Anyone born in the 1970s or 1980s has memories as a child of.

When you had a cold or a fever, your parents would often take you to the health center so that the doctor could give you a shot in the butt that felt particularly painful. This injection was penicillin.

But now, in many primary health centers, it has been difficult to see the figure of penicillin.

Why don't hospitals use penicillin for anti-inflammatory drugs anymore? What is the reason for this? Some people say it is because penicillin has a more serious allergic reaction and can cause death, while cephalosporins have a relatively mild allergic reaction.

Others say that penicillin is unstable to acid, has a narrow antimicrobial spectrum, has severe allergic reactions, and bacteria are prone to resistance to it, so it can't be taken orally but can only be injected.

However, some experts say that in fact, penicillin and cephalosporin cause allergies to the same substances, and the allergic reactions to these two drugs are the same, but there will be individual differences.

After careful folding, I think the reasons are mainly the following.

I. On the part of the patient, a skin test must be done for the use of penicillin, a process that requires a 30-minute injection. Some patients do not want to wait and doctors find it troublesome and prefer to use cephalosporins or other types of antibiotics.

Second, on the doctor's part, allergic reactions to penicillin are more serious and other antibiotics are used to avoid trouble. More realistically, penicillin is a very cheap antibiotic, penicillin is only fifty cents a unit, eight hundred thousand, ten units of five dollars. And cephalosporins are upwards of twenty dollars a pop, and highly profitable. Who loses penicillin; .

Third, drug manufacturers sales, penicillin production process is very strict, manufacturers have to spend a lot of talent and material resources to set up a factory specializing in the manufacture of penicillin, harsh conditions, generally have the support of the state, but the production of penicillin manufacturers are few and far between, the cost is high, the price is low.

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The history of antibiotics dates back as far as nearly a hundred years ago, and before that time, there was little that humans could do about bacterial infections, any one of which could claim a life.

In 1928, the British bacteriologistAlexander FlemingIn a chance encounter, it was found that the growth of staphylococci was inhibited in a Petri dish of Penicillium, and from this it was hypothesized that a certain substance secreted in the growth of Penicillium could inhibit the growth and reproduction of other bacteria, and it was namedPenicillinIt published the discovery in the British Journal of Experimental Pathology in 1929, but at that time he had not mastered the method of purifying penicillin.

Australia in 1940Howard Walter Floreyand the UKErnst Boris ChainSuccessfully mastered the technology of purifying penicillin from culture fluid and applied it to clinical use in 1943, which was in the middle of the Second World War. The application of penicillin saved the lives of countless wounded and sick people, and it also became an important strategic reserve material at one time, and the three of them shared the Nobel Prize in Physiology/Medicine in 1945 for their contribution to the discovery and application of penicillin.

After the glorious history of penicillin, let's take a look at the current state of penicillin:

Due to the widespread use of penicillin, many bacteria producetolerance，

Secondly, penicillin'santimicrobial spectrumNarrower, less effective for infections at specific sites and with specific pathogens

In addition, from the present point of view, the early penicillin chemical structure is primitive, the preparation technology is rough, and the application to the clinic is easy to produceadverse reaction, some adverse reactions (e.g., allergic reactions) can even be fatal.

These problems have greatly limited the use of penicillin.

In fact, as pharmacological research and pharmaceutical technology have advanced, the early penicillins have evolved into a large class of antibiotics calledBeta-lactam antibioticsIt includesPenicillin, cephalosporins, carbapenems, monocyclics, cephalosporinsetc.

Amoxicillin, various cephalosporins, imipenem, meropenem, roxithromycin and so on, which we commonly use nowadays, are all improved and manufactured on the basis of penicillin. They are greatly improved in terms of efficacy, drug metabolism, antimicrobial spectrum, drug side effects and so on, compared with the first generation of penicillin.

This is why modern clinicians rarely use penicillin anymore

The history of penicillin is in fact a microcosm of the history of mankind's understanding of nature, transformation of nature, and ultimately living in harmony with nature.

