Introduction
Antibacterial drugs play a crucial role in the treatment of primary health-care facilities. They are powerful weapons for the treatment of bacterial infectious diseases, but if they are not used rationally, they not only affect the effectiveness of treatment, but also raise a number of serious problems, such as increased bacterial resistance, increased adverse patient reactions and waste of medical resources. It is therefore of far-reaching significance to emphasize the rational use of antibacterial drugs in primary health-care institutions.
II. Status of use of antibacterial drugs in primary health institutions
(i) Overuse
In some primary health-care institutions, overuse of anti-bacterial drugs occurs due to limited levels of diagnosis or to patient requirements. For example, antibacterial drugs are also often used to treat non-bacterial infectious diseases, such as common influenza and viral respiratory infections. This practice not only does not contribute to the medical condition, but may also undermine the micro-ecological balance of the patient.
(ii) Unreasonable choice of medication
Some grass-roots doctors do not take due account of the type of pathogen, the antibacterial spectrum of the drug and the individual differences of the patient when choosing antibacterial drugs. Some doctors are accustomed to using broad-spectrum antibacterials, rather than choosing more specific narrow-spectrum antibacterials based on the specific case, which can easily lead to herb-commodity disorders and drug-resistant bacteria.
(iii) Irregular drug use and treatment process
In terms of doses, there are under- or overdoses. Inadequate dosages may not effectively kill pathogens, leading to continued transmission and even drug resistance; excessive use increases the risk of adverse patient reactions. In the course of treatment, some patients stop taking their own medication after a slight reduction in symptoms, or doctors stop taking it too soon, so that the infection is not cured and is prone to relapse.
III. Measures for the rational use of antibacterial drugs
(i) Improved professionalism of medical personnel at the grass-roots level
1. Strengthening training
Basic doctors are regularly organized for training in antibacterials, including pharmacology of antibacterials, pharmacological dynamics, antibacterial spectrometry, adaptation certificates, taboos, etc. Training can take a variety of forms, such as expert lectures, online courses, case analysis discussions, etc., to raise the level of awareness and application of anti-bacterial drugs by doctors.
2. Updating knowledge
Basic medical personnel are encouraged to follow the latest research progress and update the guidelines in the field of antibacterial drugs and to keep abreast of new antibacterial drug varieties, new treatment programmes and prevalence trends in drug-resistant bacteria so that they can be accurately applied in clinical practice.
(ii) Emphasis on pathogen detection and diagnosis
Improved detection equipment and technology
Basic medical institutions should, to the extent possible, be equipped with the necessary pathogen detection equipment, such as microscopes, rapid detection reagents, etc., to improve detection capabilities for common pathogens. Some cases of infection that are difficult to clearly diagnose should be examined in a timely manner at a higher level to obtain accurate pathogen information.
2. Comprehensive diagnostic methods
The doctor cannot rely solely on the results of the laboratory tests, but must also make a comprehensive assessment of the patient ‘ s medical history, symptoms, signs, etc. For example, in cases of heat and cough, the choice of anti-bacterial drugs is guided by the consideration of the part of the infection (up or down), the acute onset of the disease, and other associated symptoms.
(iii) Regulating the choice of antibacterial drugs
1. Compliance with guidelines and principles
Drugs are used in strict accordance with the guidelines and basic principles for the clinical application of antibacterial drugs issued at the national and local levels. For mild infections, priority is given to narrow-spectral antibacterials; for severe or mixed infections, joint use of antibacterials may be considered, but care may be taken that there are taboos in the distribution of drugs.
2. Consideration of patient factors
Due consideration is given to the age of the patient, liver and kidney function, allergies, etc. If the liver and kidney function of the elderly and children is relatively weak, it is important to avoid the use of drugs that are more damaging to the liver and kidney function in the choice of antibacterial drugs, and to strictly prohibit the use of the relevant allergies for patients with a sensitive history.
(iv) Reasonable determination of the dose and course of treatment
1. Individualized medicine
The appropriate dose is calculated on the basis of the patient ‘ s weight, severity, etc. Special dose adjustments are made for special groups such as obese, pregnant and nursing mothers.
2. Ensuring an adequate course of treatment
The treatment process is determined according to the type of infection and the characteristics of the pathogens. In general, acute infections should continue for a period of time after normal body temperature and symptoms have disappeared, in order to completely remove pathogens. For example, acute renal inflammation is usually 10 – 14 days.
IV. Strengthening antibacterial drug management
(i) Establishment of anti-bacterial drug management systems
Primary health-care institutions should have well-developed antibacterial drug management systems, including the procurement, storage, use and monitoring of antibacterial drugs. (c) To establish a hierarchy for the management of anti-bacterial drugs and to clarify the authority of doctors at all levels, such as the requirement that restrictions on the use of anti-bacterial drugs be prescribed by the doctor in charge and by the doctor with the above title.
(ii) Monitoring and evaluation
1. Monitoring of drug use
Regular statistical analysis of data on the variety, dosage and frequency of use of antibacterial drugs to understand trends in their use. At the same time, the occurrence of adverse reactions to antibacterial drugs is monitored and potential problems are identified and addressed in a timely manner.
2. Treatment impact assessment
The efficacy assessment of patients treated with anti-bacterial drugs is carried out and the improvement of patients ‘ symptoms, the elimination of pathogens, etc. is observed. If treatment is not effective, the treatment programme should be adjusted in a timely manner to analyse the reasons.
Conclusions
The rational use of antibacterial drugs in primary health-care institutions is a systematic and long-term endeavour. The implementation of a number of measures, such as improving the quality of medical personnel, valuing diagnostics, regulating medications and improving management, can improve the rationality of the use of anti-bacterial drugs, reduce the production of bacterial resistance, guarantee the safety of patients and the effectiveness of treatment, and promote the quality of medical services at the grass-roots level. This has an important role to play in the sustainable development of health care as a whole and in the maintenance of public health.
