形可能更加严重。在经济因素、社会因素之外，我们还可以从文化的角度、从中国人的思维习惯方面找到中国人滥用抗生素甚于他国的原因。
中国人缺乏科学观，这是下面一切问题的根源所在。科学需要高度理性，而中国却是一方极为感性的土壤；加上科学没有诞生在东方，结果，中国人对它产生了一种抵触、敬畏和迷信同时存在的矛盾心理。一方面，人们看到了科学的力量；而另一方面，科学的力量是有限的，但中国人从来更愿意去迷信那些“全能”的事物。
在见证到科学的强大力量之后，他们不自觉地就把科学给神化了，把它看成是无所不能的。对药本身就存在的一种崇敬、迷信，导致中国人自古就在寻找能够包治百病的“灵丹妙药”。而类似于抗生素一样见效快的药物，则自然很容易地被当成万能的药物来使用。
中国人过分讲究实用主义。19世纪末，基督文化很难进入中国，但基督医学却很容易就进来——人们看到了它的快速有效。恐怕在中国人眼中，最能体现现代医学(俗称“西医”)特性的，就是手术和抗生素，它们都有效果明显、见效快的优势。这种“打倒土豪就能分到田地”“求用大于求真”的心理一直保持到现在，导致人们只管眼前效果，至于使用抗生素之后可能出现的问题，他们不会太多去考虑。
“眼见为实”的思维习惯有时会欺骗你。一个街头卖艺的人，都会先表演一下他的“绝技”，让人们见证了他的本领，然后就能把他的膏药、跌打药卖出去——其实，他的“绝技”和跌打药的用途之间并无必然关系。同样，人们看到了抗生素在对付一些感染性疾病时所显示出的威力，于是就把它泛化，用它来对付一切疾病。
追求“立竿见影”的倾向有时是不明智的。在中国，一个病人去找医生，医生如果告诉他“这种治疗三个月以后才会产生效果”，病人恐怕不会再愿意来找这个医生了。所以一些本来应该让它慢慢好起来的病，医生也会想方设法去找那些见效快的药物或者疗法。一些疾病本来根本不需要吃药，在美国和欧洲，很多疾病是只有诊断没有治疗、任其自愈的；但在中国，一个医生不给开药，病人反而接受不了——这就是讲究“立竿见影”“吹糠见米”带来的问题。而抗生素恰好具有这样的优点：效果来得快而明显。在这样的情况下，人们很容易忽略它的不足，进而导致滥用。
(袁钟，协和医科大学出版社社长、中国医学科学院院长助理，研究方向为医学哲学、医学史)
抗生素80年
人类寿命的增加，约有10岁得益于抗生素的广泛使用；今天抗生素的开发已近枯竭，而已经严重依赖于抗生素的人类，比任何时候都更迫切地需要新型抗生素
本刊特约撰稿/张功耀 本刊记者/蔡如鹏
1941年2月，伦敦拉德克利夫医院。48岁的警察艾伯特·亚历山大因伤口化脓感染，正濒临死亡边缘。
亚历山大是因为刮脸不慎划破皮肤，引发细菌感染的。在那个年代，由于缺乏特效药，感染就意味着死亡。尽管医院使用了当时最好的抗菌药——磺胺，但亚历山大的病情仍不断恶化。无奈之下，医生摘除了他的一个眼球引流脓肿，希望能控制病情，结果反而是肺部也开始出现感染。
看着病菌一步一步吞噬亚历山大的肌体，无计可施的医生决定，用牛津大学病理学系刚刚送来的一种仍在实验中的药物试一试。这是一种看上去有点像玉米淀粉的黄色粉末，溶解后，每隔3小时给感染者注射一次。
几次注射后，奇迹出现了——亚历山大的炎症开始减退，体温也恢复了正常，他甚至可以坐起来进食。
但一茶匙的药很快就用完了，亚历山大的病情再次恶化。由于仍处于实验阶段，牛津大学也没有更多的药物。为了能继续治疗，医生甚至把亚历山大的尿液收集起来，从中提取残留的药物，以挽救他的生命。
亚历山大终究没有逃脱病菌的魔爪，不久就离开了人世。但这种神奇的黄色粉末却给医生们留下了深刻的印象——它是一种杀灭细菌的强有力的武器。
这种新药就是青霉素。
艰难的无抗生素时代
远在公元前1550年的古埃及，就有医生用猪油调蜂蜜来敷贴，然后用麻布包扎因外伤感染而发炎红肿的暑疖、疔疮和无名肿毒。最近，有人对古埃及人发明的这个方法进行了药理学考据，证实了它的有效性和安全性。其机理来自两个方面。一是蜂蜜具有困住细菌并从细菌身体中吸收水分，最后导致细菌因干渴而死的作用；二是蜂蜜中含有一种抑菌霉，具有抑制细菌繁殖甚至消灭细菌的功能。但是，古埃及人只是这么做，并不知道这么做的医学意义在于抑菌。
得出许多疾病是由于微生物感染而引起的这个认识，是微生物学的奠基人巴斯德的功劳。可以感染人体引起人类疾病的微生物有五类：细菌(如大肠杆菌)、病毒(如冠状病毒)、真菌(如扁平苔藓)、原生生物(如疟原虫)、蠕虫(沙虫)。其中，能够被抗生素有效杀灭的是细菌。
著名的美国科学史家乔治·萨顿在他的《科学史导论》中发表评论说：“战争是外科之母。”战争需要外科，可是外科的安全又由什么来保证呢？
19世纪60年代，一位名叫辛普森的外科及妇产科医生发出感慨说：“躺在任何一家医院手术台上的病人，都要比滑铁卢战场上的士兵具有更多的死亡机会。”中国古代典籍《汉书·外戚传》有“妇人免乳大故，十死一生”的说法。到了公元5世纪，还有描述妇女生产时“下地坐草，法如就死也”(陈延之《小品方》)的恐怖记载。可见，当时，因为外科手术和生产而引起的死亡率是何等的高。
值得指出的是，因为外科和生产而引起的死亡，都是在外科手术或生产之后发生的。在19世纪60年代，外科手术之后的死亡率在40%～60%之间。可见，外科要成功、妇女生产孩子以后还要平安，须待医学科学取得新的进步。
1867年英格兰外科医生李斯特首创石炭酸(化学名为“苯酚”)消毒法，改变了手术前景，使原来手术后感染的死亡率由60%下降到了15%。如果先在妇女生产的房间喷洒石炭酸，也可以大大提高妇女生产以后的存活率。
但是，石炭酸消毒法有一个缺点，它只能进行表面消毒，不能进行体内深层次的“杀毒”(灭菌)。梅毒感染曾经是一种流行性的性病，对于这种深层次的细菌感染，用石炭酸进行表面消毒是无效的。巴斯德学说指出的细菌感染，绝大部分属于细菌进入人体深层次以后出现的感染。
伟大的发明
如何才能在人体内杀灭这些细菌，同时又做到对人体无害呢？
1910年，德国医生埃尔利希在经历605个化合物配方实验的失败以后，在第606个配方实验中取得了成功，它就是现在还在用的阿斯凡纳明，代号“埃尔利希606”。它既能杀死侵入人体内的梅毒细菌，又不伤害宿主。这个药物的问世，开创了化学药物疗法的新纪元。1940年，埃尔利希的这个伟大发明被搬上银幕，片名叫“埃尔利希医生的魔弹”。以后的抗生素(不属于化学药物疗法)都是按照“埃尔利希魔弹”已经达到的安全性目标来开发的。
1932年，德国化学工业巨头克拉尔合成了一种鲜艳的橙色染料。同年，细菌学家兼药物学家多马克尝试着用这种染料来杀灭链球菌，首先在老鼠身上实验成功，同样能够满足“埃尔利希魔弹”那样的要求。就在这个时候，多马克6岁的女儿被刺绣针扎了一下，发生了链球菌感染并扩散到了淋巴结，引起了严重的败血症。当时的医生主张截肢，甚至说，即使截肢也不能保证保全性命。多马克冒险给女儿注射了这种药，取得了成功。这就是可以使生产妇女免受产褥期败血症威胁的百浪多息。它的问世，标志着抗生素时代的开始。多马克因此获得了1939年的诺贝尔奖。
接下来最著名的就是青霉素。它开始于英国科学家弗莱明在1922年的一个伟大发现。在这一年，弗莱明从人体鼻腔分泌物中观察到一种酶，即“溶菌酶”，具有抵抗微生物的能力。一种微生物能够抑制另一种微生物生长的这种现象，微生物学中就叫做“抗生现象”。6年以后的1928年，弗莱明又发现一种抗生现象，那就是青霉素的抗生作用。次年，他发表了题为《论青霉菌培养物的抗菌作用》的论文，这一年被视为“抗生素元年”。
但是，青霉素极不稳定，提纯很困难。直到1941年，一个受希特勒排挤的犹太裔德国人钱恩(这位科学家与爱因斯坦有着相似的命运，居然连长相也与爱因斯坦相似)，逃离德国到了英国，与来自澳大利亚、在牛津大学做访问学者的弗洛里合作，成功分离出了青霉素。可是，虽然分离成功，英国却没有能力支持生产这种药品。
1944年，在美国洛克菲勒基金会提供5000美元的资助下，青霉素终于首次在美国生产出来了。很快，它被投入第二次世界大战的战地救护，拯救了许多濒临死亡的盟军将士的生命。就连患了肺炎的英国首相丘吉尔，也是靠它才得以恢复健康。
青霉素的成功轰动了全世界，人们把它同原子弹、雷达并列为二次大战中的三大发明。不同的是，原子弹和雷达是用于战争，而青霉素则是用于挽救生命。1945年，弗莱明、弗洛里和钱恩，因发明青霉素而共同分获了诺贝尔医学或生理学奖。
“淘菌时代”
青霉素进入临床后，虽然治愈了多种细菌性传染病，但对结核病却束手无策。
