藥學(xué)英語：抗生素的另一面

The Other Side of Antibiotics
抗生素的另一面

Antibiotics have eliminated or controlled so many infectious diseases that virtually everyone has benefited from their use at one time or another. Even without such personal experience, however, one would have to be isolated indeed to be unaware of the virtues, real and speculative, of these “miracle” drugs1. The American press, radio, and television have done a good job of reporting the truly remarkable story of successes in the chemical war on germs. What′s more, any shortcomings on their part have been more than made up for by the aggressive public relations activity of the pharmaceutical companies which manufacture and sell antibiotics.

抗生素可以消除或控制很多種感染疾病，以致幾乎每人生病時(shí)都習(xí)慣于使用它而受益，但是如果一個(gè)人沒有這樣的親身經(jīng)歷，他必定是離群索居才會(huì)不知道這些“特效藥物”或真實(shí)或推測的優(yōu)點(diǎn)。美國的出版物、電臺(tái)或電視臺(tái)用大量的篇幅報(bào)道了有關(guān)對(duì)細(xì)菌的化學(xué)戰(zhàn)中獲得的這些顯著功績。而它的缺點(diǎn)卻被生產(chǎn)和銷售抗生素的制藥公司通過公關(guān)活動(dòng)掩藏了。

In comparison, the inadequacies and potential dangers of these remarkable drugs are much less widely known. And the lack of such knowledge can be bad, especially if it leads patients to pressure their doctors into prescribing antibiotics when such medication isn’t really needed, or leads them to switch doctors until they find one who is, so to speak, antibiotics-minded2.

相比而言，使用這些藥物的危險(xiǎn)性并不廣為人知。對(duì)這種知識(shí)的缺乏將更糟糕，特別是當(dāng)患者要求醫(yī)生開處方用抗生素而事實(shí)并不需要，或患者頻繁地更換醫(yī)生直至找到一個(gè)同意開抗生素處方的醫(yī)生。

Because the good side of the antibiotics story is so very well-known, there seems more point here to a review of some of the immediate and long-range problems that can come from today’s casual use of these drugs. It should be made clear in advance that calamities from the use of antibiotics are rare in relation to the enormous amounts of the drugs administered. But the potential hazards, so little touched on generally, do need a clear statement.

因?yàn)榭股氐暮玫囊幻嬉褟V為人知，今天抗生素的濫用導(dǎo)致短期或長期問題。我們預(yù)先應(yīng)該知道與抗生素的巨大的使用量相比,它產(chǎn)生危害的例子是少見的。但是，盡管十分少見，需要對(duì)這種潛在的危險(xiǎn)作一個(gè)清楚的說明。

The antibiotics are not, strictly speaking, exclusively prescription drugs. A number of them are permitted in such over-the-counter products as nasal sprays, lozenges, troches, creams, and ointments. Even if these products do no harm there is no point whatsoever in using them. If you have an infection serious enough to warrant the launching of chemical warfare, you need much bigger doses of the antibiotics than any of the non-prescription products are allowed to contain.

嚴(yán)格來講，抗生素并不全是處方藥。許多抗生素被允許作為非處方藥(如鼻噴霧劑、鍵劑、片劑、軟膏和乳膏),盡管它們沒有危害，也不能隨意地使用。如果你患了嚴(yán)重的感染，你就得需要比非處方藥所允許最大劑量更大劑量的抗生素了。

Over-the-counter products, however, account for only a small percentage of total antibiotics production. It is the prescription dosages that give people trouble.

然而，非處方藥品只是整個(gè)抗生素類產(chǎn)品的一小部分，正是處方藥物給人類帶來了麻煩。

These drugs—even allowing for the diverse abilities of the many narrow-spectrum ones and the versatility of the broad-spectrum ones—are not the cure-alls they often are billed as being. There are wide gaps in their ability to master contagious diseases. Such important infections as mumps, measles, common colds, influenza, and infectious hepatitis still await conquest. All are virus infections and despite intense efforts, very little progress has been made in chemotherapy against viruses. Only small progress has been achieved against fungi. Many strains of bacteria and fungi are naturally resistant to all currently available antibiotics and other chemotherapeutic drugs.