To be born in response to the times and to retire in response to the times is the inevitable choice of historical materialism and discernment

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Penicillin utilization in hospitals is indeed getting lower and lower nowadays, which simply means that the rate of bacterial resistance in hospital infections is increasing, the types of infecting bacteria as well as the types of antimicrobial drugs are increasing. The next step is to introduce you to penicillin as a drug:

The discovery of penicillin's contribution to mankind, I believe we all know very well, here do not repeat, we will talk about the current stage of penicillin in the clinical application, in accordance with the instructions of the drug its antimicrobial spectrum, including streptococcus, staphylococcus, enterococci, leptospirosis, diphtheria, anthrax, clostridium, meningococcus, gonococcus, actinomyces, listeria, in addition to the fragile anabolic bacillus in addition to the anaerobic bacteria, I believe that the antimicrobial spectrum will be puzzled when you see it. You see its antibacterial spectrum will be puzzled, such a broad antibacterial spectrum, why not use it, in fact, as said earlier, there are a lot of drug-resistant, before we analyze the drug resistance of these bacteria, first understand the outpatient emergency and hospitalized patients with infections of the common causative organisms are.

For common infectious diseases in outpatient and emergency clinics, mainly respiratory tract infections, genitourinary tract infections, gastrointestinal tract infections, etc., and the common causative organisms of these infections are Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, Mycoplasma, Chlamydia, etc., and then it is not difficult to find out that there are only Streptococcus pneumoniae in them by contrasting with the penicillin antimicrobial spectrum, but Streptococcus pneumoniae is very high in the rate of resistance to penicillin so basically it is not used. Hospital infections of common pathogenic bacteria are mainly staphylococci, enterococci, enterobacteria, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and so on, and then against only staphylococci and enterococci, and these two bacteria on penicillin resistance rate of more than 95%.

The above mentioned are some objective situations, penicillin has no antibacterial activity against most of these bacteria, what is the situation of these groups of bacteria in the antibacterial spectrum of penicillin, first of all, streptococcus, it has been mentioned that Streptococcus pneumoniae is highly resistant to penicillin, but penicillin still has antibacterial activity against other populations of streptococcus, such as Streptococcus pyogenes and Streptococcus anisopliae; staphylococcus and enterococcus have a high rate of resistance against penicillin. Like leptospirosis, diphtheria, anthrax caused by disease is rare, penicillin still has antibacterial activity against them; Listeria monocytogenes mainly causes infection of the population is the newborn and the elderly, at the same time, the resistance rate of penicillin is also gradually increasing; meningococcus mainly causes meningitis, there is resistance to penicillin, because of the seriousness of the disease, in order not to delay the treatment time, usually directly use ceftriaxone or vancomycin; gonococcal Penicillin is still the first choice for the treatment of gonococcus.

By analyzing the antimicrobial spectrum of penicillin and the objective account of common causative organisms of hospital infections, I believe you can understand why the use of penicillin in hospitals is getting lower and lower nowadays.

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Penicillin is still one of the indispensable drugs for clinical use, but why don't you see it more often?

There are several reasons for this:

1. Penicillin (also known as penicillin) is highly allergenic due to the manufacturing process and its instability in solution, as well as having a broad antibacterial spectrum that is not well-targeted to specific bacteria, and is therefore not preferred when there is an alternative drug.

2. Drugs are also constantly being introduced. Since penicillin was first discovered in 1942, new penicillin-based antimicrobial drug formulations have been developed, such as piperacillin and meloxicillin. The newer drugs have the advantages of being more targeted, having fewer adverse effects, less nephrotoxicity, and bacterial resistance can be resolved, etc., and are used in the clinic.

3. Frequent use of the same antibiotic, very easy to cause drug resistance. Penicillin, often used in the past, is easily inactivated by bacterial β-lactamase hydrolysis in the human body and loses its antibacterial ability, which has no therapeutic effect. Nowadays, most of the drugs of the same kind use β-lactamase inhibitors, such as "sulbactam" or "tazobactam", to strengthen the antibacterial ability and avoid being hydrolyzed by bacterial enzymes. Nowadays, most of the similar drugs use the addition of β-lactamase inhibitors such as "sulbactam" or "tazobactam" to strengthen the antimicrobial ability and avoid being hydrolyzed by bacterial enzymes. For example, Banda (piperacillin sodium tazobactam sodium for injection), Yihong (piperacillin sodium sulbactam sodium for injection), Kailin (meloxicillin sodium sulbactam sodium for injection), and so on.

Promote the rational use of knowledge, popularize the general knowledge of safe use of drugs, I am taking action, welcome to pay attention.

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Until now, there are a lot of older patients, after coming to the hospital, directly asked the doctor to take penicillin. Because of the past experience, once you get sick, you will be fine with penicillin. Other drugs do not believe.

However, we have been working in the clinical front line for a long time, we will find that the effect of using common penicillin in a considerable number of patients is very poor, or even completely ineffective. What is the reason for this?