在20世纪40年代以前，结核病被称为“白死病”。人们把它与中世纪的“黑死病”(鼠疫)相提并论，因为在19世纪的欧洲，它是引起死亡最多的一种疾病。在很多文学作品中，结核病患者苍白的脸色和带血的手绢，甚至成为那个时期人物的典型特征。
青霉素成功后，人们迫切地期待能再找到一种同样强大的抗菌药，帮助人类战胜结核病。完成这一使命的是土壤微生物学家瓦瑟曼。
瓦瑟曼出生于乌克兰，1913年移民到美国，在加利福尼亚大学获得生物化学博士。他对土壤中一类叫放线菌的微生物非常感兴趣。
放线菌产生抗生素的能力很强，据说1932年瓦瑟曼就曾观察到这一现象，但他当时并没有在意。直到1939年，瓦瑟曼注意到医学界正大力寻找各种抗菌药，才改变研究方向，集中力量从放线菌中探索杀灭细菌的物质。
瓦瑟曼抛弃了传统的靠碰巧来分离抗生素的方法，开始通过筛选成千上万的微生物来有意识、有目的地寻找抗生素。
从1939年到1943年，瓦瑟曼从土壤中共分离出1万株放线菌，发现其中有10株能够产生对病原细菌有抑制作用的抗生素。然而，由于大部分放线菌毒性太大而无法应用于临床。
转机出现在1943年。这一年，瓦瑟曼终于分离出一株灰色的放线菌，它产生的抗生素不仅能杀死结核杆菌，对人体也没有毒性。瓦瑟曼把这种抗生素命名为链霉素，并发表了研究报告。
这一发现，很快就被默克公司获悉了。在这家美国最大的制药企业支持下，1947年初链霉素就投入了市场。
链霉素虽然不是第一个问世的抗生素，但引起的轰动一点不亚于青霉素——因为它征服的是“白死病”。 链霉素的发明使得美国1904年以前10万肺结核患者死亡188人的比率下降到1953年每10万患者死亡4人。1952年，瓦克斯曼因发明链霉素而获得诺贝尔医学或生理学奖。
瓦瑟曼的成功不仅挽救了许多结核病患者的生命，更重要的是，为其他科学家指明了寻找抗生素的方向——土壤放线菌。迄今为止，大多数临床应用的抗生素都来源于这类微生物。
此后，开发抗菌药的微生物学家纷纷来到污水沟旁、垃圾堆上、沃野之中“淘金”——采集样本、筛选菌种，揭开了大规模筛选抗生素的时代。
金霉素(1947)、氯霉素(1948)、土霉素(1950)、制霉菌素(1950)、红霉素(1952)、卡那霉素(1958)等都是在这期间发现的。这一时期，抗生素研究也进入了有目的、有计划、系统化的阶段，还建立了大规模的抗菌素制药工业。
从1910年埃尔利希发明阿斯凡纳明算起，到2005年，抗生素家族成员已经增加到133个，它们都为人类征服疾病做出了巨大的贡献。统计资料显示，今天人类的寿命较上世纪初增加了近20岁之多，其中约有10岁得益于抗生素的广泛使用。
抗生素枯竭？
进入20世纪60年代后，人们从自然界中寻找新的抗生素的速度明显放慢，取而代之的是半合成抗生素的出现。1958年，希恩合成了6-氨基青霉烷酸，开辟了生产半合成青霉素的道路。
20世纪50年代至70年代，是抗生素开发的黄金时期。新上市的抗生素逐年增多，1971年至1975年达到顶峰，5年间共有52种新抗生素问世。但从上世纪80年代开始，每年新上市的抗生素逐年递减。1996年至2000年的5年中，只开发出6种新抗生素。进入新世纪后，这一趋势变得更加明显。2003年全球仅一个新产品——达托霉素上市，而2004年竟是空白。
造成这种局面的一个原因是，现在抗生素的开发正变得越来越难。在过去的80年里，科学家已经发现了20多类抗生素，几乎把所有能够找到的微生物都翻了个遍。
另一个原因则是，新抗生素的开发速度远远跟不上细菌耐药发生的步伐，导致研制的利润大不如前，制药公司缺乏热情。在最初上市的20年，青霉素的疗效无与伦比，给当时的制药公司带来了大量的利润。但今天一种新型抗生素问世，甚至不到几个月，就会出现耐药细菌。
2000年，辉瑞公司的利奈唑烷获准上市，曾在医学界引起轰动。因为它是世界第一个人工合成的恶唑烷酮类抗生素，被寄予厚望。但仅仅不到1年，就出现了肠球菌对利奈唑烷耐药的报道，迫使人们不得不寻找新的抗生素来替代其进行治疗，而一个新抗生素从研发到上市至少需10年，投资10亿美元左右。
如今，一些大型制药公司纷纷把研发重点，转向利润更丰厚的抗癌药物和艾滋病药物上，并不热衷开发新型抗生素——与此同时，已经严重依赖于抗生素的人类，现在比任何时候都更迫切地需要新型抗生素。
非议：抗生素的10大“罪状”
根据美国疾病控制中心提供的数据，美国国内2008年发生的因使用抗生素而送往急救的人数达142505人，占美国全国全部急救人数的19%。其中，78%属于抗生素过敏。但是，没有报道因使用抗生素而死亡的病例。
据印度新德里的MeDiCaLGeeK公司主办的《V版》网2008年8月发表的英文稿《认识抗生素的副作用》，印度也有超过7%的患者因药物反应需要急救。其中，16%属于使用抗生素引起的药物反应。这个数字比美国低，但情形依然是严重的。根据印度的报道，抗生素引起的药物反应主要有五个方面的表现：过敏、心律失常、内分泌紊乱、药物干扰和皮肤出现红疹。其反应类型可以分为四种：一是直接的过敏反应；二是细胞毒素反应；三是迟滞机体免疫反应；四是间接细胞反应。
美国的劳伦斯·威尔森医生2008年10月发表网络文章为抗生素列举了10大“罪状”：
1。增加患癌症的风险。
2。过敏反应。
3。解构肠内有益菌丛，破坏肠内“生态”。
4。增加微生物的耐药性。
5。迟滞免疫功能。
6。假丝酵母菌(如念珠菌)过分增多并引起对肠子更有害的感染。
7。引起慢性疲劳综合症。
8。由于抗生素虽然没有直接伤害人体，但它解构了体内的有益细菌，降低了肠胃功能，妨碍了矿物质的吸收，而使患者沦为营养不良。
9。疗效虚假。有些疾病不使用抗生素也能好。
10。成本太高。
劳伦斯·威尔森并不否认抗生素在治病救人中的独特作用和崇高地位。抗生素之所以出现那么多的问题，比率又那么大，悉归于抗生素的滥用。劳伦斯·威尔森引述2000年前后的一个抽样统计数据说，全美每周产科医生和妇科医生开出的含抗生素的处方2645000个，内科医生每周开出含抗生素的药方1416000。仅此两类医生每年开出的含抗生素药方就高达211172000个。拿这个数字去除每年因使用抗生素而需要急救的总人次数，则使用抗生素出现需要急救的概率是0.67‰。这个比率并不高。很明显，问题出在滥用。如果降低抗生素的使用率，因滥用抗生素而需要急救的人次数就要大大降低。
“超越”抗生素
1994年，美国两位营养医学医生Keith Sehnert和Lendon Smith出版了一本著作“Beyond Antibiotics: 50 (Or So) Ways to Boost Immunity and Avoid Antibiotics”，在全世界引起了相当大的反响。中国台湾的原水文化出版社出版了它的中文版。译作者把正标题翻译成“破解抗生素迷思”，副标题翻译成了“50个不用抗生素的免疫力提升法”。这个翻译容易给人一个错误印象，似乎人们此前在用抗生素提升免疫力。其实，原书名的“提升免疫力”和“避免使用抗生素”是各自独立的。
这本书是针对滥用抗生素而写的。作者建议通过一些营养医学手段来替代抗生素的治病作用。对于作者的这个设想(仅仅是设想)，医学界存在不同的看法。反对的评论认为，滥用抗生素与人体免疫力下降的关系并不明显，试图通过营养医学途径来重新提升人体免疫力，这个想法的前提并不充分。况且，没有证据可以证明营养医学方法可以杀灭那些导致人类疾病的细菌。赞成的评论认为，许多现代医学使用抗生素的场合，使用传统的营养医学方法也能解决问题。这种评论明显缺乏足够的科学依据，来证明医学营养学方法的确可以征服病菌。
不过，不管赞成还是反对，我们应该“超越抗生素”，这是得到医学界广泛认同的一个提法。
那么，如何才能超越抗生素呢？
首先是新方法的探索。抗生素被滥用导致的危害已经有目共睹，它如今来到了一个被新方法超越的前夜。到目前为止，试图通过建立杀菌的新方法来替换抗生素的思路有三个：噬菌体杀菌法、细菌素杀菌法和益生菌方法。
其次是减少对抗生素的依赖。现代人免疫力下降的责任不能简单地归结为滥用抗生素。环境状况、生活节奏、生活习惯，都有可能影响了人们的免疫力。因此，改善人居环境，调整生活节奏，培养良好的生活习惯，尤其是饮食习惯，加强身体锻炼，都是超越抗生素的好方法。
第三是通过营养医学方法，提升自身的免疫力。Keith Sehnert和Lendon Smith出版的著作中共介绍了50种方法，都可以参考。对于普通人来说，合理膳食、适量运动、心理调适以及戒烟限酒是普遍被建议的做法。