這些藥物一即使允許最大能力,很多窄譜抗生素和廣譜抗生素也并不是如宣傳的那樣治療百病。它們的能力與治療傳染性疾病間還存在很大的差距。如腮腺炎、麻疹、普通感冒、流行性感冒和傳染性肝炎等嚴(yán)重感染性疾病仍有待解決。這些都是病毒感染，盡管做出了很大的努力，但是在抗病毒的化療藥物的研究上幾乎沒有什么進(jìn)展?？拐婢幬锏难芯可现蝗〉靡稽c(diǎn)小成就。很多細(xì)菌和真菌對(duì)現(xiàn)有的抗生素和其他化療藥物具有耐藥性。

Some microorganisms originally sensitive to the action of antibiotics, especially staphylococcus, have developed resistant strains. This acquired resistance imposes on the longrange value of the drugs a very important limitation, which is not adequately met by the frequent introduction of new antimicrobial agents to combat the problem.

一些原來對(duì)抗生素敏感的細(xì)菌，特別是葡萄球菌現(xiàn)在也產(chǎn)生了耐藥性，這些獲得的耐藥性對(duì)藥物的長期使用產(chǎn)生重要的限制，頻繁引人新的抗菌藥物也不能完全解決這個(gè)問題。

It has been pretty well established that the increase in strains of bacteria resistant to an antibiotic correlates directly with the duration and extent of use of that antibiotic in a given location. In one hospital a survey showed that, before erythromycin had been widely used there, all strains of staphylococci taken from patients and personnel were sensitive to its action. When the hospital started extensive use of erythromycin, however, resistant staphylococcus strains began to appear.

現(xiàn)已經(jīng)確定，在一些地區(qū)，抗生素廣泛和長期的使用與細(xì)菌耐藥性增加有直接的相互關(guān)系。某醫(yī)院調(diào)查顯示，在紅霉素廣泛使用以前，所有從病人身上取出的葡萄球菌都對(duì)紅霉素敏感.然而，自從醫(yī)院開始廣泛應(yīng)用紅霉素以來，耐藥葡萄球菌菌株開始出現(xiàn)。

The development of bacterial resistance can be minimized by a more discriminating use of antibiotics, and the person taking the drug can help here. When an antibiotic must be used, the best way to prevent the development of resistance is to wipe out the infection as rapidly and thoroughly as possible. Ideally, this requires a bactericidal drug, which destroys, rather than a bacteriostatic drug, which inhibits. And the drug must be taken in adequate dosage for as long as is necessary to eradicate the infection completely. The doctor, of course, must choose the drug, but patients can help by being sure to take the full course of treatment recommended by the doctor, even though symptoms seem to disappear before all the pills are gone. In rare instances the emergence of resistance can be delayed or reduced by combinations of antibiotics. Treatment of tuberculosis with streptomycin alone results in a high degree of resistance, but if para-aminosalicylic acid or isoniazid is used with streptomycin the possibility that this complication will arise is greatly reduced.

更有區(qū)別的應(yīng)用抗生素可以最大限度地抑制細(xì)菌耐藥性的發(fā)展，使用藥物的病人可對(duì)此有所幫助。當(dāng)必須使用一種抗生素時(shí)，最好的避免耐藥性方法就是盡快徹底地去除感染。這就需要用能殺死細(xì)菌的殺菌藥，而不是抑制細(xì)菌的抑菌藥。這種藥物必須使用一定劑量，并且一定的時(shí)間以完全根除這種感染。醫(yī)生當(dāng)然得選這種藥，但患者須遵醫(yī)囑、使用足夠的治療量，即使在藥物吃完以前癥狀似乎已經(jīng)消失。少數(shù)情況下聯(lián)合用藥可以推遲或降低耐藥性的產(chǎn)生。用鏈霉素單獨(dú)治療結(jié)核病會(huì)導(dǎo)致高度的耐藥，但如果鏈霉素聯(lián)用對(duì)氨基水楊酸或異煙肼將大大降低耐藥性。

In hospital treatment of severe infections, the sensitivity of the infecting organism to appropriate antibiotics is determined in the laboratory before treatment is started. This enables the doctor to select the most effective drug or drugs; it determines whether the antibiotic is bactericidal or bacteriostatic for the germs at hand; and it suggests the amount needed to destroy the growth of the bacteria completely. In either hospital or home, aseptic measures can help to reduce the prevalence of resistant strains of germs by preventing cross infection and the resultant spreading of organisms.

