Chinanews.com, April 19th. A few days ago, under the guidance of the National Health and Health Commission's Medical Administration and Hospital Administration, jointly sponsored by the Health News Agency and the Hainan Provincial Health and Health Commission, and supported by Suzhou Yiteng Pharmaceutical Sales Co., Ltd., the scientific diagnosis and treatment of children's respiratory diseases and reasonable A symposium of medication experts was held in Haikou City, Hainan Province.
The symposium was hosted by Wang Xiaoling, Director of the Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, and Wang Yuqin, Department of Pharmacy, Xuanwu Hospital, Capital Medical University.
Taking the abuse of antibacterial drugs as the starting point, the participating experts introduced the dilemmas faced by clinical pediatric drugs from different aspects, and discussed topics such as the plight of children's medication management, the application of antibacterial drugs in the field of children's respiratory diseases, and the choice of aerosol treatment options.
Antibacterial drug abuse is particularly prominent in children
According to Zhang Shunguo, director of the Department of Pharmacy of the Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, the center has participated in the statistics of adverse drug reactions among children in Shanghai.
Statistics show that the adverse reactions of antibacterial drugs in children between 0 and 18 years old accounted for half.
"The characteristics of high intensity, wide variety and high proportion of broad-spectrum drugs, injection drugs, and new drugs have led to an increase in the rate of children's antimicrobial resistance year by year." Zhang Shunguo said.
These characteristics are more significant in the treatment of childhood respiratory infections.
Chen Dehui, Department of Pediatrics, The First Affiliated Hospital of Guangzhou Medical University, compared the medication differences between my country and some countries in Northern Europe.
The most significant difference is that the first-generation and second-generation antibacterial drugs of cephalosporin are commonly used in Nordic countries, while in my country, the use rate of the two is only 7.8%.
"Chinese doctors often use the third-generation cephalosporin antibacterial drugs, such as azithromycin." Chen Dehui said that using the third-generation cephalosporin is equivalent to a sledgehammer for killing chickens, which is likely to cause drug resistance.
The formation of Chinese doctors' medication habits is the result of multiple factors.
In this regard, Zhang Shunguo believes that in order to use drugs rationally, correct diagnosis and identification of pathogens are the key.
Inhaled hormone therapy of choice for children with asthma
Among children’s respiratory diseases, there are many diseases that cause coughing or wheezing, and the diagnosis of asthma lacks specific examination methods. It is difficult to diagnose asthma, and symptomatic medication cannot be achieved, resulting in repeated attacks.
The results of the survey on the incidence of asthma in my country in 2000 showed that 90% of asthma patients had been treated with antibacterial drugs.
Among children with undiagnosed asthma in the past, nearly half have been suspected of having asthma or diagnosed with asthmatic bronchitis.
"Virus-induced asthma does not require the application of antibacterial drugs, and antibacterial drugs are aimed at bacterial infections, so antibacterial drugs are not effective in the treatment of virus-induced asthma." said Shang Yunxiao, Department of Pediatric Respiratory Medicine, Shengjing Hospital, China Medical University. Appropriate use of antibacterial drugs can increase airway sensitivity, increase the burden on children, and cause repeated asthma attacks.
The survey showed that 90% of asthma patients were hospitalized 1 to 5 times, 10% of asthma patients were hospitalized 6 to 10 times, and 2.2% of asthma patients were hospitalized more than 10 times.
"Asthma treatment is difficult, and the main difficulty is the long-term prevention of attacks. Once an acute attack of asthma is very harmful, even life-threatening." Hao Chuangli, director of the Respiratory Department of the Children's Hospital of Soochow University, said that inhaled corticosteroids are a timely and effective treatment. One of the drugs.
Shang Yunxiao suggested that short-term and high-dose inhaled corticosteroids can be used to control the condition during the acute attack of childhood asthma.
The results of a number of clinical studies have shown that fluticasone propionate physicochemical suspension has a strong anti-inflammatory effect, half of the dose can achieve the same curative effect as budesonide suspension, and the incidence of adverse reactions is low and local oral candida occurs. The rate is low and does not affect the growth and development of children.
On September 20, 2017, fluticasone propionate was marketed for acute treatment.
Hao Chuangli believes that the efficacy of fluticasone propionate has been clinically verified, "it is recommended to strive for long-term medication, adequate medication in the acute phase, and long-term control of appropriate medication." Hao Chuangli said.
Pediatric pharmaceutical management needs a bigger "stage"
Another reason for the irrational use of drugs in pediatrics is particularly serious. There are too few drugs suitable for children's dosage and taste, and children's drug use has to be achieved through manual drug distribution.
A survey led by Wang Shu, director of the Clinical Pharmacy and Experimental Center of the First People’s Hospital of Jinzhong City, Shanxi Province, showed that among the 158 antibacterial drugs, only 9 have indications for children, and the usage and dosage involve children’s content. There are only 47 kinds.
"Children's drug lack of evidence in clinical trials is not unique to China. 50% of the drugs used in children in Europe do not have clinical research and approval." Wang Yuqin said that this is not the fundamental reason for the lack of children's drug research and development companies.
In this regard, Liu Shiting, director of the Department of Pharmacy of Southern Hospital of Southern Medical University, analyzed that the usage and dosage suitable for children and the tastes that children like to eat and are willing to eat require relevant research. Pre-market research on drugs often does not increase child-related trials. Can not bring additional profits, the enterprise has no original motivation.
The lack of drug formulations suitable for children triggers a series of negative reactions. One is that the guidelines for treatment of related diseases lack relevant content on children’s medication; the other is that it is difficult to implement the clinical pathway of pediatrics; and the third is that children’s medications are often affected by centralized drug procurement. Ignore; Fourth, re-evaluate the use of children who lack children after the drug is marketed.
Zou Jili, chief pharmacist of Wuhan Third Hospital in Hubei Province, said that general hospitals face more problems, so he suggested that children's medicine should be handled by professionals, and pediatric clinical pharmacists should participate in the relevant work and give the voice of pharmacists.
Wang Yuqin also deeply feels the urgency of pediatric pharmaceutical management: "Pediatric pharmacy services must be developed with high quality, and the individualized diagnosis and treatment needs of children must be met first, and issues such as drug dosage and medication guidelines must be resolved first, otherwise the rational use of pediatric drugs will not be discussed. "
Huang Weidong, chief operating officer of Suzhou Yiteng Pharmaceutical Sales Co., Ltd., said that children’s drug R&D investment is high, the risk is high, the cycle is long, and the return is low. Although the scale of Yiteng is not large, it has always paid attention to the children’s drug market and hopes to do something valuable. thing.
He said that in the future, Eton will introduce a variety of good medicines, including cardiovascular disease treatments and antiplatelet drugs, by purchasing prescriptions and production processes, to improve clinical diagnosis and treatment, and help the "Healthy China 2030" strategy be realized as soon as possible.