当然，在新的杀菌方法发明之前，抗生素依然是能够拯救感染者生命的、可被安全使用的重要药物。 ★
(本文作者张功耀为中南大学科学技术与社会发展研究所医学史教授。感谢张大庆和肖永红对本文的帮助)
一个研究所的坚持
三种替换抗生素的新方法
。噬菌体杀菌法
噬菌体是一种比细菌结构更简单的病毒，它以吞噬细菌作为自己生存和繁衍的物质基础。而且，正如抗生素具有选择性杀伤细菌一样，噬菌体也具备这样的选择性。如果我们可以找到一些噬菌体，它对人体无害，但又能吞噬那些感染人体的细菌，这种噬菌体就是比抗生素更好的抗菌药。
。细菌素杀菌法
细菌素是细菌分泌出来的类蛋白毒素，它可以杀死那些与之相似或同一家族的细菌。而且，不同的细菌素具有不同的潜在医疗价值。已经有比较看好的前景表明，这是最可能率先超越抗生素的方法。
值得指出的一点是，在植物体内，这种细菌素杀毒法还可以通过基因方法进行移植，使得被移植的植物，天然地具有杀菌能力。如果这样的基因工程也能在人体中实现的话，其提升人类免疫力的能力就是营养医学方法望尘莫及的了。
。益生菌方法
这种方法的思路是利用一些益生菌，如，俄国细菌学家梅切尼可夫发现的乳酸菌，植入人体，并在人体中自己建立起与其他细菌共生、竞争、禁止殖民占领的关系，这种益生菌可能能够自己生成一些抗生素或细菌素，以阻止有害细菌对人体的伤害。
一个研究所的坚持
中国人对抗生素的使用过分积极，但对研发则投入不足——四川抗生素工业研究所面临的窘境，正是整个抗生素工业研发领域的缩影
本刊记者/严冬雪 文/李赫然
一场角逐正在进行——一方是抗药性越来越强的病菌，另一方则是抗菌素工业研究者。
“全国的抗生素研发大部分源自国家级研究所里，我们上世纪50年代从苏联搭了班子、1965年从上海内迁到成都。”接受《中国新闻周刊》采访时，四川抗菌素工业研究所(下称“川抗”)所长易八贤说。
这家拥有400多名员工的机构改制前直属于国家食品药品监督管理局。在近50年的历史中，开发出挽救了众多人生命的利福喷丁、庆大霉素(为了庆祝中共“九大”得名)、正定霉素(在河北省正定县找到的菌种)，以及丁胺卡那霉素、头孢氨噻肟、环孢菌素和万乃洛韦等在内的70多个重要医药品种。1990年前，有影响的抗生素大都出自川抗。
“它也是国内唯一‘坚持’下来的抗生素工业研究所。”易八贤说。
之所以用“坚持”，是因为超级细菌的飞速出现，使得研发机构越发难以招架。在抗生素研究领域，一二十年的累计投入是无法计算的。其中大部分都是国家投入，纳入每年的财政预算。对川抗而言，每年至少有一千万资金、三四百人力投入，一种新药的周期最少也得十几年。与此对应的是，由于抗生素的中国式滥用使得一种耐药菌的产生，只需要一两年，甚至几个月。
另一点值得关注的是，对于国内而言，抗生素生产面临着“短平快”的低水平仿制窘境。易八贤告诉记者，药监局将抗生素列为高危品种，因为在仿制中，各厂家都追求快速收益，在技术和深度上面，工业的基础没做扎实。
与研制抗生素的十几年投入相比，仿制药品的时间周期短，最多三年。“但是仿制药品就像做出一个低档轿车，能达到人家奔驰的性能吗？”易八贤这样比喻，“现状上，国内抗生素的现状就像我们的环境一样——脏、乱、差，水平参差不齐，价格体系也很乱。新的产品要价就高，为了赚钱。”
由于这一追求“短平快”现状，中国的抗生素工业产品与印度都差距甚远。“我们只能做粗原料出口给人家，然后由印度制成药品。”易八贤说。目前，中国出口的抗生素都是以原料出口的，不是医药品出口的。
业内认为：造成这一现状的原因，主要由于国家医药规划的改变。20世纪90年代之前，国内抗生素紧缺，国家集中了有限的资源来搞抗生素研究，取得了重大的进展。近年则对抗生素的投入非常少。战略上，国家医药到2020年中长期发展规划里，都没有将抗生素研究作为重点。
易八贤对此规划也很理解，“这些药从经济上肯定是不合算的，但是我们(国属机构)不做这些事情谁做呢？”因此，唯有“坚持”。
作为中国最大的抗生素菌种保藏地点，川抗担负着保管几十万种菌种的任务，新药的研究也一直没有停。由于耐药菌的飞速出现，在收益缓慢甚至零收益的紧逼下，川抗这样一棵国内的独苗苗，面临着无以为继的困境。
“我们现在就是没钱。”易八贤说。川抗的菌种库里，菌种都已采集完毕，但是没有资金供人筛选。研发任务非常艰巨，需要几千万到上亿美金、几百个高级科技人员，而筛选的时间周期快慢则依赖运气的好坏了。“少则8～10年，多则几十年，才可能搞出一个药，还不一定能真正上市；即使上市，也可能1～2年就耐药了”。
但易八贤始终觉得，有这么多好东西都放在库里，就像一个庞大的未知宝藏，“我估计还能筛出不少好东西来”。
对于川抗这样的国属科研院所，国家每年拨款700万元。但这一拨款，全部用于离退休职工的工资、保险、医疗费，尚有缺口两三千万。“于是，所里靠做一些标准、卖‘青苗’、给企业提供技术支持来创收，填补每年上千万的缺口。”
2000年，川抗转给哈药集团头孢噻肟，转给浙江海正药业表阿霉素(是用于抗肿瘤的)。这两项转让的技术收入仅一两百万，“但是制药厂的受益则肯定上亿。”易八贤说。
“国内抗生素工业化的研究所本来就不多，现在还被边缘化。”易八贤说。除了这家国内唯一的国家级抗生素工业研究所，省级的抗生素研究所也仅剩下“福建省微生物研究所”——行内人仍习惯称它作“福抗”。但与国内绝大部分抗生素研究所一样，“福抗”已经不再以抗生素为唯一研究对象，并将名字改为了更为宽泛的“福建省微生物研究所”。唯一保留着“抗菌素研究所”名称的川抗，对抗生素的研究也仅占工作比例的60%。
易八贤跟发改委、国家医药总局呼吁：抗生素领域，要按照科学发展观，调整产业结构，从基础上一点一滴做起，国家要引导科研单位、工厂做这个事情；第二要全面提高抗生素质量，对上市产品进行再评价，不能追求短平快，要淘汰落后生产工艺，至少要把仿制标准达到其他国家原产地的标准。
At 10:50 on March 25, 2009 China News Network
Chinese antibiotic misuse of the root causes of system defects are ineffective monitoring. According to the current trend of development, "the new 'super bacteria' will continue, 10 ~ 20 years, and now all of the antibiotics will lose their effectiveness"
Text Guide:
Of antibiotics in Chinese-style abuse of antibiotics to the birth of super bacteria
Antibiotics in a 80-year Institute insist
Misuse of antibiotics
黄小洁the blind date again failed. The other is an officer, the reply introducer the grounds that "her teeth healthy."
This is the first N times黄小洁failed blind date, and still are the same reasons for failure.黄小洁as nurses have the handsome looks and slim; affect the outcome of her blind date is that she has a gray-black teeth - a typical "四环素牙."
黄小洁only because of hundreds of thousands of childhood excessive use of tetracycline to cure and cause "四环素牙" one of the victims. From the last century 60's to 80's, tetracycline was once in China as a "one size fits all" in use.
