What are antibiotics? Instructions on using antibiotics in some cases in Vietnam

Hello, Lawnet would like to answer as follows:

1. What are antibiotics?

According to the Instructions for use of antibiotics issued together with Decision 708/QD-BYT, the definition of antibiotics is as follows:

Antibiotics are a special group of drugs because their use not only affects the patient but also the community. For developing countries like Vietnam, this is an important group of drugs because infectious diseases are among the leading diseases in terms of both morbidity and mortality.

The spread of antibiotic-resistant bacterial strains is the most urgent problem today. The emergence of resistant bacterial strains affects treatment effectiveness and patient health. Limiting the emergence of antibiotic-resistant bacteria is the task not only of the health sector but of the entire community to protect this group of drugs.

Antibiotics are defined:

“Antibiotics are antibacterial substances produced by strains of microorganisms (bacteria, fungi, Actinomycetes), which inhibit the growth of other microorganisms.

Currently, the word antibiotics is extended to include antibacterial agents of synthetic origin such as sulfonamides and quinolones.

To ensure reasonable use of drugs, it is necessary to master knowledge related to antibiotics, pathogenic bacteria and patients.

Antibiotic groups are arranged according to chemical structure. According to this classification, antibiotics are divided into the following groups:

Classification of antibiotics according to chemical structure

What are antibiotics?

Antibiotics are drugs that kill or inhibit the growth of bacteria, thereby reducing the inflammatory response caused by bacteria. Antibiotics are an effective tool for treating bacteria when used carefully and safely.

Antibiotics are often prescribed by doctors to treat inflammatory diseases caused by bacteria:

- Sinusitis, otitis media,... caused by bacteria

- Meningitis

- Tooth infection

- Respiratory tract infections

- Urinary tract infections

- Skin and soft tissue infections

- Sepsis

2. Instructions for using antibiotics in some cases in Vietnam

2.1 Boils (skin and soft tissue infections)

(1) Definition

Furuncle is an acute inflammatory condition that causes necrosis of the hair follicles and surrounding tissue.

- The disease is common in the summer and is more common in men than women. All ages can get the disease, but the disease is more common in children.

(2) Cause

- The cause of the disease is Staphylococcus aureus (S. aureus). Normally, this bacteria lives parasitically on the skin, especially hair follicles in folds such as nasolabial folds, inter-buttock grooves... or natural cavities such as nostrils. When hair follicles are damaged, combined with favorable conditions such as poor immunity, malnutrition, and patients with diabetes... bacteria grow and cause disease.

(3) Symptoms

a) Clinical

- The initial symptoms are small, red papules in the hair follicles that are swollen, firm, and red. After 2 to 3 days, the lesion spreads and turns into pus, forming an abscess in the middle and a pus sting. Pain is a common physical symptom, especially in the nose and ear lobes, sometimes causing children to cry a lot. Common locations are on the head, face, neck, back, buttocks, legs, and arms. The number of lesions may be small or large, accompanied by systemic symptoms such as fever, fatigue, and infectious syndrome.

- The disease can be cured but can last for many consecutive episodes.

- Complications of sepsis can occur, especially in malnourished patients. Boils in the upper lip and cheek areas can lead to cavernous sinus phlebitis and severe sepsis.

- Cluster boils, also known as cluster boils or cluster boils, are an acute bacterial infection of the skin consisting of a number of boils arranged in clusters. The disease often occurs in people who are malnourished, immunocompromised, or have chronic diseases such as diabetes, bronchial asthma, and tuberculosis.

- Diagnosis is mainly based on clinical findings. In the early stages, it is necessary to differentiate between folliculitis, disseminated skin herpes, acne, and purulent hidradenitis.

b) Paraclinical

- Increased white blood cells in peripheral blood.

- Increased blood sedimentation.

- Procalcitonin may increase, especially in patients with many lesions.

- Histopathological examination: Abscess in hair follicle; hair follicle structure is broken, in the middle is necrotic tissue, surrounded by many inflammatory cells, mainly neutrophils.

- Purulent culture showed the growth of Staphylococcus aureus.

(4) Antibiotic treatment

- Personal hygiene: Wash your hands regularly to avoid self-infection in other skin areas with Lifebuoy soap, Septivon, etc.

- In the early stages without pus: avoid squeezing or stimulating the lesion.

- Purulent stage requires a wide surgical incision to clean the lesion.

- Need to combine local treatment and systemic antibiotics.

