有多少次我見過朋友和家人的感冒藥裡面有抗生素？大約80％左右（在亞洲接近95％..）
當我看見這樣的抗生素處方，想也沒想我就會問他們，你們有肺部感染嗎？答案通常是沒有，但醫生告訴他們這是普通感冒，但他們會告訴醫生有非常糟糕的喉嚨痛（他們 ”糟糕" 的定義是之後還可以去一間貴價酒店擦一餐豐富的自助晚餐，顯然喉嚨不是怎麼痛吧），因此他們覺得抗生素可以幫助止痛，所以他們 “希望” 醫生會開藥。
親愛的朋友和家人（或其他自己去用抗生素來治療一些小病痛的人，抗生素的來源我就不想問了），請允許我解釋為什麼這是一個壞主意。
把不同種類的細菌想像成好多隊無家可歸的士兵。他們的工作是攻打成都（在這裡我們比喻為人類的身體）使它據為己有，成為的自己家園。顯然，成都的主人（人類）不會讓士兵們奪去自己的家園，所以他發明了超級武器（抗生素），試圖殺死所有侵略者。由於要殺死的士兵數以百萬計，成都主人在這麼短時間內根本無法將武器升級，來足以應付所有的士兵，然而每次戰鬥之後總會有一些殘兵可以幸存。幸運可以活著的士兵們會互相學習如何逃生和對抗成都的超級武器（抗生素耐藥性）。這就是故事的結局......不被殺的士兵們(細菌)經過每次戰鬥後就會越強，成都所使用的超級武器（抗生素）就再不管用了....
當我們開始使用抗生素來治療輕微感染像喉痛或普通感冒等小病，這就是噩夢的開始！咽喉痛通常是由病毒或細菌感染引起的。但它是一種自限性的病種（意思是說，病情多在3-4天或1週前會好轉，甚至消失）。如果你的喉嚨痛並沒有在1週內消失或者你喉嚨痛到甚至不能喝水，或者你有其他警號性的症狀，你就需要看醫生去排除嚴重感染或其他病的可能。
當你服用抗生素去治療喉嚨痛，那些“存活的細菌” 會因為長期暴露於低濃度抗生素的環境而產生抗藥性，因為：1）你可能沒有完成整個抗生素療程，使細菌有機會存活，2）抗生素無法達到的感染部位，細菌存活後抗藥的機會大大提高 3）錯誤的選擇抗生素治療。所有這些助抗藥性因素，超級細菌就會形成，這樣會使好多常規抗生素都變成一無事處。
後果？
我們可能會沒有有效的抗生素來治療嚴重以及危害生命的感染，本來容易治療的感染會變得難上加難以及有危害生命的危險！
想像一下，....在未來，因為病菌抗藥性，你的子孫可能需要去醫院打一些超強力的靜脈抗生素去治療一種原來在你的時代裡本來是很容易處理的感染，而且分分鐘會變成奪命感染啊！
相當可怕吧？
How many times have I come across antibiotics in the prescriptions of friends and families for the treatment of their common cold? Approximately 80% of the time (close to 95% in Asia ..)
When I saw the antibiotics, without thinking I would ask if they were having a very bad chest infection? The replies were usually NO but doctor told them it was common cold and they had very bad sore throats (when they defined BAD, they would tell me they had just been to a fancy hotel to have a huge buffet dinner, apparently they could still swallow food properly), therefore they figured the antibiotics would help with the pain, so they would 'prefer' doctors to prescribe them.
Dear friends and families (or other people out there who self medicate themselves with antibiotics for whatever minor ailments they have), please allow me to explain WHY it is a BAD idea.
Imagine different kinds of bacteria as troops of homeless soldiers. Their job is to take over cities (metaphorically the physical being of humans) to make them their own homes. Obviously the owners of the cities (humans) won't just let them take their homes, they have invented super ammunition (antibiotics) to try to kill all the invaders. Since there are MILLIONS of homeless soldiers to kill, with the little time that the owners of cities have, they cannot upgrade ammunition fast enough to kill all the soldiers, and the high number of soldiers always result some runaways after each battle. The luckily alive soldiers would then learn from each other how to escape and improve themselves (antibiotic resistance) for the next battle. This is how the story goes... the homeless soldiers are getting stronger after each battle, and the ammunition owners use doesn't serve the purpose anymore....
This is the start of the nightmare when we use antibiotics for minor infections like sore throat or common colds! Sore throat is commonly caused by viral or bacterial infections. But it is a self-limiting conditions (which means it will go away in 3-4 days OR 1 week at most). It is important to get your sore throat seen to by a doctor when it does not go away in 1 week OR it is so sore that you cannot even drink water OR when you present with some other symptoms that suggest more serious conditions.
When you take antibiotics for your sore throat, you are risking low grade persistent exposure of antibiotics to 'surviving bacteria', because 1) there are chances that you don't finish the course of antibiotics, 2) the antibiotics cannot reach to the site of infection 3) wrong choice of antibiotics.. All these factors can contribute to the development of super bacteria that would be resistant to all conventional antibiotics.
What could be the consequences?
We might run out of effective antibiotics to treat serious life threatening infection and eventually what was thought to be simple infection would be difficult to treat.
Imagine again.... In future, your children or grandchildren might need to go to the hospital for intravenous antibiotics treatment for what was thought in your time to be an non complicated infection, and such infection had become life threatening!
Pretty scary right?
Media coverage of antibiotics resistance:
https://www.hongkongfp.com/2015/07/07/abuse-of-antibiotics-in-china-sparks-fear-of-superbugs/
Reference:
- WHO @2015 worldwide antibiotic resistance analysis http://www.who.int/drugresistance/documents/situationanalysis/en/
- Clinical knowledge summeries @NICE 2015 Sore throat http://cks.nice.org.uk/sore-throat-acute#!background
- Centers of Disease Control and Prevention (US) @2015 http://www.cdc.gov/drugresistance/about.html
在香港社區藥房工作，往往有令我‘大開眼界’的經驗，這都令我‘讚歎’香港的處方習慣，以下是我遇到的實例