However, a greater variety of antibiotics followed by a universal abuse, no longer just on the left as "四环素牙" easy mark on the same, but gave birth to strong resistance capacity, it is almost helpless Doctor "super bacteria" -- - Today, with strong resistance in the capacity of Staphylococcus aureus infection in the hospital separation rate of up to 60%; antibiotics are the result of the abuse of our lives have to pay a price.
From Fleming in 1929 published "On the Penicillium cultures antibacterial role" thesis date, antibiotics and combat human disease which has existed for 80 years. However, when the first 14 World TB Day (March 24) the dawn, we got this one set of data: At present, all over the world an annual increase of nearly 10 million TB cases each year about three million people died of tuberculosis; single in China, currently there is active pulmonary tuberculosis patients 4,500,000.
Once because of the bactericidal power of antibiotics, which were almost extinct in the resurgence of tuberculosis. Even worse is that the majority of today's TB germs are strong resistance capacity of the so-called "super bacteria", as if we are back to the time without antibiotics.
Cause this result, we have the responsibility of everyone - precisely because every one of us on the abuse of antibiotics to promote the evolution of bacteria to drug resistance; At the same time, once distant "super bacteria" has now been with us every near extreme.
2009 World TB Day slogan is still "I have come to control TB." As an ordinary person, we focused on a practical approach for this subject is this: From now on, cherish the few remaining resources of antibiotics to stop the abuse of antibiotics.
Chinese-style abuse of antibiotics
Chinese antibiotic misuse of the root causes of system defects are ineffective monitoring. According to the current trend of development, "the new 'super bacteria' will continue, 10 ~ 20 years, and now all of the antibiotics will lose their effectiveness"
Our reporter / Cai Peng winter snow such as text / Lee out
In 2009, shortly after the Spring Festival, Beijing Union Medical College Hospital medical director of infection Liu Indian doctors encountered a difficult patient.
ICU patients are a 21-year-old girl, has just received lung transplantation, but the doctors at her pleural effusion and sputum were found in highly resistant Acinetobacter baumannii.
"It can resist our hand in almost all antibiotics." Liu printed on "China Newsweek magazine," said the micro-organisms called only a polymyxin-sensitive drugs. Polymyxin is a very old antibiotics, "but because of the kidney there is serious injury, has long been out of the market."
In fact, even if able to find polymyxin, Liu and India did not dare use because the patient happens to suffer from renal failure. "Now after the laboratory report, I asked, watching myself, have any way to deal with this' super bacteria 'do?" Said infectious disease expert said memory.
The so-called "super bacteria" is defined as one which almost all antibiotics have the ability to resist bacteria, they are precisely because the emergence of the use of antibiotics.
Liu India said that the carry "super bacteria" of patients, at 13-year-old was diagnosed on the lungs of cystic fibrosis - This is an extremely vulnerable to bacterial infection diseases. Therefore, in the past 8 years, "she has been used repeatedly to various antibiotics." Although many antibiotics kill numerous bacteria Girl trying to erosion, but also "temper" a no longer afraid of their "super bacteria."
"Super bacteria" the birth of
Liu and India this is not the first encounter "super bacteria" has been.
Told him "China Newsweek magazine," Today "super bacteria" list getting longer and longer, including Escherichia coli producing extended-spectrum enzymes, multi-drug resistant Pseudomonas aeruginosa, multi-drug resistant Mycobacterium tuberculosis. Among them, the most famous one is methicillin-resistant Staphylococcus aureus (abbreviated MRSA).
Staphylococcus aureus is a common bacteria, can cause skin, lung, blood, joint infection. That year, Fleming discovered penicillin by accident when it is used against the bacteria.
Antibiotics found in the prior hospital Staphylococcus aureus is one of the main killer, the doctor did not approach it to. The advent of penicillin, to some extent it's rampant. However, with the widespread use of penicillin, some of Staphylococcus aureus resistant to begin there, to produce penicillinase, penicillin damage.
In order to deal with drug-resistant Staphylococcus aureus, the scientists also developed a semi-synthetic penicillin, namely methicillin-resistant. After clinical application in 1959, achieved very good results. However, the rules rule breakers, just after two years, at the United Kingdom has emerged methicillin-resistant Staphylococcus aureus - MRSA.
MRSA are resistant to many antibiotics, and after evolution to an alarming rate worldwide spread. It is estimated that each year hundreds of thousands of people around and therefore hospitalized.
Chinese even though the 20th century 70s found MRSA, but this kind of "super bacteria" the speed of the spread is very alarming. In 1978, the medical staff in Shanghai sampling of 200 Staphylococcus aureus, MRSA isolated from less than 5%. "But now, MRSA infection in the hospital separation rate of up to 60%." Peking University Institute of Clinical Pharmacology Professor Xiao Yonghong told "China Newsweek magazine." He had just completed a question of abuse of antibiotics for Chinese studies. This means that patients at the hospital, there is more than the六成Staphylococcus aureus, are difficult to kill the MRSA.
MRSA with the same strong resistance pneumoniae resistant pan, pan-resistant Pseudomonas aeruginosa, then to all known antibiotic resistance, they are referred to as "super bacteria."
October 2006, XIAO Yong-hong assumed a significant association for science and technology policy-related research topics, "the public safety problem of antibiotic misuse of research." Research Group of Beijing, Hubei, Sichuan, Shandong, and Ningxia provinces, municipalities, and five of the survey shows that the current international medical profession recognized as a "super bacteria" has been very common in China, which has become an important nosocomial pathogens.
In fact, the hospital is "super bacteria" hotbed generated. Infectious Diseases Society of America, former chairman of Robert莫勒林Say, MRSA first appeared in the intensive care unit. Ten years ago, about it all the cases have occurred in the hospital or in nursing homes.
"They are popular in the hospital, because there are the use of antibiotics in the greatest frequency and intensity." XIAO Yong-hong said. They survey found that Chinese patients, the antibiotic usage reaches 70%, surgical patients are the use of almost everyone, the ratio of up to 97%.
"Because of the lack of relevant knowledge, people often think that antipyretics antibiotics, anti-inflammatory drugs.'s No need to use high-grade low-grade, and several antibiotics can not be combined in a single, intravenous drip can not be oral. These practices are propelled a 'super bacteria' of the epidemic. "Ministry of Health clinical use of antibacterial drugs Monitoring Center consultant experts, from Fudan University Huashan Hospital antibiotic Institute Professor Zhang Yongxin sadly.
At the same time, regardless of doctors or patients are willing to use the new, broad-spectrum antibiotic, which should have been used for severe infections, to save the lives of patients. XIAO Yong-hong said the hospital most frequently used 10 kinds of antibiotics, more than half of new antibiotics.
The stronger the resistance means that the higher infection rate and mortality. XIAO Yong-hong and other experts found that the infection in hospitalized patients, the drug-resistant infection mortality rate (11.7%) than that of ordinary case-fatality rate of infection (5.4%) more than twice. In other words, if you are infected with drug-resistant, increases the probability of illness was doubled.
Accordingly projections, 2005 National drug-resistant bacterial infections because antibiotics cause the death of hundreds of thousands of people.
Antibiotics everywhere
Antibiotics, Chinese people used to called "anti-inflammatory drugs", as most home standing drug, it is a little headache as long as the fever, would habitually eat a few films.
XIAO Yong-hong et al investigate projections, the production of antibiotics in China each year around 210,000 tons of raw materials, except the export of raw materials (about 30,000 tons), the remaining 180,000 tons in the domestic use (including medical and agricultural use), annual per capita consumption at around 138 grams - The American figure is 10 times.
"One can say that today almost no one used antimicrobial agents has not been all his life." Professor Zhang Yongxin This introduction of antimicrobial agents. To have 16 million population of Shanghai as an example, spot checks over the past five years found that more than 40 samples of various types of drugs used in hospital, the high cost of antibiotics first, the annual consumption of 5 million to 9 million, accounting for the cost of all drugs 1 / 3.
At all drugs, the consumption of pre-10 Medium, antibiotics accounted for half of the country, such as cephradine, ceftriaxone, ciprofloxacin, levofloxacin and so on.
"From these data, we can see that what are commonly used antimicrobial agents. Although infection is still a threat to our health and life, but after all, is not the primary cause of death of people, the drugs still account for the first place, it would be difficult to explain."张永信Say, for today's antibiotics, especially antibiotics, people need to have a correct understanding.
According to the 1995 ~ 2007年investigate the classification of diseases, infectious diseases in China the total number of total incidence of the disease 49 percent, one of bacterial infectious diseases accounted for 18% ~ 21%. In other words, the use of antibiotics really necessary number of patients less than 20%, 80% belong to the abuse of antibiotics.
XIAO Yong-hong at it, China is the world's most serious abuse of antibiotics country. Because of antibiotic abuse in China, the overall bacterial resistance rates to much higher than Europe and the United States, at around 45%.