- Antiseptic solution: Disinfect 2-4 times a day for 10–15 days. You can use one of the following disinfectant solutions:

+ Povidone-iodine 10%.

+ Hexamidin 0.1%.

+ Chlorhexidine 4%.

- Topical antibiotics: Apply the medicine to the lesion after disinfection; the treatment time is 7–10 days. Use one of the following medications:

+ 2% fucidic acid cream or ointment; apply 1-2 times a day.

+ Neomycin ointment; apply 2-3 times/day.

+ Silver sulfadiazine cream, 1%, apply 1-2 times/day.

+ Mupirocin 2% ointment, applied 3 times/day.

+ Erythromycin 1-2 times/day.

+ Clindamycin 1-2 times/day.

- Systemic antibiotics with one of the following antibiotics:

+ Penicillin M (cloxacillin) 2g/day.

+ Amoxicillin-clavulanate.

Children 80 mg/kg/day divided into 3 times.

Adults: 1.5-2 g/day divided into 2 times.

+ Roxithromycin 150mg tablets:

Children 5-8 mg/kg/day divided into 2 times.

Adults 2 tablets/day divided into 2 times.

+ Azithromycin 500 mg the first day, then 250 mg/day x 4 days.

+ Pristinamycin:

Children 50 mg/kg/day, divided into 2 times.

Adults 2-3 g/day, divided into 2 times.

+ Fucidic acid tablets 250 mg.

Children are dosed 30–50 mg/kg/day, divided into 2 times.

Adults 1-1.5 g/day, divided into 2 times.

+ Treatment time is 7 - 10 days.

(5) Disease prevention

- Clean personal hygiene: cut nails and wash hands daily.

- Avoid using products that cause skin irritation.

- Improve physical condition.

2.2 Diarrhea caused by bacteria (gastrointestinal infection)

(1) General

- Diarrhea caused by bacteria is a common disease of all ages and closely related to food hygiene and safety. Common clinical manifestations are: fever, vomiting, abdominal pain, and diarrhea several times a day.

- Severe diarrhea can cause dehydration or systemic infection, leading to death, especially in children and the elderly.

(2) Common causes

- Diarrhea caused by bacterial toxins: Vibrio cholerae, E. coli, Clostridium difficile, staphylococcus.

- Diarrhea caused by bacteria itself (invasive diarrhea): Shigella, Salmonella, E. coli, Campylobacter, Yersinia...

(3) Diagnosis

Based on clinical and laboratory testing.

a) Clinical: Manifestations vary depending on the cause of the disease.

- Vomiting and nausea.

- Frequent diarrhea: the nature of the stool depends on the cause of the disease:

+ Diarrhea caused by bacterial toxins: Stools have a lot of water and no white blood cells or red blood cells in the stool.

+ Diarrhea caused by bacterial invasion: Stools often contain mucus, sometimes blood.

- Whole body manifestations:

+ May or may not have a fever.

+ Intoxication: fatigue, headache, possible hypotension.

+ Dehydration.

b) Clinical features of some common causes:

- Diarrhea due to bacillary dysentery (dysentery syndrome): high fever, intermittent abdominal pain, tenesmus, and loose stools mixed with blood.

- Diarrhea due to cholera: Onset very quickly within 24 hours; diarrhea is severe and continuous 20-50 times/day, stools are watery like rice water, no fever, no tenesmus, no abdominal cramps.

- Diarrhea caused by staphylococcal toxins: short incubation period of 1-6 hours, nausea, vomiting, watery diarrhea, but no fever.

- Diarrhea caused by E. coli:

+ Diarrhea caused by enterotoxigenic E. coli (ETEC): loose stools without bloody mucus, no fever. The disease usually goes away on its own.

+ Diarrhea caused by E. coli (EIEC, EPEC, EHEC): fever, abdominal cramps, tenesmus, loose stools that may be mixed with bloody mucus (dysentery syndrome).

- Diarrhea caused by Salmonella: diarrhea, high fever, vomiting, and abdominal pain.

c) Testing:

- Blood formula: The number of white blood cells increases or decreases depending on the cause.

- Blood biochemical test: evaluate electrolyte disorders and accompanying kidney failure.

- Stool test:

+ Stool examination: Look for red blood cells, white blood cells, parasitic protozoa, fungi, parasite eggs...

+ Stool culture to find disease-causing bacteria.