The above picture of this drug we must be very familiar with, many people's homes are often prepared. In addition to amoxicillin, there are a variety of XX cillin, a variety of cephalosporin XX, in the drugstore are very popular sales varieties, I believe that many people usually buy eaten.

XXcillin are all penicillin-like drugs, and cephalosporins cover the antibacterial spectrum of penicillin. It's so easy to buy drugs in our society nowadays that thoseUsually often their own abuse of these antibiotics patients, the body bacteria have long been drug-resistant. Especially a lot of patients have eaten at home the effect of the medicine is not good before coming to the hospital, and then use penicillin is basically no longer useful.

Even patients who normally use less medication are hardly alone in this climate. The spectrum of bacteria prevalent in the entire social population has long been quietly changing.

In addition to human beings' own medication, the livestock, aquaculture and aquaculture industries are the hardest hit by antibiotic abuse. Most of the antibiotics produced annually in the country are actually used in these industries.Antibiotic residues can be detected in our food and water sources. Generations of bacteria have grown up in an environment of low-dose antibiotics; the non-resistant ones have long since been eliminated, leaving the ones that are left behind increasingly resistant to antibiotics.

Why is penicillin being used less and less?

1 Because penicillin has been used for so long, there are more and more bacteria that are not afraid of penicillin. Nowadays, in the medical environment, doctors are under a lot of pressure if the medicine is ineffective for a few days, so they would rather go for a stronger antibiotic with a broader antibacterial spectrum.

2 On the other hand, penicillin has not really disappeared. Rather, it has appeared in the form of various semi-synthetic penicillins that are superior to natural penicillins in every way, which are the various xxcillins mentioned earlier.

Natural penicillin has a narrow antimicrobial spectrum, is not resistant to gastric acid, is ineffective when taken orally, is enzyme intolerant, and is easily hydrolyzed. Synthetic penicillin has overcome these disadvantages. Since it can be taken orally, there is no need to necessarily come to the hospital for injection.

For your own health, remember that antibiotics should always be used under a doctor's supervision!

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Kirk gives an analysis of why penicillin is used less in hospitals now.

Penicillin made a great contribution to people's health as the most commonly used antibiotic with reliable efficacy before the 1980s. The reasons for this decline in clinical use are.1. The formation of drug resistance due to long-term abuse reduces the efficacy of penicillin, coupled with the continuous updating of broad-spectrum antimicrobials such as cephalosporins on the market, and the vigorous marketing by drug distributors.2. Cheaper prices reduce the growth of revenue for healthcare units and the performance of healthcare units is linked to the income of doctors is also a very important factor.3. Although penicillin allergic reactions are of low incidence, when they do occur it can be very dangerous without considerable experience and equipment In today's medical environment, doctors are also a bit afraid to take risks and take responsibility. Hak believes that the above is the reason why the clinical application of penicillin is getting less and less. However, Hak still suggests that as long as there is no history of allergy and there is indication for penicillin, penicillin should be preferred as the right choice for the treatment of infectious diseases. Xiao Ke is so insisted, just like the truth-telling doctor.

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There is a large hospital income a critically ill patient, with the most advanced pioneer failed to see the effect of a few times under the notice of critical illness, one day Professor, Dr., expert attending physician checking the patient, guiding the use of medication program, next to a young intern inserted a sentence, can not be replaced with a penicillin to try? The professor looked at the young man, impatiently said try it, the results of the fever that night, the second day of the symptomatic improvement, the first three days of discharge from the hospital to go ，，，，， I personally experienced.

Penicillin was earlier translated as penicillin, at the end of World War II, penicillin came out of nowhere, reversed the war situation, saved countless lives, penicillin as antibiotics in the "old man", is still active in the clinical front line, and has not been eliminated.

The biggest advantage of penicillin is high efficiency and low toxicity, it can be used by children, pregnant women and the elderly in the clinic. With the continuous extension of clinical use, we find that penicillin has many disadvantages, it is destroyed by gastric acid and digestive enzymes after oral intake, so that penicillin can't be taken orally, the antibacterial range is small, it is only effective for positive bacteria, and it is almost ineffective for negative bacteria, and what is even more scary is that, in the 1950's, there was a decomposition of penicillin β-lactamase, so that penicillin produced bacterial resistance. At present, the use of antibiotics in the clinic is still chaotic, and the people can buy antibiotics in pharmacies at will, the abuse of antibiotics makes drug-resistant bacteria appear frequently, and even the emergence of super drug-resistant bacteria, theSo it's not so much that penicillin use is declining and on the verge of obsolescence as it is that drug-resistant bacteria have rendered penicillin useless.However, clinically, penicillin remains the drug of choice for a number of infectious diseases, such as syphilis, infective endocarditis, and actinomyces infections, to name a few.