Shanghai Changning District Central Hospital of Gynecology and Obstetrics, director of the left-threaded Lei told "China Newsweek magazine," Since birth infections, obstetrics and abuse of antibiotics has long been the hardest hit. Sections based on their years of monitoring show that: At present, penicillin resistance was almost 100 percent, in which case also the use of antibiotics, in addition to waste money, there is no other significance. Therefore, in Changning District Central Hospital of Gynecology and Obstetrics, left thread sections Lei doctors on the use of antibiotics has a strict control.
At the same time, antibiotics in the aquaculture industry by leaps and bounds in the application. "In China, every year half of the antibiotics used in aquaculture." XIAO Yong-hong said. However, these drugs are not used to treat sick animals, but animals for the prevention of illness. Since the current large-scale intensive rearing, it is easy to the outbreak of various diseases.
In addition, the diet of antibiotics, can promote animal growth, this is the breeding industry practice. Say there is a theory of antibiotics kill the intestinal bacteria, a decrease of their energy needs, make animals be able to get more food, so grow faster.
However, the consequences of doing so are in the air around farms and in soil, surface water and groundwater, retail meat and poultry, and even wild animals are everywhere full of antibiotics. These antibiotics can be through various means, accumulate in the human body. It will not only happen cause organ lesions, and can cultivate the human body into a "super bacteria" of the small environment. Liu told India, "China Newsweek magazine" Now there is much to carry "super bacteria" of patients, neither the history of infectious diseases, nor lived in hospital, the cause is very wrong, "It's probably related to the environment."
Abuse of antibiotics has caused scientists and government attention
Policy: there is enacted, non-implementation of
Abuse of antibiotics in China have long attracted the attention of scientists and government.
Ministry of Health Committee of Experts on Rational Use of Drugs, vice chairman of吴永佩of "China Newsweek magazine," recalled that in 2001, he commissioned by the Ministry of Health, beginning in the preparation of "clinical use of antibacterial drugs guiding principle." This principle in 2004, promulgated and implemented, and set up the first time in China's domestic system, "Bacterial Resistance Surveillance Network."张永信also participated in the formulation of this provision, he told "Newsweek China" at the "guiding principles", the Chinese put a comprehensive and systematic manner the status of bacterial, anti-bacterial drugs, the principles of rational drug use (such as what circumstances should oral , what circumstances want injections, intravenous administration want what circumstances and under what circumstances the United multidrug want) provide clear, the purpose is to standardize the Doctor medication.
"But because of not enough enforcement, the problem is still very grim."吴永佩said.
June 2003, SARS swept through China, Bao-Feng Yang, Harbin Medical University Vice-Chancellor issued a thesis "against the abuse of antibiotics and the" atypical pneumonia "Enlightenment happened," points out: In the nation's battle against SARS, we should fully understand the abuse of the harmful effects of the antibiotics, but antibiotic use and management should be strengthened to prevent the broad masses of the people and medical personnel for SARS prevention and control and abuse of antibiotics in a short time the rapid emergence of resistant microorganisms increased, another wave of new problems.
Since then, the Xinhua News Agency reporters Ju Cilun and Wen Xiecheng "internal", was after reading the relevant state leaders made important instructions. A result, SARS, the Chinese about how to achieve the scientific use of antibiotics, specific recommendations were下发到各authorities.
Regrettably, this did not prevent antibiotics at substantial use during SARS. At more than 90 pharmaceutical companies listed, 1 / 3 of the listed companies involved in the production of SARS drugs, really benefit from one of the main business is the production of antibiotics. North China Pharmaceutical, Lukang Pharmaceutical, North China Pharmaceutical, Baiyun Mountain, such as pharmaceutical companies, and its front-line sales performance and the performance of the company's stock market as a comprehensive飘红.
Livzon Group and published in 2003 showed that one quarter of Report: The company's main business the same period last year profit increase of 0.8 billion, mainly due to roxithromycin, anti-virus particles, such as antibiotics, medicines used as raw materials Sales revenue growth. In fact, used to kill bacteria, rickettsia and other micro-organisms to antibiotics, and should not produce inhibition of the SARS virus.
January 9, 2009, at吴永佩"national grass-roots medical institutions rational application of antimicrobial agents of clinical training program" on the launching ceremony said that the "unreasonable use one of the most important reason is lack of physician knowledge of drug use." By the Ministry of Health carried out this plan will 30,000 ~ 45,000 grass-roots medical staff training in order to improve the Chinese medical institutions the status of antibiotic abuse.
Past 60 years, the Chinese ranging from more than 400 kinds of medicines soared to about 7000 kinds, and many doctors use some of the basic principles of antibiotics also did not know, especially at the grassroots level.
However, some doctors do not over-use of antibiotics because the lack of knowledge, but because of various pressures. XIAO Yong-hong said that China's hospital about 50% of revenue comes from the drugs, all drugs and antibiotics accounted for about 25% of income. Many antibiotics, it means that open way of getting money. At the same time, people put it as a "panacea", they will even take the initiative to ask the doctor to open some of many, the majority of doctors will meet the requirements of patients.
XIAO Yong-hong think, the Chinese root causes of the abuse of antibiotics, are system deficiencies, ineffective supervision.
Tug of war is entering a critical moment
At the golden era of antibiotics - 20 century, 60-80 years, as more and more discoveries and the use of antibiotics, in the face of bacteria, all of a sudden it seems that human beings possess a large number of weapons. Encountered a lot of staphylococcal infections, doctors mostly unthinkingly penicillin injection, the effect significantly.
But it also quickly found that things change at quietly. To penicillin as a case, it just put into use when the use of 100,200 units a day is very effective, and later a marked increase in the use of dose, and then later, even if the dose is just as poor increased efficacy. Today, even the treatment of common respiratory tract inflammation, a bag of normal saline injection (250ml) add in the required dose of penicillin 10 million units - an increase of the amount of hundreds of thousands of times.
"Penicillin is not bad, and enemies are becoming more and more cunning, powerful."张永信that some enzymes can be produced penicillin resistance, the scientists on the development of an enzyme inhibitor, so that the role of penicillin to continue to play an important role. This approach, which is equivalent to sweeping the obstacles blocking the entry into force of penicillin, and later this method is widely used, the role also slowly declining.
"The situation is very serious. At people struggle with the bacteria, antibiotics after the start of those years are leading us; but pulled a seesaw battle now, and it is more and more short distance."张永信said that even though Nevertheless, humanity today is still going ahead in bacteria. "However, we are far五六十年on behalf of, the big step to go ahead in bacteria. At that time only a few antimicrobial agents, but the Doctor has to do in clinical very cool - because on these types of drugs, effects are good. But now there is so many drugs, the effect is not working. "
Research scientists are still racking their brains to antibiotics, but want to take into account if one day, all antibiotics are produced for those who can not be the role of bacteria how to do?张永信said that not only are doctors, pharmacists, and all people should see this situation. "Everyone should cherish the existing clinical effective antimicrobial agents, each of the people on earth must be very care to use it, which when used with the amount of how much."
XIAO Yong-hong at it, antibiotics and oil, coal, as is also a non-renewable natural resources. "The new 'super bacteria' will continue, perhaps 10 years to 20 years, and now all of the antibiotics will lose their effect." He concluded people shudder.
Antibiotic how the birth of super bacteria
In the long run, MRSA these "super germs" will be popular all over the world, and many more and more antibiotic resistant. "Super bacteria" generation, what are antibiotics because bacteria mutate stimulation, which has a resistance, or already exists a small number of variant strains, and the antibiotics just were screened, making it resistant mutants survive accounted for advantage?
In other words, the emergence of drug resistance, whether it is because use and disuse or natural selection? Microbiologists have been proved by experiment: bacteria in contact with antibiotics even before the existence of resistant mutants. And antibiotics and the use of antibiotics, bacteria are in fact carried out a natural selection, in the vast majority of ordinary bacteria killed after his death, the original does not account for the number of advantages, resistant "super bacteria" survived substantial start multiply, and dominate, making more and more big dose of antibiotics, failure of antibiotics is also increasing.
Since "super bacteria" inherent existence, bacterial resistance is inevitable. However, this does not mean that human beings can not control this. In recent years, more and more and more microbiologists, medical scientists began to call for: to prevent "super germs" popular essential means, is to immediately stop the abuse of antibiotics.
Yuan Zhong: Chinese-style habits of mind lead to abuse
Lack of scientific ways of thinking, too much pragmatism and the pursuit of quick psychological cause the Chinese people "voluntarily" abuse of antibiotics
Our reporter /方玄chang (collation)
Exist all over the world have the problem of antibiotic misuse. But compared with Europe and the United States, China's situation may be more serious. At economic factors, social factors, we can also from a cultural perspective, from the Chinese people's thinking habits of Chinese people to find the abuse of antibiotics rather than the reasons for his country.
Chinese lack of scientific concept, which is below the root of all problems. Science requires a high degree of rationality, while the Chinese side it is very sentimental soil; NOT add the birth of science in the East, as a result, China has created a conflict with it, awe and superstitious exist simultaneously ambivalence. On the one hand, people have seen the power of science; and on the other hand, the strength of science is limited, but China has never been more willing to go blind faith in those "all-around" things.
