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常见抗生素可能造成严重副作用

更新时间:2020-2-24 8:09:39 来源:本站原创 作者:佚名 浏览:

Popular Antibiotics May Carry Serious Side Effects
常见抗生素可能造成严重副作用

Antibiotics are important drugs, often restoring health and even saving lives. But like all drugs, they can have unwanted and serious side effects, some of which may not become apparent until many thousands of patients have been treated.

抗生素是重要的药物,常常可以用来帮助人们恢复健康,甚至有可能拯救生命。但跟所有药物一样,抗生素也会带来人们不想要的严重的副作用,其中一些副作用,需要等到成千上万的病人因此求医后才会显现出来。

Such is the case with an important class of antibiotics known as fluoroquinolones. The best known are Cipro (ciprofloxacin), Levaquin (levofloxacin) and Avelox (moxifloxacin). In 2010, Levaquin was the best-selling antibiotic in the United States.

氟喹诺酮是一类重要的抗生素,在这种药上就出现了副作用的问题。这类抗生素中最著名的要数赛普洛(环丙沙星)、列瓦奎因(左氧氟沙星)和拜复乐(莫西沙星)。2010年,列瓦奎因是美国卖得最好的抗生素。

But by last year it was also the subject of more than 2,000 lawsuits from patients who had suffered severe reactions after taking it.

但在去年,该药也是超过2000宗医疗诉讼的主角,病人抱怨在服用药物后产生了严重反应。

Part of the problem is that fluoroquinolones are often inappropriately prescribed. Instead of being reserved for use against serious, perhaps life-threatening bacterial infections like hospital-acquired pneumonia, these antibiotics are frequently prescribed for sinusitis, bronchitis, earaches and other ailments that may resolve on their own or can be treated with less potent drugs or nondrug remedies - or are caused by viruses, which are not susceptible to antibiotics.

部分原因出在医生往往在不适当的时候开具了氟喹诺酮类药物处方。这种抗生素原本只应用于严重、有可能危及生命的细菌感染,比如医院内感染性肺炎,但在实际操作中,这类抗生素往往还用来治疗鼻窦炎、支气管炎、耳朵痛和其他疾病,这些病有可能自愈,要么也能用不那么强效的药物或者使用不吃药的方法来治疗——另一种可能是它是由病毒引起的,对抗生素并不敏感。

In an interview, Mahyar Etminan, a pharmacological epidemiologist at the University of British Columbia, said the drugs were overused "by lazy doctors who are trying to kill a fly with an automatic weapon."

在接受采访时,英属哥伦比亚大学(University of British Columbia)的药理流行病学家玛赫亚·埃特米南(Mahyar Etminan)说这类抗生素被滥用,“开药的医生太懒,他们打算用自动武器来杀死一只苍蝇。”

Dr. Etminan directed a study published in April in The Journal of the American Medical Association showing that the risk of suffering a potentially blinding retinal detachment was nearly fivefold higher among current users of fluoroquinolones, compared with nonusers. In another study submitted for publication, he documented a significantly increased risk of acute kidney failure among users of these drugs.

埃特米南主导的一项研究,其报告已刊登在今年四月的《美国医学会杂志》(The Journal of the American Medical Association)上,报告指出在现有使用氟喹诺酮的病人中,发生视网膜脱落导致眼盲的风险,是不用该类药物的人群的近五倍。他做的另一项研究已经投稿,研究发现使用这类抗生素的患者发生急性肾衰竭的可能性出现了显著提高。

The conditions Dr. Etminan has studied are relatively easy to research because they result in hospitalizations with diagnoses that are computerized and tracked in databases. Far more challenging to study are the array of diffuse, confusing symptoms suffered by fluoroquinolone users like Lloyd Balch, a 33-year-old Manhattan resident and Web site manager for City College of New York.

埃特米兰医生所关注的这些病症相对要容易研究些,因为这些病人已入院治疗,而且诊断结果已记录联网,可以通过数据库来查找。远比他的研究更具挑战性的,是要去厘清使用了氟喹诺酮类药物的患者所出现的一系列混乱、让人迷惑的症状,在33岁的曼哈顿居民、纽约城市学院(City College of New York)网站主管洛伊德·巴尔切(Lloyd Balch)身上,就出现了这种事情。

In an interview, Mr. Balch said he was healthy until April 20, when a fever and cough prompted him to see a doctor. Nothing was heard through a stethoscope, but a chest X-ray indicated a mild case of pneumonia, and he was given Levaquin. Although he had heard of problems with Levaquin and asked the doctor if he might take a different antibiotic, he was told Levaquin was the drug he needed.

