药学英语：抗生素的另一面

The Other Side of Antibiotics
抗生素的另一面

Antibiotics have eliminated or controlled so many infectious diseases that virtually everyone has benefited from their use at one time or another. Even without such personal experience, however, one would have to be isolated indeed to be unaware of the virtues, real and speculative, of these “miracle” drugs1. The American press, radio, and television have done a good job of reporting the truly remarkable story of successes in the chemical war on germs. What′s more, any shortcomings on their part have been more than made up for by the aggressive public relations activity of the pharmaceutical companies which manufacture and sell antibiotics.

抗生素可以消除或控制很多种感染疾病，以致几乎每人生病时都习惯于使用它而受益，但是如果一个人没有这样的亲身经历，他必定是离群索居才会不知道这些“特效药物”或真实或推测的优点。美国的出版物、电台或电视台用大量的篇幅报道了有关对细菌的化学战中获得的这些显著功绩。而它的缺点却被生产和销售抗生素的制药公司通过公关活动掩藏了。

In comparison, the inadequacies and potential dangers of these remarkable drugs are much less widely known. And the lack of such knowledge can be bad, especially if it leads patients to pressure their doctors into prescribing antibiotics when such medication isn’t really needed, or leads them to switch doctors until they find one who is, so to speak, antibiotics-minded2.

相比而言，使用这些药物的危险性并不广为人知。对这种知识的缺乏将更糟糕，特别是当患者要求医生开处方用抗生素而事实并不需要，或患者频繁地更换医生直至找到一个同意开抗生素处方的医生。

Because the good side of the antibiotics story is so very well-known, there seems more point here to a review of some of the immediate and long-range problems that can come from today’s casual use of these drugs. It should be made clear in advance that calamities from the use of antibiotics are rare in relation to the enormous amounts of the drugs administered. But the potential hazards, so little touched on generally, do need a clear statement.

因为抗生素的好的一面已广为人知，今天抗生素的滥用导致短期或长期问题。我们预先应该知道与抗生素的巨大的使用量相比,它产生危害的例子是少见的。但是，尽管十分少见，需要对这种潜在的危险作一个清楚的说明。

The antibiotics are not, strictly speaking, exclusively prescription drugs. A number of them are permitted in such over-the-counter products as nasal sprays, lozenges, troches, creams, and ointments. Even if these products do no harm there is no point whatsoever in using them. If you have an infection serious enough to warrant the launching of chemical warfare, you need much bigger doses of the antibiotics than any of the non-prescription products are allowed to contain.

严格来讲，抗生素并不全是处方药。许多抗生素被允许作为非处方药(如鼻喷雾剂、键剂、片剂、软膏和乳膏),尽管它们没有危害，也不能随意地使用。如果你患了严重的感染，你就得需要比非处方药所允许最大剂量更大剂量的抗生素了。

Over-the-counter products, however, account for only a small percentage of total antibiotics production. It is the prescription dosages that give people trouble.

然而，非处方药品只是整个抗生素类产品的一小部分，正是处方药物给人类带来了麻烦。

These drugs—even allowing for the diverse abilities of the many narrow-spectrum ones and the versatility of the broad-spectrum ones—are not the cure-alls they often are billed as being. There are wide gaps in their ability to master contagious diseases. Such important infections as mumps, measles, common colds, influenza, and infectious hepatitis still await conquest. All are virus infections and despite intense efforts, very little progress has been made in chemotherapy against viruses. Only small progress has been achieved against fungi. Many strains of bacteria and fungi are naturally resistant to all currently available antibiotics and other chemotherapeutic drugs.

这些药物一即使允许最大能力,很多窄谱抗生素和广谱抗生素也并不是如宣传的那样治疗百病。它们的能力与治疗传染性疾病间还存在很大的差距。如腮腺炎、麻疹、普通感冒、流行性感冒和传染性肝炎等严重感染性疾病仍有待解决。这些都是病毒感染，尽管做出了很大的努力，但是在抗病毒的化疗药物的研究上几乎没有什么进展。抗真菌药物的研究上只取得一点小成就。很多细菌和真菌对现有的抗生素和其他化疗药物具有耐药性。

Some microorganisms originally sensitive to the action of antibiotics, especially staphylococcus, have developed resistant strains. This acquired resistance imposes on the longrange value of the drugs a very important limitation, which is not adequately met by the frequent introduction of new antimicrobial agents to combat the problem.

一些原来对抗生素敏感的细菌，特别是葡萄球菌现在也产生了耐药性，这些获得的耐药性对药物的长期使用产生重要的限制，频繁引人新的抗菌药物也不能完全解决这个问题。

It has been pretty well established that the increase in strains of bacteria resistant to an antibiotic correlates directly with the duration and extent of use of that antibiotic in a given location. In one hospital a survey showed that, before erythromycin had been widely used there, all strains of staphylococci taken from patients and personnel were sensitive to its action. When the hospital started extensive use of erythromycin, however, resistant staphylococcus strains began to appear.

现已经确定，在一些地区，抗生素广泛和长期的使用与细菌耐药性增加有直接的相互关系。某医院调查显示，在红霉素广泛使用以前，所有从病人身上取出的葡萄球菌都对红霉素敏感.然而，自从医院开始广泛应用红霉素以来，耐药葡萄球菌菌株开始出现。

The development of bacterial resistance can be minimized by a more discriminating use of antibiotics, and the person taking the drug can help here. When an antibiotic must be used, the best way to prevent the development of resistance is to wipe out the infection as rapidly and thoroughly as possible. Ideally, this requires a bactericidal drug, which destroys, rather than a bacteriostatic drug, which inhibits. And the drug must be taken in adequate dosage for as long as is necessary to eradicate the infection completely. The doctor, of course, must choose the drug, but patients can help by being sure to take the full course of treatment recommended by the doctor, even though symptoms seem to disappear before all the pills are gone. In rare instances the emergence of resistance can be delayed or reduced by combinations of antibiotics. Treatment of tuberculosis with streptomycin alone results in a high degree of resistance, but if para-aminosalicylic acid or isoniazid is used with streptomycin the possibility that this complication will arise is greatly reduced.

