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小儿的细菌性感染为常见病,新生儿、早产儿和婴幼儿一旦罹患细菌性感染,严重者常危及生命。因此,在及时诊断的同时,尽早根据病原及患儿病情正确选用药物是一关键问题。除此外小儿在生理和病理方面具有特殊性,尤其是新生儿,其生理过程随日龄的增长而迅速变化,这些特点直接影响到药物在体内的吸收、分布、结合、灭活和排泄等药物代谢动力学和药理性质。因此治疗小儿感染的另一关键问题是必须根据小儿的生理特点合理用药,忽视上述任何一方面均可导致抗菌药物疗效不能发挥。而药物不良反应发生率增高的结果,以对耳、肾均有明显毒性的氨基甙类抗生素(庆大霉素、卡那霉素、链霉素等)为例,近年来由于不合理应用该类药物在小儿中致耳毒性反应发生的情况屡见报道,据上海耳鼻喉科研究所报道在325例应用氨基甙类抗生素发生耳毒性反应的小儿病例中,应用卡那霉素或庆大霉素产生耳毒性病例中属严重耳聋者占70％以上;又如口服四环素或土霉素后在婴幼儿中可致牙齿染色,牙釉质及骨发育不良,有报道学龄前儿童服用该类药物者20％出现牙齿变色。给新生儿服用四环素后40％患儿出现骨骼生长抑制。因此,在治疗小儿感染性疾患时,只有根据小儿特点合理选用药物才会使抗菌药物应用安全而有效。本文对抗生素药物在新生儿、婴幼儿和儿童常见感染性疾患中的应用分述如下。
Bacterial infections in children as a common disease, newborns, premature children and infants once suffering from bacterial infections, often serious life-threatening. Therefore, in the timely diagnosis at the same time, the correct selection of drugs according to the pathogen and children’s condition is a key issue. In addition to the special physiological and pathological aspects of children, especially newborns, their physiological processes rapidly change with age, these characteristics directly affect the absorption of drugs in the body, distribution, binding, inactivation and excretion of drugs Metabolism and pharmacological properties. Therefore, the treatment of pediatric infection is another key issue is that children must be based on physiological characteristics of rational use of drugs, regardless of any one of the above can lead to anti-bacterial drug efficacy can not play. As a result of the increased incidence of adverse drug reactions, taking aminoglycoside antibiotics (gentamicin, kanamycin, streptomycin, etc.) having obvious toxicity to the ear and kidney as examples, in recent years, due to the unreasonable application of the Drugs in children caused by ototoxic reactions are often reported, according to the Shanghai Institute of Otolaryngology reported in 325 cases of aminoglycoside antibiotics ototoxic reactions occurred in children, the application of kanamycin or gentamicin Suffering from ototoxicity in cases of severe deafness accounted for more than 70%; Another example is the oral administration of tetracycline or oxytetracycline in children can cause tooth staining, enamel and bone dysplasia, there are reports preschool children taking such drugs Tooth discoloration appears in 20%. Bone growth inhibition occurred in 40% of children with tetracycline. Therefore, in the treatment of pediatric infectious diseases, only rational use of drugs according to the characteristics of children will make antimicrobial drugs safe and effective. This article on antibiotics in neonatal, infants and children common infectious diseases in the application are described below.