在采访中,巴尔切介绍说,他原本是个很健康的人,可是在4月20日他因为咳嗽发热去看了医生,一切都变了。医生并没有从听诊中听出问题,但胸部X光片显示他患上了轻微的肺炎,于是开了左氧氟沙星。他听说这种药有问题,问医生能不能换种抗生素,但医生告诉他,他现在就应该吃左氧氟沙星。

After just one dose, he developed widespread pain and weakness. He called to report this reaction, but was told to take the next dose. But the next pill, he said, "eviscerated" him, causing pain in all his joints and vision problems.

他只服用了一次药,就出现了周身疼痛和虚弱的症状。他打电话跟医生描述了药物反应,但医生的回答是让他再吃一次药。他说,这第二粒药把他折磨得“死去活来”,引起全身关节疼痛和视力问题。

Debilitating Side Effects

使人衰弱的副作用

In addition to being unable to walk uphill, climb stairs or see clearly, his symptoms included dry eyes, mouth and skin; ringing in his ears; delayed urination; uncontrollable shaking; burning pain in his eyes and feet; occasional tingling in his hands and feet; heart palpitations; and muscle spasms in his back and around his eyes. Though Mr. Balch's reaction is unusual, doctors who have studied the side effects of fluoroquinolones say others have suffered similar symptoms.

巴尔切身上出现了一连串反应,除了无法上坡、爬楼梯、视物不清,他的症状还包括眼睛、口腔和皮肤变得干燥;耳鸣;尿潴留;身体颤抖;双眼和双脚灼痛;四肢偶尔刺痛;心悸;后背和眼周肌肉痉挛。巴尔切出现的反应可算少见,但研究氟喹诺酮副作用的医生们表示,在别的病人身上也曾出现过类似的症状。

Three and a half months after he took that second pill, these symptoms persist, and none of the many doctors of different specialties he has consulted has been able to help. Mr. Balch is now working with a physical therapist, but in a phone consultation with Dr. David Flockhart, an expert in fluoroquinolone side effects at the Indiana University School of Medicine, he was told it could take a year for his symptoms to resolve, if they ever do disappear completely.

在巴尔切服用第二粒左氧氟沙星三个半月后,这些症状仍然连绵不去,他看过各科专家,可是没有一个人能改善这些问题。巴尔切现在在接受一位理疗师的帮助,他也电话咨询了印第安纳大学医学院(Indiana University School of Medicine)大卫·弗洛克哈特(Dr. David Flockhart)医生,对方是一位研究氟喹诺酮副作用的专家,结果得知,如果他身上的这些症状真的有可能完全消失的话,也要经过一年时间。

Guidelines by the American Thoracic Society state that fluoroquinolones should not be used as a first-line treatment for community-acquired pneumonia; it recommends that doxycycline or a macrolide be tried first. Mr. Balch didn't know this, or he might have fought harder to get a different antibiotic.

美国胸科学会(American Thoracic Society)给出的指引中明确表明,氟喹诺酮类药物不应是用于治疗在社区感染的肺炎的一线药物;该学会推荐首先使用强力霉素或大环内酯类抗生素(前者为四环素类药,后者的常用药物为红霉素、阿奇霉素等。——编注)。巴尔切并不知道这一点,否则他可能会更加努力争取让医生换药。

Adverse reactions to fluoroquinolones may occur almost anywhere in the body. In addition to occasional unwanted effects on the musculoskeletal, visual and renal systems, the drugs in rare cases can seriously injure the central nervous system (causing "brain fog," depression, hallucinations and psychotic reactions), the heart, liver, skin (painful, disfiguring rashes and phototoxicity), the gastrointestinal system (nausea and diarrhea), hearing and blood sugar metabolism.

氟喹诺酮类药物产生的不良反应可能会出现在身体各处。它的副作用会偶见于肌肉骨骼系统、视觉和肾脏系统,但在极少数情况下,也有可能会对中枢神经系统(导致“脑雾”[brain fog]、抑郁、幻觉和精神病症状)、心脏、肝脏、皮肤(疼痛、难看的皮疹和光毒反应)、胃肠道(恶心、腹泻)、听力以及血糖代谢产生严重损害。

The rising use of these potent drugs has also been blamed for increases in two very serious, hard-to-treat infections: antibiotic-resistant Staphylococcus aureus (known as MRSA) and severe diarrhea caused by Clostridium difficile. One study found that fluoroquinolones were responsible for 55 percent of C. difficile infections at one hospital in Quebec.