更有区别的应用抗生素可以最大限度地抑制细菌耐药性的发展，使用药物的病人可对此有所帮助。当必须使用一种抗生素时，最好的避免耐药性方法就是尽快彻底地去除感染。这就需要用能杀死细菌的杀菌药，而不是抑制细菌的抑菌药。这种药物必须使用一定剂量，并且一定的时间以完全根除这种感染。医生当然得选这种药，但患者须遵医嘱、使用足够的治疗量，即使在药物吃完以前症状似乎已经消失。少数情况下联合用药可以推迟或降低耐药性的产生。用链霉素单独治疗结核病会导致高度的耐药，但如果链霉素联用对氨基水杨酸或异烟肼将大大降低耐药性。

In hospital treatment of severe infections, the sensitivity of the infecting organism to appropriate antibiotics is determined in the laboratory before treatment is started. This enables the doctor to select the most effective drug or drugs; it determines whether the antibiotic is bactericidal or bacteriostatic for the germs at hand; and it suggests the amount needed to destroy the growth of the bacteria completely. In either hospital or home, aseptic measures can help to reduce the prevalence of resistant strains of germs by preventing cross infection and the resultant spreading of organisms.

在医院治疗严重感染时，感染菌对抗生素的敏感性在治疗前已在实验室确定，这样可以使医生选择最有效的药物，可以决定使用抑菌还是杀菌的抗生素，并可对能完全破坏细菌生长所需的用量给出建议。无论在医院或是在家里，无菌措施由于避免了交叉感染以及由此造成的生物体传播，从而可以降低细菌耐药菌株的广泛流行。

Every one of the antibiotics is potentially dangerous for some people. Several serious reactions may result from their use. One is a severe, sometimes fatal, shock-like anaphylactic action, which may strike people who have become sensitized to penicillin. Anaphylactic reaction happens less frequently and is less severe when the antibiotic is given by mouth. It is most apt to occur in people with a history of allergy, or a record of sensitivity to penicillin. Very small amounts of penicillin, even the traces which get into the milk of cows for a few days after they are treated with the antibiotic for mastitis, may be sufficient to sensitize; hence, the strong campaign by food and drug officials to keep such milk off the market.

对有些人来说任何一种抗生素都可能有潜在的危险。一些严重的反应可能是由于它们的应用产生的，其中之一就是严重的有时甚至是致死性的过敏性休克，对青霉素过敏的人使用青霉素将很危险。口服抗生素将使过敏频率降低或降低严重性。青霉素过敏或有过敏史者更容易发生。奶牛使用抗生素治疗乳腺炎几天后，其牛奶中带入的极其少量甚至痕量的青霉素也可能足以引起过敏。所以食品药品监督官员采取强有力的措施防止这种牛奶进人市场。

To minimize the risk of anaphylactic shock in illnesses where injections of penicillin are the preferred treatment, a careful doctor will question the patient carefully about allergies and previous reactions. In case of doubt another antibiotic will be substituted, if feasible, or other precautionary measures will be taken before the injection is given.

当注射青霉素是首选治疗方案时，为降低这种过敏性休克，谨慎的医生会仔细询问病人的过敏史及其反应。如过敏史不清楚，医生会用其他抗生素代替或注射前用其他方法检查其是否过敏。

Other untoward reactions to antibiotics are gastrointestinal disorders—such as sore mouth, cramps, diarrhea, or anal itch—which occur most frequently after use of the tetracycline group but have also been encountered after use of penicillin and streptomycin. These reactions may result from suppression by the antibiotic of bacteria normally found in the gastrointestinal tract. With their competition removed, antibiotic-resistant staphylococci or fungi, which also are normally present, are free to flourish and cause what is called a super-infection. Such infections can be extremely difficult to cure.

其他抗生素不良反应包括胃肠道不适，如口腔疼痛、痉挛、腹泻、肛门瘙痒，这种情况在使用四环素类抗生素后经常发生，在使用青霉素和链霉素后也会遇到。这些反应可能是由于使用的抗生素抑制了正常的胃肠道菌群引起的。随着这种竞争的消除，正常存在的葡萄球菌或真菌耐药菌株自由繁殖并引起所谓的超感染，这种感染将更难治疗。

A few antibiotics have such toxic effects that their usefulness is strictly limited. They include streptomycin and dihydro-streptomycin, which sometimes cause deafness, and chloramphenicol, which may injure the bone marrow. Drugs with such serious potential dangers as these should be used only if life is threatened and nothing else will work

有些抗生素有毒性作用，使其应用受到了严格的限制。这类抗生素包括会导致耳聋的链霉素和双氢链霉素，以及会产生骨髓损伤的氯霉素。这些有严重危险的药物只有在生命受到威胁或其他药物无效时才使用。

All the possible troubles that can result from antibiotic treatment should not keep anyone from using one of these drugs when it is clearly indicated. Nor should they discourage certain preventive uses of antibiotics which have proved extremely valuable.

由于有些抗生素疗效确切，因此使用抗生素所带来的所有可能的麻烦也不能阻止任何人用任何一种抗生素，对于被证明是有效的抗生素，人们不会不鼓励它们的使用。

医学英语