Witnesses at the powerful forces of science, they do not consciously put to the deification of science, and put it as omnipotent. Existence of the drug itself is a kind of reverence, and superstition, and cause the Chinese people since ancient times, be able to find a panacea in the "panacea." And similar to the efficiency of drugs, like antibiotics, then naturally be easily seen as a panacea to the use of drugs.
Finicky Chinese pragmatism. The late 19th century, Christian culture it is very difficult to enter China, but Christ is very easy to come in medicine - people see it quickly and efficiently. I am afraid that in the eyes of Chinese people, can best embody the modern medicine (commonly known as "Western") characteristics, that is, surgery and antibiotics, they are effective, quick advantage. This "Down土豪will be able to share the land," "seeking to use more than truth-seeking" mentality has remained to the present, only the immediate effects of people's cause, as to the use of antibiotics that may arise after the problem, they will not go too much to consider.
"Seeing is believing" the habit of thinking sometimes deceive you. A street show of the people, will first try to show his "skills", allow people to witness his skills, then we can put him in plaster, bone-setters go sell drugs - in fact, his "stunt" and bonesetter drug use are not necessarily related. Similarly, people have seen a number of antibiotics in the fight against infectious diseases have shown the power, so the generalization put it, use it to deal with all diseases.
Pursuit of "immediate" the tendency to sometimes be unwise. In China, a patient see a doctor, the doctor told him if "this treatment will be effective after three months," no longer sick, I am afraid that the doctor has been willing to come. Some of it should have been so good up slowly disease, doctors will try to find that the efficiency of drug or therapy. Do not need a number of diseases have been basically take medicine in the United States and Europe, a lot of diseases are not only diagnostic treatment, any of its self-healing; but in China, a doctor does not give medications, patients can not but accept - that is, pay attention to "immediate "" blowing rice bran see "the problems brought about. And the antibiotics just have such advantages: faster and obvious effect. Under such circumstances, it is easy to overlook its deficiencies, which led to abuse.
(Yuan Zhong, Peking Union Medical College Press, Chinese Academy of Medical Sciences Assistant to the President, Research for medical philosophy, medical history)
Antibiotics in 80 years
The increase in life expectancy, about 10-year-old benefited from the widespread use of antibiotics; today the development of antibiotics for nearly depleted, and has been heavily dependent on antibiotics in humans, more than ever the urgent need for new antibiotics
Our special writer / Zhang Gong-Yao Journal reporter / Cai Peng such as
February 1941, London Radcliffe hospital. 48-year-old Albert Alexander Policemen suppurative wounds due to infection, are the verge of death.
Since Alexander is accidentally cut through the skin shave and trigger bacterial infections. At that time, because of the lack of medicine, infection means death. Even though the hospital was the best use of antimicrobial drugs - sulfadoxine, but Alexander's condition continued to deteriorate. In desperation, the doctor removed one of his eye abscess drainage, hoping to control the disease, resulting in the lungs but are also beginning infection.
Step by step, looking at bacteria devour the body of Alexander, the doctors decided to do with Oxford University Department of Pathology has just sent a still experimental drug to try. This is a kind of looked a bit like the yellow corn starch powder, dissolved every 3 hours give infected injection.
Several times after injection, a miracle occurred - in Alexandria beginning inflammation receded, has also resumed normal body temperature, he can even sit up to eat.
1 teaspoon of the medicine but soon run out of Alexander's condition deteriorate again. Because still in the experimental stage, Oxford University nor more drugs. In order to be able to continue treatment, the doctor even put Alexander urine collected from the extraction of drug residues in order to save his life.
Alexander did not escape the end of the claws of bacteria, soon passed away. However, this magic powder gave yellow doctors left a deep impression - it is a powerful bacteria killing weapons.
This new drug is penicillin.
Difficult time without antibiotics
Far in 1550 BC ancient Egypt, some medical practitioners to use lard tune Sticking honey, and then bandaged with linen and inflammation due to infection in traumatic swelling of the summer furuncle, carbuncle swollen sores and unknown toxicity. Recently, someone on the ancient Egyptians invented the method of textual criticism pharmacology confirmed its efficacy and safety. Its mechanism from two aspects. First Honey has the trapped bacteria and bacteria from the body to absorb moisture, the final cause of bacterial death due to the role of thirst; are two honey contains an antibacterial molds, inhibit bacterial growth or even kill germs functions. However, the ancient Egyptians just do this, do not know the medical significance of the inhibition.
Come to many diseases are caused by microbial infection because of this understanding, are the founders of microbiology Pasteur credit. Infected with the human body can cause disease in humans have five types of micro-organisms: bacteria (such as E. coli), viruses (such as corona virus), fungi (such as lichen planus), native biology (such as Plasmodium falciparum), worms (the problem). Among them, the antibiotics can be effective to kill the bacteria.
Well-known American science historian George Dayton in his "Introduction to the history of science" in the comment said: "War is the mother of surgery." War required surgery, but surgery safe and what to ensure this?
19th century 60s, a surgical and obstetrics名叫辛普森issued to doctors and said with emotion: "lying in a hospital operating table of any of the patients, Waterloo than soldiers on the battlefield deaths have more opportunities." Ancient China books, "Han Chuan relatives" have "woman-free milk so big, ten die life" argument. By the 5th century, women have described the production of "sitting Shimoji grass, such as the Law on the die also" (Chen's "short side") of the terrorist records. Can be seen that at the time, because surgery and production are what caused the high mortality rate.
It is worth noting that because of production caused by surgery and death, are at after the surgery or the production happen. 60 era in the 19th century, the mortality rate after surgery at 40% ~ 60%. Can be seen, surgery to be successful, women would also like to peace after the production of children will have to wait for medical science to achieve new progress.
College of Surgeons of England in 1867, Listeria monocytogenes, the first phenol (chemical known as "phenol") disinfection method, the prospect of changing the operation so that the original post-operative infection rate fell from 60% to 15%. If the first women's production room spraying carbolic acid, it can greatly improve the survival rate of women in production since.
However, the carbolic acid disinfection method has a drawback, it can only surface disinfection, the body should not be deep-seated "antivirus" (sterilization). Syphilis infection once an epidemic of sexually transmitted diseases are, for such deep-seated bacterial infection, using carbolic acid to disinfect the surface are null and void. Pasteur noted that the doctrine of the bacterial infection, the vast majority belong to the bacteria have entered the human body after the emergence of deep-seated infection.
Great inventions
How can those in the human body to kill bacteria, while harmless to the human body to do it?
1910, Germany experienced Doctor Ehrlich at 605 compounds the failure of the experimental formula, the formula in section 606 experiment has been successful, it is now also used in Aspen where纳明, code-named "Ehrlich 606. " It can kill people invaded the body of syphilis bacteria, without harm to the host. The advent of this drug, creating a new era of chemical drug therapy. In 1940, Ehrlich was the greatest invention of the silver screen, film, called "Doctor Ehrlich's magic bullet." After antibiotics (do not belong to the chemical drug therapy) are in accordance with the "magic bullet Ehrlich" has already reached the safety of the goal to develop.
In 1932, the German chemical industry giant Clare synthesized a bright orange dye. The same year, the bacteriologist and many drug experts Mark try to use this dye to kill Streptococcus mutans, the first successful experiments in mice, be able to meet the same "Ehrlich magic bullet" as the request. On at this time, many 6-year-old daughter of Mark embroidery needle was a bit taken place in streptococcal infection and spread to the lymph nodes, causing a severe sepsis. At that time, doctors advocated amputation, and even said that even if there is no guarantee the preservation of amputated lives. Mark give her many adventures injected with the drug, has been successful. This is what enables the production of women against the threat of puerperal sepsis interest many hundred waves. Its advent marks the beginning of antibiotic era. Thus received many marks of the Nobel Prize in 1939.
The next most famous is penicillin. It began in Britain in 1922 scientists at Fleming's a great discovery. In this year, Flemming from human nasal secretions observed in an enzyme, that is, "Lysozyme", with the ability of microbial resistance. A kind of micro-organisms can inhibit the growth of another microorganism such situation, micro-organisms on the study called "Kang-sheng situation." 6 years after 1928, Fleming also found that an antibiotic, that is the role of penicillin antibiotics. The following year, he delivered a speech entitled "On the Penicillium cultures antibacterial role" of the thesis, in that year, be regarded as "the first year of antibiotics."
However, penicillin extremely unstable, purification very difficult. Until 1941, a Jewish Hitler Germany marginalized people money TU (Einstein the scientist with a similar fate, even the appearance was similar with Einstein), to escape from Germany to the United Kingdom, and from Australia, at a visiting scholar at Oxford University to do the Florian cooperation, the success of isolation of penicillin. However, although the separation of the success of the United Kingdom are not able to support the production of such drugs.
In 1944, the United States at the Rockefeller Foundation provided funding from 5000 U.S. dollars, penicillin was first produced by the United States. Very soon, it been invested in the Second World War battlefield ambulance, saved many Allied officers and men of the dying life. Even suffering from pneumonia in the United Kingdom Prime Minister Winston Churchill, but also relied able to restore health.