(4) Treatment

4.1. Rule:

- Antibiotic treatment depends on the cause. It is necessary to predict the cause and treat it immediately. Adjust antibiotics if necessary after stool culture results are available.

- Assess dehydration and replace electrolytes.

- Symptomatic treatment.

4.2. Use antibiotics for infectious diarrhea due to some common causes:

Antibiotics are often effective in cases of invasive diarrhea.

- Often use oral antibiotics. Intravenous antibiotics are only used in severe cases of systemic infections.

- Antibiotic dosage here mainly applies to adults. For children, refer to "Guidelines for treating diarrhea in children" (Ministry of Health 2009).

a) Diarrhea caused by E. coli (ETEC, EHEC), Campylobacter, Yersinia, Salmonella, Vibrio spp.

- Preferred drugs: quinolone antibiotics (oral or infusion) x 5 days (people > 12 years old):

+ Ciprofloxacin 0.5 g x 2 times/day.

+ or norfloxacin 0.4 gx 2 times/day.

- Alternative medicine:

+ Ceftriaxone intravenously (IV) 50–100 mg/kg/day x 5 days.

+ TMP-SMX 0.96g x 2 times/day x 5 days.

+ Doxycycline 100 mg x 2 times/day x 5 days.

b) Diarrhea caused by Clostridium difficile

- Preferred drug: Metronidazole 250 mg (oral) every 6 hours x 7-10 days.

- Alternative medicine: Vancomycin 250 mg (oral) every 6 hours x 7-10 days.

c) Diarrhea caused by Shigella (bacillary dysentery)

- Preferred drug: Quinolone (oral or intravenous infusion) x 5 days (people > 12 years old):

+ Ciprofloxacin 0.5 g x 2 times/day.

+ Or norfloxacin 0.4 gx 2 times/day.

- Alternative medicine:

+ Ceftriaxone (TM) 50–100 mg/kg/day x 5 days.

+ Or azithromycin (oral) 0.5 g/day x 3 days (priority for pregnant women) or azithromycin (oral) 10 mg/kg/day x 3 days (for children <12 years old).

d) Diarrhea caused by typhoid (Salmonella typhi, paratyphi)

- Preferred drug: Quinolone (oral or infusion) x 10–14 days (adults > 12 years old):

+ Ciprofloxacin 0.5 g x 2 times/day.

+ Or norfloxacin 0.4 gx 2 times/day.

- Alternative medicine: Ceftriaxone (TM) 50–100 mg/kg/time x 1 time/day x 10–14 days.

e) Diarrhea caused by cholera bacteria

- Currently, cholera bacteria are resistant to common antibiotics; the current drugs of choice are:

- Quinolone group (oral) x 3 days (people > 12 years old):

+ Ciprofloxacin 0.5 g x 2 times/day.

+ Or norfloxacin 0.4 gx 2 times/day.

Or azithromycin (oral) 0.5 g/day x 3 days (priority for pregnant women) or azithromycin (oral) 10 mg/kg/day x 3 days (for children <12 years old)

- Alternative medicine:

+ Erythromycin 1g/day orally divided into 4 times/day (children 40 mg/kg/day), used for 3 days.

+ Or doxycycline 300 mg single dose (used in case the bacteria are still sensitive).

4.3. Treat symptoms

a) Assess and treat dehydration

- Must immediately assess and promptly treat dehydration when the patient arrives at the hospital, in parallel with finding the cause of the disease.

+ Patients with grade I dehydration who can drink: rehydrate by mouth, using ORESOL solution.

+ Patients with grade II or higher dehydration who cannot drink: rehydrate intravenously. Solution of choice: Ringer Lactate or Ringer Acetate. Additionally, NaCl 0.9%, Glucose 5% at a ratio of 1:1.

b) Supportive treatment

- Reduces spasms: Spasmaverin.

- Firms the intestinal mucosa: dioctahedral smectite

- Do not abuse anti-diarrheal drugs such as loperamide.

(5) Disease prevention

- Enhance food hygiene and safety.

+ Eat cooked food and drink boiled water.

+ Wash your hands before eating and after going to the bathroom.

+ Improve water supply and drainage system.

- Preventive treatment when in epidemic areas.

(According to the Instructions for use of antibiotics issued together with Decision 708/QD-BYT )

Note: The information in the article is for reference only. Readers, please contact your doctor, pharmacist, or medical professional for the most specific and accurate advice.

Best regards!

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