I. Introduction
Upper respiratory tract infection is a common clinical disease, which has a high incidence and complex condition in special population. Special groups include the elderly, children, pregnant women, lactating women, people with low immune function, etc. Due to their physiological characteristics or special physical conditions, these groups need to be particularly cautious in the use of antibiotics. General practice faces a wide range of patients, including a large number of special groups, so understanding the application of antibiotics for upper respiratory tract infection in special groups plays a vital role in ensuring the safety and effective treatment of patients.
2. Physiological characteristics of special population and characteristics
of upper respiratory tract infection (I) The elderly
The body function of the elderly is declining, the respiratory mucosa is atrophic, the ciliary movement is weakened, the cough reflex sensitivity is reduced, and the self-purification ability is poor. At the same time, the immune function decreased, and the function of T cells and B cells decreased. When upper respiratory tract infection occurs, fever symptoms may not be typical, often accompanied by listlessness, loss of appetite, etc., easily complicated by pulmonary infection, and often accompanied by a variety of chronic diseases, such as cardiovascular disease, diabetes, chronic obstructive pulmonary disease, etc., affecting the condition and treatment.
(II) Children
Children’s respiratory tract development is not yet perfect, the nasal cavity is short, the nasal meatus is narrow, the mucosa is tender and rich in blood vessels, and they are susceptible to infection. The immune system is not yet mature, especially in infants and young children, IgA levels are low, and they are susceptible to respiratory tract infections. Children’s upper respiratory tract infection is often manifested as high fever, cough, runny nose, etc. The condition changes rapidly, and it is easy to develop into bronchitis, pneumonia and other lower respiratory tract infections.
(III) Pregnant women
During pregnancy, the physiological changes are great, the blood volume of pregnant women increases, the hemodynamics changes, the respiratory mucosa congestion and edema, and the resistance decreases. At the same time, in order to avoid adverse effects on the fetus, medication is restricted. Upper respiratory tract infections may affect both pregnant women and fetuses, such as premature delivery and fetal growth restriction.
(IV) Lactating women
Lactating women should not only consider their own treatment, but also avoid drugs affecting their babies through breast milk. Upper respiratory tract infection may affect milk secretion, and antimicrobial drugs may have a certain concentration in milk, which has potential effects on infants.
(5) Patients with
low immune function Including people with AIDS, malignant tumors and long-term use of immunosuppressants. Their immune defense mechanism is damaged, they are vulnerable to various pathogens, upper respiratory tract infections are easy to recur, and the pathogens are diverse, the condition is often serious, and the treatment is difficult.
3. Common pathogens
of upper respiratory tract infection in special population (I) The elderly
Virus-based, such as influenza virus, rhinovirus, bacterial infections are mostly secondary, common Streptococcus pneumoniae, Haemophilus influenzae, hemolytic Streptococcus, long-term hospitalization may also have Gram-negative bacilli such as Escherichia coli, Pseudomonas aeruginosa, etc.
(II) Children
Viruses are the main pathogens, such as respiratory syncytial virus, adenovirus, influenza virus, etc. Bacterial infections are common, such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, etc. Moraxella catarrhalis is also common in young children.
(III) Pregnant women
Similar to the general population, common viral and bacterial infections, viruses such as influenza virus are more harmful to pregnant women, bacterial infections are mostly Streptococcus pneumoniae, hemolytic streptococcus and so on.
(IV) Lactating women
Pathogens are similar to those of the general population, mainly mixed infections of viruses and bacteria.
(5) Patients with
low immune function There are many kinds of pathogens, besides common viruses and bacteria, there may also be opportunistic pathogens such as fungi, Mycobacterium tuberculosis and Pneumocystis carinii.
IV. Selection principle
of antibiotics in special population (1) Safety first
1. The elderly: Avoid using drugs that are harmful to liver and kidney function, such as aminoglycosides, because the decline of liver and kidney function in the elderly can easily lead to drug accumulation poisoning. Drugs with adverse reactions to the central nervous system should be used with caution in order to prevent the aggravation of cognitive impairment in the elderly.
2. Children: try to choose drugs with high safety and less adverse reactions. Avoid using drugs that may affect children’s growth and development, such as quinolones, which can affect cartilage development and are generally not suitable for children. Accurately calculate the dosage of drugs according to the weight of children.
3. Pregnant women: Choose drugs that have little effect on the fetus. For example, penicillins and cephalosporins are relatively safe during pregnancy, while tetracyclines can affect the development of fetal teeth and bones and should be banned.
4. Lactating women: Choose drugs with less milk secretion and less impact on infants. Breastfeeding may be suspended or the time of breast-feeding may be adjusted during medication.
5. Patients with low immune function: consider the impact of drugs on the immune system and avoid using drugs that may further inhibit immune function. At the same time, attention should be paid to the prevention of opportunistic infections.
(2) The principle
of effectiveness Antibiotics are selected according to the type of pathogen. For the special population with definite bacterial infection, sensitive drugs should be selected according to the results of drug sensitivity test. For example, penicillins can be used for penicillin-sensitive strains of Streptococcus pneumoniae in children, and antifungal drugs should be used for fungal infections in patients with low immune function.