The success of penicillin sensation all over the world, people put it with the atomic bombs of World War II as a radar in the three great inventions. Difference is that the atomic bomb and radar are used to war, and penicillin are used to save lives. In 1945, Fleming, Florey and Chain, as the invention of penicillin and co-won the Nobel Prize for Medicine or Physiology.
Clinical penicillin, although cure a variety of bacterial sexually transmitted diseases, but could do nothing about TB.
In the 20th century 40 years ago, tuberculosis was known as "white disease die." People put it with the medieval "Black Death" (bubonic plague) mentioned in the same breath, because in 19th century Europe, it is the largest number of deaths caused by a disease. At a lot of literary works, the TB patients face pale and bloody handkerchief, and even become a figure that the typical characteristic of the period.
After the success of penicillin, it is urgent to find a longer look the same powerful antibacterial agents to help human beings to overcome tuberculosis. Achieve this mission are microbial瓦瑟曼of Jurists.
瓦瑟曼was born in Ukraine, immigrated to the United States in 1913, was biochemistry at the University of California doctor. He called for a class of soil actinomycetes was very interested in micro-organisms.
Actinomycete antibiotic's ability to generate strong, it was said in 1932瓦瑟曼was observed that this phenomenon, but he did not care. Until 1939, noted瓦瑟曼the medical profession is making great efforts to find a variety of antimicrobial drugs, only to change the research direction, focus from Actinomyces explore material to kill bacteria.
瓦瑟曼abandoned the traditional separation of antibiotics by the coincidence method, start by screening hundreds of thousands of micro-organisms to have awareness, there is a destination looking for antibiotics.
From 1939 to 1943, the Chinese Communist瓦瑟曼isolated from soil 10000 Actinomyces and found there is one of 10 be able to produce inhibition of pathogenic bacteria have to antibiotics. However, because the majority of actinomycete toxicity can not be too big and clinical application.
Transfer appear in 1943. This year, finally瓦瑟曼isolated from a gray Actinomyces, it can not only produce antibiotics to kill Mycobacterium tuberculosis, there is no toxicity to humans.瓦瑟曼put the name of this antibiotic streptomycin, and published a research report.
The findings, soon to be Merck & Co., Inc. was informed. The United States at the biggest pharmaceutical companies, supported by early 1947 into the market on streptomycin.
Streptomycin, although not the first advent of antibiotics, but a little less than a sensation caused by penicillin - to conquer because it is "white disease die." Streptomycin invention allows the United States in 1904 before 100,000 people of 188 patients with pulmonary tuberculosis death ratio in 1953 dropped to 10 million patients every 4 people died. In 1952, Waxman streptomycin because of the invention and the Nobel Prize for Medicine or Physiology.
瓦瑟曼the success of not only saved the lives of many TB patients, but more importantly, to other scientists pointed out the direction of looking for antibiotics - soil actinomycetes. So far, the majority of clinical application of antibiotics are derived from such micro-organisms.
Since then, the development of antibacterial drugs microbiologists came to污水沟next to the garbage heap up,沃野of "Gold Rush" - collecting samples, filter bacteria, opened a large-scale screening of antibiotics in time.
Aureomycin (1947), chloramphenicol (1948), oxytetracycline (1950), nystatin (1950), erythromycin (1952), kanamycin (1958) are found at this period . This period, the antibiotic research has entered a purpose, planned, systematic phase, but also set up a large-scale antibiotic pharmaceutical industry.
Ehrlich in 1910 from the hair明阿斯Where纳明run, by 2005, members of the family of antibiotics has risen to 133, all of them to conquer the disease of mankind has made enormous contributions. Statistics show that today's human life than the beginning of the century on an increase of nearly 20-year-old as many as one of about 10-year-old benefited from the widespread use of antibiotics.
Depletion of antibiotics?
20th century 60's, people from the natural world in search of new antibiotics to slow down the speed significantly, replaced by the emergence of semi-synthetic antibiotics. In 1958, Sheehan synthesis of 6 - aminopenicillanic acid, has opened up a semi-synthetic penicillin production path.
The 20th century, the 50's to 70's, are the golden era of antibiotic development. New listing of antibiotics is increasing year by year, from 1971 to 1975 reached a peak 5-year period there were 52 kinds of new antibiotics available. However, from the last century 80's start, the annual listing of antibiotics dropped year by year. From 1996 to 2000 of 5 years, only six kinds of the development of new antibiotics. After entering the new century, this trend becoming more pronounced. The world in 2003 only one new product - Cubicin listed, and in 2004 was blank.
Caused by one of the reasons for this situation is that the development of antibiotics is becoming more and more difficult. In the past 80 years, scientists have discovered more than 20 types of antibiotics, almost all micro-organisms can be found all over the个times.
Another reason is that the development of new antibiotics, bacterial resistance can not keep up much faster pace happen, cause the development of the profit has been watered down, lack of enthusiasm for pharmaceutical companies. Listed in the first 20 years of unparalleled efficacy of penicillin, pharmaceutical companies give at that time has brought substantial profits. However, today introduced a new type of antibiotics, or even less than few months, there will be drug-resistant bacteria.
In 2000, Pfizer's linezolid listing is permitted, has caused a sensation in the medical profession. Since it is the world's first one is the synthesis of oxazolidinone antibiotics, have been high hopes. But only less than 1 year, there have been enterococci resistant to linezolid coverage, forcing people to have to find new antibiotics to replace its treatment, and a new antibiotic from the R & D to market at least 10 years of investment 10 million dollars.
Today, some large pharmaceutical companies have put R & D focus towards more profitable anti-cancer drugs and AIDS drugs on, are not keen to develop new antibiotics - at the same time, has been heavily dependent on antibiotics in humans, now more than ever more urgent need of new antibiotics.
Criticism: antibiotics 10 "counts"
According to the United States Centers for Disease Control data provided by the United States occurred in 2008 due to the use of antibiotics and sent to a total of 142,505 first-aid people, accounting for the National All American 19 percent the number of first aid. Among them, 78 percent belong to allergic to antibiotics. However, no reports of deaths due to the use of antibiotics in cases.
According to MeDiCaLGeeK New Delhi, India, the company sponsored "V Edition" Net in August 2008 released the English version of "Know the side effects of antibiotics," India also has more than 7% of patients required first aid due to drug reactions. Among them, 16 percent belong to the use of antibiotics caused by drug reactions. The lower figure than the United States, but is still the case are serious. According to Indian reports, antibiotic-induced drug reaction has five main aspects of the performance of: allergy, arrhythmia, endocrine disorders, drug interference and skin rashes. Its response can be divided into four types: first, direct allergic reactions; two are cytotoxic reaction; three are delayed immune reaction; four cells are an indirect response.
Doctor Lawrence Wilson of the United States in October 2008 the network issued for antibiotics cited article 10, "count":
1. Increased cancer risk.
2. Allergic reactions.
3. Deconstruction has intestinal bacteria plexus, intestinal damage "ecological."
4. Increase in microbial resistance.
5. Delayed immune function.
6. Candida (eg Candida albicans) increased too much and cause more harmful to the intestine infection.
7. Caused by chronic fatigue syndrome.
8. Because of antibiotics, while not directly harmful, but it is a useful deconstruction of the body of bacteria, reduces gastrointestinal function, hampering the absorption of minerals, which become malnourished patients.
9. Efficacy false. Some diseases can not be good use of antibiotics.
10. Too costly.
Lawrence Wilson does not deny the role of life saving antibiotics at the unique role and high status. Antibiotics was the result of so many questions, the ratio was so large, noted attributable to the abuse of antibiotics. Lawrence Wilson cited a pre-and post-2000 sample survey data, said the United States obstetricians and gynecologists week out with the prescription of antibiotics 2,645,000, week out with a physician's prescription of antibiotics 1,416,000. Only two types of doctor per year, out on the prescription of antibiotics containing up to 211,172,000. Take this figure every year to remove the use of antibiotics and first aid required total number of people, then the use of antibiotics in the probability of emergence of first aid are required 0.67 ‰. This ratio was not high. Obviously, the problem lies in the abuse. If the lower usage of antibiotics, due to the abuse of antibiotics and the necessary first aid is necessary to greatly reduce the number of people.
"Beyond" antibiotics
In 1994, two American medical doctors nutrition Keith Sehnert and Lendon Smith published a book "Beyond Antibiotics: 50 (Or So) Ways to Boost Immunity and Avoid Antibiotics", at all over the world has aroused considerable repercussions. China Taiwan Water Culture Publishing House of the original publication of its English version. Translation Translation author is heading into a "myth crack antibiotics" and subtitled translated into "50 do not have antibiotics to enhance immunity law." This translation easier to give people a wrong impression, it seems that people previously with antibiotics to enhance immunity. In fact, the original title of "Lifting the immunity" and "avoid the use of antibiotics" are separate.