Penicillin should be skin test before use, even oral penicillin drugs should be carried out, penicillin skin test sour feeling believe that many people have felt, so clinically some patients refused to use penicillin, there are also some patients with a positive penicillin skin test, coupled with the fact that there are now many clinically available antimicrobial drugs, some of which do not need to do the skin test.So doctors will also forego the choice of penicillin for the convenience of the patient and to alleviate the pain of having to do a skin test on the affected person.In fact, only 10%-15% of the people who are really allergic to penicillin, penicillin allergy is not penicillin itself allergy, but penicillin degradation of the impurities produced by the allergy, there are also many patients with false-positive skin test, false-positive is that the patient is not really allergic to the patient, but a lot of external factors lead to a positive skin test, so in order to be more standardized penicillin skin test, to avoid the false-positive error, in 2017, the National Health Planning Commission issued the Expert Consensus on Penicillin Skin Test.

Many would argue that the use of penicillin has decreased because of its low price.I still think penicillin is by far the best value for money antibiotic in the clinic, bar noneInfectious diseases caused by sensitive bacteria, such as pharyngitis, tonsillitis, pneumonia, etc., can still be used, which not only reduces medical expenditure, but also slows down the pressure of bacterial drug resistance.

The decrease in the use of penicillin in hospitals is only an illusion. Because of the prominent disadvantages of penicillin, many new penicillins have been developed to overcome its many shortcomings, so that penicillin, as well as penicillin antibiotics, still have their place in the clinic.

References:

Guidelines for the Clinical Use of Antimicrobial Drugs (2015)

Expert Consensus on Penicillin Skin Tests (2017)

The reason for this is well explained, but it's nothing like the shady stuff many people want to hear, and in reality the doctor is the one who wants you to get well the most, even if it's for bonuses and reputation.

By penicillin we actually mean the earliest potassium penicillin G. There is only one reason why this drug is basically no longer used, it is becoming less and less effective. In fact, in the past, penicillin was often used in hundreds of thousands of units which was sufficient, but nowadays it is often ineffective to hit millions of units a day, because bacterial resistance is on the rise.

For most patients with bacterial infections, the use of cultures to detect sensitive drugs is a result of the TV show looking at more than one. This is because by the time the culture results come back, some patients have gotten better on their own, some have gotten worse, and some have died. That's why empiric broad-spectrum antibiotic medication needs to be used first, whether or not flora culture is used.

And penicillin G potassium is already tolerated by too many bacteria, so to give this again now would either require an oversized dose or delay valuable treatment.

But the penicillin family is the largest family of antibiotics, and although we no longer use penicillin potassium on a regular basis, penicillin derivatives, which are very effective, especially the carbapenem penicillins, just have a different name.

As a final addition, penicillin potassium injections have not completely disappeared from hospitals, and at the very least for syphilis, the simplest penicillin potassium salts are still very good first-line drugs

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First of all, who can't get penicillin?

Penicillin is the most basic antibiotic, initially widely used, now slowly many people no longer play penicillin, because penicillin allergy is too much of the population, once an allergic reaction occurs, mild hives, diarrhea, etc., severe respiratory, central system and circulatory symptoms such as: asphyxia, respiratory distress; loss of consciousness, coma, convulsions; drop in blood pressure, weak pulse, and so on, the serious can be life-threatening. In severe cases, it can be life-threatening.

In the case of numerous antibiotic allergies, many community clinics and hospitals have been experiencing accidents due to limited facilities and equipment and untimely rescue, and again, penicillin is gradually no longer used and other antibiotics with fewer allergies are used instead.

Why don't people who can get penicillin get penicillin?

Antibiotic abuse in this country is currently far greater than in any other country in the world, and after using higher levels of antibiotics, antibiotic resistance develops, meaning that going back to penicillin is no longer as effective as it should be. The problem here is not just the use of antibiotics by doctors, but also the fact that the vast majority of people go directly to the pharmacy to buy antibiotics when they need them. This creates a status quo problem in that even if the patient is not allergic to penicillin and is given antibiotics, they are not always effective.

Therefore, when there is a disease that needs to be treated, you need to do regular and reasonable treatment, and you can't force your doctor to prescribe penicillin because it is cheap and delay your condition.