研究：美国43%的抗生素处方是不必要的

研究：美国43%的抗生素处方是不必要的

So-called “superbugs” — bacteria that are resistant to drugs — aren’t something to worry about for the future. They’re already here.

所谓的“超级细菌”——一种对药物有抗药性的细菌——在未来是不用担心的。他们已经在这里。

Thanks to decades of unmitigated use of antibiotics and antibacterial products, 35,000 people in the US die each year from infections that are immune to treatment, according to the Centers for Disease Control and Prevention (CDC). And while that number has actually declined by 28% since 2012, a new study published in the BMJ found that up to 43% of antibiotic prescriptions in the US are either unnecessary or “inappropriate.”

美国疾病控制与预防中心(CDC)的数据显示，由于数十年来抗生素和抗菌产品的大量使用，美国每年有3.5万人死于对治疗免疫的感染。虽然这个数字自2012年以来已经下降了28%，但发表在《英国医学杂志》(BMJ)上的一项新研究发现，美国高达43%的抗生素处方要么是不必要的，要么是“不合适的”。

Antibiotics are antibacterial agents designed to eradicate bacterial infections or, at least, prevent multiplying — a fact that hasn’t stopped many doctors from prescribing the drugs even for viral illnesses, such as the flu, which antibiotics do not treat. As a result, the viral pathogen remains untouched. Meanwhile, bacteria already present in the body become exposed to the drugs, giving them another opportunity to evolve and strengthen their defenses against medicine.

抗生素是用来消灭细菌感染的抗菌剂，或者至少是用来防止细菌繁殖的——这一事实并没有阻止许多医生开出抗生素处方，即使是对于病毒性疾病，比如流感，抗生素也不能治疗。结果，病毒病原体保持原样。与此同时，已经存在于体内的细菌开始接触药物，这给了它们另一个进化的机会，并增强了它们对药物的抵抗力。

Study authors analyzed notes from more than 28,000 outpatient appointments during 2015 using data from the National Ambulatory Medical Care Survey, which asks physicians to describe their patients’ visits and treatments during a specific period of time. They found that antibiotics were provided during 13.2% of these visits, and concluded that just 57% of those prescriptions were given correctly. However, another 25% of those patients were given antibiotics under false pretense, while doctors’ notes for the remaining 18% of cases were not clear enough to determine the effectiveness of the treatment. Doctors find this particularly worrisome.

研究作者分析了2015年超过28000个门诊预约的记录，数据来自全国门诊医疗调查，该调查要求医生描述他们的病人在特定时期的就诊和治疗情况。他们发现有13.2%的患者在就诊期间服用了抗生素，最后得出的结论是只有57%的处方是正确的。然而，另外25%的患者在虚假的借口下服用了抗生素，而剩下18%的患者的医生记录不够清楚，无法确定治疗的有效性。医生们发现这尤其令人担忧。

“Antibiotic prescribing without making note of the indication in a patient’s medical records might be leading to a significant underestimation of the scope of unnecessary prescribing,” said Oregon State University researcher Michael Ray, who led the study. “When there’s no indication documented, it’s reasonable to think that at least some of the time, the prescription was written without an appropriate indication present.”

“没有在病人的医疗记录中注明适应症就开抗生素处方，可能会导致对不必要处方范围的严重低估，”俄勒冈州立大学研究员迈克尔·雷(Michael Ray)说，他领导了这项研究。“当没有证据证明有任何症状时，我们有理由认为，至少在某些情况下，处方中没有适当的症状。”

Researchers also found that medical specialists were more often to blame for wrongfully prescribing antibacterial drugs compared with primary care physicians.

研究人员还发现，与初级保健医生相比，医疗专家更容易因为错误地开抗菌药物处方而受到指责。

The CDC also reports that some 2.8 million Americans each year contract antibiotic-resistant infections, including strains of gonorrhea, tuberculosis and bacterial pneumonia, and survive. Those illnesses then go on to become stronger and spread farther, forcing doctors to turn to increasingly aggressive treatments, which may come with their own health consequences.

美国疾病控制与预防中心还报告说，每年约有280万美国人感染耐抗生素的传染病，包括淋病、结核病和细菌性肺炎，并存活下来。这些疾病随后会变得更强，传播得更远，迫使医生转向越来越激进的治疗，这可能会带来自身的健康后果。