抗菌药物合理应用的宏观和微观问题

抗菌药物不合理应用现象长期得不到纠正，细菌耐药稳步攀升，正引起医学界、社会和政府的高度关注。本文就宏观上的抗菌药物使用政策与微观上的临床用药两方面存在的问题进行探讨。介绍了国际上关于抗菌药物政策的研究以及抗菌药物合理使用的新观点（尽早开始经验性治疗、“降阶梯”治疗策略、运用抗菌药物PK／PD原理指导临床用药、短程治疗）。主张调整宏观抗生素策略，去除该政策单纯、片面限制使用和应用药敏实验结果指导临床用药绝对化的做法。吸纳国际上的新成果，强化监管力度，更多采用教育和技术手段。

Macroand Micro-View of Rational Use for Antimicrobial Agents

Long-term irrational use of antimicrobial agents and steady increase in bacterial resistance are highly concerned in medical science, society and government. This paper discusses both problems about antimicrobial agent policy in aspect of macroview and clinical use in aspect of micro - view. It also introduces the research of antimicrobial agents policy internationally and new view- point of appropriate antimicrobial treatment clinically. Those new viewpoints include early empirical antirnicrobial therapy, de- escalation therapy, using PK/PD theory of antimicrobial agents guide to the clinical therapy, short course therapy. The author suggests modifying antimicrobial agents policy, in which the simple, one - sided items for restrictive use and to taking antimicrobial susceptibility test in absolute terms should be diminate, and intensifying superintend with educational and technical measures.