This book is written against the abuse of antibiotics. The author recommends the adoption of some means of nutritional medicine to replace the role of antibiotic treatment. For the author the idea (just a scenario), the medical profession there are different views. Comments object to think that the abuse of antibiotics and the human immunodeficiency declining relationship is not obvious that trying to nutritional medicine to improve the ways the human body immunity, the premise of the ideas are not strong enough. Moreover, there is no evidence that medical nutrition method can kill those bacteria cause human disease. Comments in favor of the view that much of modern medicine the use of antibiotics occasions, the use of traditional methods of nutritional medicine can solve the problem. This comment obviously the lack of adequate scientific basis to prove that medical nutrition study methods can indeed conquer germs.
However, regardless of a yes or no, we should "go beyond the antibiotics," This is has been widely recognized by the medical profession as a reference.
So how do we go beyond them antibiotics?
The first is to explore new approaches. Abuse of antibiotics cause the harm has been obvious to all, it now came to a new method for the eve of beyond. So far, attempts to set up a new method of sterilization to replace the idea of antibiotics has three: phage sterilization method, sterilization bacteriocin Ways and probiotics.
Second is to reduce dependence on antibiotics. Modern decline duty immunity can not be simply attributed to the abuse of antibiotics. Environmental conditions, pace of life, living habits, may affect people's immunity. Therefore, to improve the living environment, adjusting the pace of life, help them develop good habits, especially eating habits, to strengthen the physical training, are well beyond the Ways of antibiotics.
The third is through nutritional medicine methods to enhance their immunity. Keith Sehnert and Lendon Smith book describes 50 kinds of Chinese Communist methods can reference. For ordinary people, reasonable diet, regular exercise and psychological adjustment as well as smoking cessation alcohol limit is generally recommended practices.
Of course, in the new method of the invention prior to sterilization, antibiotics are still able to save the lives of infected people can be safe use of essential drugs. ★
(The author of this article for Zhang Gong Yao Central South University of Science and Technology Research Institute for Social Development and Professor Shi Medicine. Thank XIAO Yong-hong Zhang Daqing and assist on this article)
A Institute insist
Three new methods to replace antibiotics
. Phage bactericidal method
Phage is a kind of structure is more simple than the bacterial virus, which engulfed bacteria to survive and thrive as their basic material. And, as selective anti-bacterial antibiotics, like phage also possess this kind of selectivity. If we can find a number of phage, it is harmless to human body, but those who can swallow up the body's bacterial infection, such phage is better than antibiotics, antibacterials.
. Bacteriocins sterilization law
Bacteriocins are bacterial proteins secreted by the type of toxin, it can kill those with similar or the same family of bacteria. Moreover, the different bacteriocin with different potential medical value. Have been relatively optimistic about the prospects that this was most likely the first to go beyond the methods of antibiotics.
It is worth pointing out is that in plants, this bacteriocin antivirus Act can also be carried out by gene transfer method, the transplanted plants, natural ability to have a sterilization. If such a genetic engineering can achieve in the body, its ability to enhance the human immune system is the nutrition of a medical method to catch up.
. Probiotics Ways
The idea of this method is the use of some probiotics, such as, Russia梅切Baryshnikov bacteriologist found lactic acid bacteria, the human body implants, and in the body to build its own with other bacteria symbiosis, competition, the relationship between the prohibition of colonial occupation Such probiotics may be able to generate some of their own bacteriocin antibiotics or to prevent harmful bacteria on the human body injury.
A Institute insist
China on the use of antibiotics over-active, but is insufficient investment in R & D - Industrial Research Institute, Sichuan Antibiotics dilemma facing, it is a whole field of antibiotics, the epitome of industrial R & D
Our reporter / winter snow text / Lee out
A race under way - one side are more and more highly resistant bacteria, antibiotics are the other industrial researchers.
"Most of the national R & D of antibiotics derived from the national institute, we have the last century, the 50s from the Soviet Union take the team in 1965 with the move to Chengdu from Shanghai." Accepted "China Newsweek" interview, Sichuan Industrial Institute of Antibiotics (hereinafter referred to as "anti-Chuan") director, said eight easy.
The owner of more than 400 employees before the Re-directly under the State Food and Drug Administration. At near 50-year history, developed to save the lives of many people Rifapentine, gentamicin (to celebrate the Chinese Communists in order to "nine" is named after), Zhengding adriamycin (Zhengding County in Hebei Province found in bacteria ), and amikacin, cefotaxime, cyclosporin and valaciclovir, including more than 70 varieties of essential medicines. In 1990 before the impact of antibiotic resistance mostly from Sichuan.
"It is also the only 'insist' from the Industrial Research Institute of Antibiotics." Yi-yin, said eight.
The reason why the "insist" is because the rapid emergence of super bacteria, making R & D institutions become more and more overwhelming. At the field of antibiotic research, one or two decades of cumulative investment is incalculable. Most of them are one of country inputs into the annual budget. Sichuan anti-run, there is at least 10 million a year funding three or four hundred human input, a cycle of new drugs should at least be more than a decade. Corresponding with this is that because of Chinese-style abuse of antibiotics makes the emergence of a resistant, required only in 2012, or even months.
Another point of concern is that the domestic terms of antibiotic production is faced with "短平快" dilemma of low-level imitation. Easy eight-yin told reporters that SFDA will be classified as high-risk antibiotics varieties, because at imitation, all manufacturers are pursuing rapid gains in technology and the depth of the above, industry did not make a solid foundation.
And development of antibiotics in ten years compared to generic drugs, short cycle time, maximum of three years. "But as generic drugs to make a low-grade sedan, Mercedes-Benz to achieve the performance of others吗?" Yi-yin eight such an analogy, "the status quo on the domestic status of antibiotics in our environment is like, like - dirty, messy, bad, the level of uneven, the price system into confusion. new products on the high asking price, in order to make money. "
As a result of this pursuit of "短平快" the status quo, China's industrial products and antibiotics are far from India. "We can only make rough exports of raw materials for others, then made into medicines from India." Yi-yin, said eight. At present, China's exports of antibiotics are based on exports of raw materials, rather than pharmaceuticals exports.
Think the industry: the reasons for this status quo, mainly because of the State Pharmaceutical Planning changes. Before the 20th century, 90's, the domestic shortage of antibiotics, the state focused on the limited resources of antibiotics来搞research, significant progress has been made. In recent years, the input of antibiotics is very small. Strategy of Chinese medicine to the country long-term development plan in 2020, the study did not focus on the antibiotics.
Easy eight-yin this planning is also very understanding, "These drugs are definitely up from the economic uneconomical, but we (the country is an organization) who do these things so?" As a result, only "insist."
As China's largest antibiotics Culture Collection locations, charged with the custody of anti-Chuan several strains of the 100,000 kinds of tasks, the study of new drugs has not stopped. Because of the rapid emergence of drug-resistant, slow or even zero in the earnings gains under pressure, such a domestic anti-Chuan single Miaomiao, faced with unsustainable situation.
"Now is our money." Yi-yin, said eight. Curitiba, the strains of anti-chuan, bacteria have finished collection, but no funds for screening people. R & D mission is very demanding, requiring tens of millions to hundreds of millions of U.S. dollars, hundreds of advanced scientific and technological personnel, and the filter cycle time depends on the speed of a good or bad luck. "At least 8 to 10 years, while many decades, only possible to produce a drug, not yet really must be listed; even listed, may also be 1 ~ 2 years on the resistance."
But the eight-hsien has always been easy to think that there are so many good things on the library, just as a huge unknown treasures, "I guess that can screen a lot of good things to come."
For such a country of anti-Chuan is a scientific research institutes, national annual allocation of 7,000,000 yuan. However, this provision was fully retired employees for wages, insurance, medical expenses, there are two million shortfall. "So, the Village relies on to do some standards and sell 'Young', to provide technical support to enterprises to generate income to fill the gap of millions each year on."
In 2000, anti-chuan to Harbin Pharmaceutical Group cefotaxime, to Zhejiang Hisun Pharmaceutical epirubicin (for anti-tumor). These two technology transfer income is only 12 million, "but it will certainly benefit from the pharmaceutical factory on the million." Yi-yin, said eight.
"The domestic industrialization Institute antibiotics have not many, and now also been marginalized." Yi-yin, said eight. Apart from this the only national Industrial Research Institute of Antibiotics, Research Institute of the provincial antibiotics only remaining "Fujian Institute of Microbiology" - insiders said it is still customary for the "anti-Fu." However, with the Institute for the vast majority of antibiotics, the "anti-Fu" is no longer with antibiotics as the only research subjects, and the name changed to the more general "Fujian Institute of Microbiology." The only reservation of "antibiotic Institute," the name of anti-chuan, to antibiotics study also accounted for only 60 percent the proportion of job.
Easy eight-yin with the National Development and Reform Commission, the State Pharmaceutical Administration of appeal: the field of antibiotics, in line with the scientific concept of development, adjust the industrial structure, from the basic start up bit by bit, the state should be guided to research institutes, factories Does this matter; the second full antibiotics improve the quality of listed products for re-evaluation, should not Pursue短平快, it is necessary to eliminate backward production technology, at least to generic standards of other countries of origin criteria.