(3) The principle
of individualization Consider the underlying disease and allergic history of special population. If the elderly are accompanied by chronic obstructive pulmonary disease, the choice of antibiotics should take into account their lung disease; for special groups with a history of drug allergy, avoid the use of related allergic drugs.
V. Application
of Commonly Used Antibiotics in Special Population (I) Penicillins
1. The elderly: It can be used to treat upper respiratory tract infections caused by Streptococcus pneumoniae and Streptococcus hemolyticus, but attention should be paid to dosage adjustment and renal function monitoring.
2. Children: It is widely used for upper respiratory tract infections in children, especially for pathogens sensitive to penicillin. However, attention should be paid to allergic reactions, and detailed allergic history and skin test should be carried out before medication.
3. Pregnant women: It is relatively safe and can be used to treat sensitive bacterial infections, but attention should be paid to the impact on the mother and fetus when used in large doses.
4. Lactating women: The amount of milk secretion is small, which has little effect on the baby, and can be used under the guidance of a doctor.
(II) Cephalosporins
1. The elderly: choose according to different generations. The first generation has a good effect on Gram-positive bacteria and can be used in the early stage of upper respiratory tract infection in elderly patients.
The second and third generations have enhanced effects on Gram-negative bacteria and are suitable for patients with the possibility of mixed infection. Be aware of drug interactions and adverse reactions.
2. Children: It is widely used in children, and different generations can be selected according to pathogens. But pay attention to accurate dosage and allergic reactions.
3. Pregnant women: Most cephalosporins are relatively safe to use during pregnancy, but caution is still needed.
4. Lactating women: Some cephalosporins can enter the breast milk in a small amount, and the infant’s reaction should be observed when using them.
(III) Macrolides
1. The elderly: It can be used in the case of penicillin allergy or atypical pathogen infection. Pay attention to liver function monitoring when using it.
2. Children: It is commonly used for mycoplasma and chlamydia infection in children, which can stimulate the gastrointestinal tract to a certain extent. Pay attention to observation.
3. Pregnant women: It can be used to treat chlamydia and mycoplasma infections during pregnancy, but attention should also be paid to potential risks.
4. Lactating women: There is a certain concentration in the milk, which may cause gastrointestinal reactions in infants, so it is necessary to weigh the pros and cons when using it.
(IV) Others
1. Aminoglycosides: Use with caution in the elderly and children because of ear and kidney toxicity. Pregnant women are forbidden to avoid affecting fetal hearing.
2. Quinolones: generally not used for children and pregnant women, the elderly and lactating women should be cautious when using, pay attention to adverse reactions.
VI. Combined Application
of Antibiotics (I) Indications
for combined application 1. Mixed infections that can not be controlled by single antibiotics, such as mixed infections of Gram-positive and Gram-negative bacteria in the elderly after long-term hospitalization.
2. Severe infections with unknown etiology, such as fever of unknown origin in immunocompromised persons and severe symptoms of infection in the upper respiratory tract.
(II) Joint application programmes
1. For children with community-acquired upper respiratory tract infections complicated with bacterial infections, the combination of beta-lactams and macrolides can be used to enhance the antibacterial spectrum.
2. Upper respiratory tract infections in the elderly with chronic diseases can be combined with different generations of cephalosporins or β-lactamase inhibitors according to the pathogen.
VII. Treatment course and efficacy evaluation
(I) Course of treatment
1. The elderly: generally 7-10 days, for those with underlying disease or serious illness, it can be extended appropriately, but attention should be paid to avoid long-term use leading to drug resistance and adverse reactions.
2. Children: According to the patient’s condition, it usually takes 5-7 days. After the patient’s condition improves, it can be consolidated for 2-3 days.
3. Pregnant and lactating women: According to the pathogen and condition, generally not more than 7 days, try to shorten the course of treatment.
4. Patients with low immune function: The course of treatment may be longer, depending on the clearance of pathogens, generally 10-14 days or longer.
(2) Evaluation
of curative effect 1. Observe whether clinical signs and symptoms such as fever, cough and runny nose are relieved, and whether mental state and appetite are improved.
2. Check the physical signs, such as lung auscultation and whether the swelling of the throat is relieved.
3. The curative effect was evaluated by laboratory tests, such as blood routine, C-reactive protein, procalcitonin and other inflammatory indicators.
VIII. Conclusion
The general application of antibiotics for upper respiratory tract infection in special population needs to consider the physiological characteristics, pathogen types, drug safety and effectiveness of special population. In the process of diagnosis and treatment, general practitioners should strictly follow the principles of antimicrobial use, carefully select and use antimicrobial drugs, closely observe the patient’s condition and adverse reactions, ensure the safety and effectiveness of treatment, improve the survival rates of upper respiratory tract infection in special population, and reduce the occurrence of complications. At the same time, health education for special groups should be strengthened to improve their awareness and ability to prevent upper respiratory tract infections.