在醫(yī)院治療嚴(yán)重感染時(shí)，感染菌對(duì)抗生素的敏感性在治療前已在實(shí)驗(yàn)室確定，這樣可以使醫(yī)生選擇最有效的藥物，可以決定使用抑菌還是殺菌的抗生素，并可對(duì)能完全破壞細(xì)菌生長所需的用量給出建議。無論在醫(yī)院或是在家里，無菌措施由于避免了交叉感染以及由此造成的生物體傳播，從而可以降低細(xì)菌耐藥菌株的廣泛流行。

Every one of the antibiotics is potentially dangerous for some people. Several serious reactions may result from their use. One is a severe, sometimes fatal, shock-like anaphylactic action, which may strike people who have become sensitized to penicillin. Anaphylactic reaction happens less frequently and is less severe when the antibiotic is given by mouth. It is most apt to occur in people with a history of allergy, or a record of sensitivity to penicillin. Very small amounts of penicillin, even the traces which get into the milk of cows for a few days after they are treated with the antibiotic for mastitis, may be sufficient to sensitize; hence, the strong campaign by food and drug officials to keep such milk off the market.

對(duì)有些人來說任何一種抗生素都可能有潛在的危險(xiǎn)。一些嚴(yán)重的反應(yīng)可能是由于它們的應(yīng)用產(chǎn)生的，其中之一就是嚴(yán)重的有時(shí)甚至是致死性的過敏性休克，對(duì)青霉素過敏的人使用青霉素將很危險(xiǎn)。口服抗生素將使過敏頻率降低或降低嚴(yán)重性。青霉素過敏或有過敏史者更容易發(fā)生。奶牛使用抗生素治療乳腺炎幾天后，其牛奶中帶入的極其少量甚至痕量的青霉素也可能足以引起過敏。所以食品藥品監(jiān)督官員采取強(qiáng)有力的措施防止這種牛奶進(jìn)人市場。

To minimize the risk of anaphylactic shock in illnesses where injections of penicillin are the preferred treatment, a careful doctor will question the patient carefully about allergies and previous reactions. In case of doubt another antibiotic will be substituted, if feasible, or other precautionary measures will be taken before the injection is given.

當(dāng)注射青霉素是首選治療方案時(shí)，為降低這種過敏性休克，謹(jǐn)慎的醫(yī)生會(huì)仔細(xì)詢問病人的過敏史及其反應(yīng)。如過敏史不清楚，醫(yī)生會(huì)用其他抗生素代替或注射前用其他方法檢查其是否過敏。

Other untoward reactions to antibiotics are gastrointestinal disorders—such as sore mouth, cramps, diarrhea, or anal itch—which occur most frequently after use of the tetracycline group but have also been encountered after use of penicillin and streptomycin. These reactions may result from suppression by the antibiotic of bacteria normally found in the gastrointestinal tract. With their competition removed, antibiotic-resistant staphylococci or fungi, which also are normally present, are free to flourish and cause what is called a super-infection. Such infections can be extremely difficult to cure.

其他抗生素不良反應(yīng)包括胃腸道不適，如口腔疼痛、痙攣、腹瀉、肛門瘙癢，這種情況在使用四環(huán)素類抗生素后經(jīng)常發(fā)生，在使用青霉素和鏈霉素后也會(huì)遇到。這些反應(yīng)可能是由于使用的抗生素抑制了正常的胃腸道菌群引起的。隨著這種競爭的消除，正常存在的葡萄球菌或真菌耐藥菌株自由繁殖并引起所謂的超感染，這種感染將更難治療。

A few antibiotics have such toxic effects that their usefulness is strictly limited. They include streptomycin and dihydro-streptomycin, which sometimes cause deafness, and chloramphenicol, which may injure the bone marrow. Drugs with such serious potential dangers as these should be used only if life is threatened and nothing else will work

有些抗生素有毒性作用，使其應(yīng)用受到了嚴(yán)格的限制。這類抗生素包括會(huì)導(dǎo)致耳聾的鏈霉素和雙氫鏈霉素，以及會(huì)產(chǎn)生骨髓損傷的氯霉素。這些有嚴(yán)重危險(xiǎn)的藥物只有在生命受到威脅或其他藥物無效時(shí)才使用。

All the possible troubles that can result from antibiotic treatment should not keep anyone from using one of these drugs when it is clearly indicated. Nor should they discourage certain preventive uses of antibiotics which have proved extremely valuable.

由于有些抗生素療效確切，因此使用抗生素所帶來的所有可能的麻煩也不能阻止任何人用任何一種抗生素，對(duì)于被證明是有效的抗生素，人們不會(huì)不鼓勵(lì)它們的使用。

醫(yī)學(xué)英語