这些强效药的大量使用,还造成了两种难以医治的严重传染病数量激增:一种是抗药性金黄色葡萄球菌(简称MRSA)感染,另一种是由难治梭菌导致的严重腹泻。一项研究发现,加拿大魁北克一家医院出现的难治梭菌感染中,有55%的元凶与氟喹诺酮有关。

Fluoroquinolones carry a "black box" warning mandated by the Food and Drug Administration that tells doctors of the link to tendinitis and tendon rupture and, more recently, about the drugs' ability to block neuromuscular activity. But consumers don't see these highlighted alerts, and patients are rarely informed of the risks by prescribing doctors. Mr. Balch said he was never told about the black-box warnings.

按照美国食品药物监督管理局(Food and Drug Administration,简称FDA)的规定,所有氟喹诺酮类抗生素的产品包装上都必须加注“黑盒子”警告(“black box”是FDA所发出的最严厉的警告。——编注),提醒医生该类药物可能导致病人罹患肌腱炎或者肌腱断裂,近期研究还显示它有神经肌肉阻滞的作用。但消费者并没有注意到这些显眼的警告,开处方的医生也几乎不会向病人告知这类药物的危险。巴尔切说,他的医生从来没告诉他有什么黑盒子警告。

Lack of Long-Term Studies

欠缺长期研究

No one knows how often serious adverse reactions occur. The F.D.A.'s reporting system for adverse effects is believed to capture only about 10 percent of them. Complicating the problem is that, unlike retinal detachments that were linked only to current or very recent use of a fluoroquinolone, the drugs' adverse effects on other systems can show up weeks or months after the treatment ends; in such cases, patients' symptoms may never be associated with prior fluoroquinolone therapy.

没人知道氟喹诺酮导致的严重副作用发生频率究竟有多高。据信,FDA关于药物副作用的报告系统仅能掌握其中大约一成的病例。令问题更为复杂的是,不像视网膜脱落这种在服用了氟喹诺酮类药物之后瞬即或不久会立刻显现的副作用,在人体其他系统中产生的副作用可能要在服药几周或几个月后才会出现;在这种情况下,病人出现的症状可能永远都不可能跟先前接受了氟喹诺酮治疗的经历联系在一起。

No long-term studies have been done among former users of these antibiotics. Fibromyalgia-like symptoms have been associated with fluoroquinolones, and some experts suggest that some cases of fibromyalgia may result from treatment with a fluoroquinolone.

研究者并未对曾使用过这类抗生素的患者进行过长期跟踪研究。类似纤维性肌痛的症状长期以来与服用氟喹诺酮联系在一起,还有一些专家认为,某些纤维性肌痛病症应该就是氟喹诺酮导致的结果。

A half-dozen fluoroquinolones have been taken off the market because of unjustifiable risks of adverse effects. Those that remain are undeniably important drugs, when used appropriately. But doctors at the Centers for Disease Control and Prevention have expressed concern that too often fluoroquinolones are prescribed unnecessarily as a "one size fits all" remedy without considering their suitability for different patients.

由于可能产生不必要的严重副作用,有数种氟喹诺酮类抗生素已经禁止销售。那些仍然在使用的药物无疑非常重要,但前提是要使用得当。美国疾病控制中心(Centers for Disease Control and Prevention)的医生们已经对滥用氟喹诺酮表示顾虑,他们指出医生在开药时没有考虑到是否适合不同的患者,不必要地采用了“一刀切”的治疗方案。

Experts caution against giving these drugs to certain patients who face higher than average risks of bad reactions - children under age 18, adults over 60, and pregnant and nursing women - unless there is no effective alternative. The risk of adverse effects is also higher among people with liver disease and those taking corticosteroids or nonsteroidal anti-inflammatory drugs.

专家警告说,一些患者产生副作用的危险性可能更高,比如18岁以下儿童、60岁以上老年人、以及孕妇和哺乳期妇女,因此除非没有其他有效药物,否则应尽量避免给他们开这类抗生素。此外,对于有肝病、正在服用类固醇或非类固醇类消炎药的患者来说,在他们身上发生副作用的危险也会更高。

When an antibiotic is prescribed, it is wise to ask what the drug is and whether it is necessary, what side effects to be alert for, whether there are effective alternatives, when to expect the diagnosed condition to resolve, and when to call if something unexpected happens or recovery seems delayed.

在医生开出抗生素的处方时,需要先明智地咨询一下医生:这是什么药,服用它是否必要,需要警惕哪些副作用,是否有有效的替代药物,服药后自己的病症何时能开始缓解,如果发生了意想不到的问题或者症状缓解得很慢,何时应该打电话求助。

At the same time, when an antibiotic is appropriately prescribed, it is extremely important to take the full prescription as directed and not to stop treatment when the patient simply begins to feel better.

与此同时,如果医生恰当地开了抗生素,病人也应按医嘱服完整个疗程的药物,切勿在开始感觉舒服了点后,就擅自停药。

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