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  3. I should start by saying as clearly as I can that I love antibiotics. Recent

I should start by saying as clearly as I can that I love antibiotics. Recent

游客2024-11-26  48
问题     I should start by saying as clearly as I can that I love antibiotics. Recently I had dinner with a pediatrician friend, and she told me the story of the day’s sickest child. Before she sent the child to the emergency room in an ambulance, she told me, she gave her 50 milligrams per kilogram of ceftriaxone, a powerful antibiotic.
    "You probably saved her life," I said, and my friend nodded: it was possible. Antibiotics represent a huge gift in the struggle against infant and child mortality, a triumph(or actually, many triumphs)of human ingenuity and science over disease and death, since the antibiotic era began back in the fourth and fifth decades of the 20th century.
    But new research is looking at questions about the complex effects of antibiotics on bacteria, on individual children, and on populations building on a greatly increased awareness of how powerful antibiotics can be. and how important it is to use them judiciously.
    Over the past 15 years or so, spurred by new realizations and new fears -about the risks of breeding resistant strains of bacteria, pediatricians in the United States have, as a group, cut back dramatically on prescribing antibiotics in situations where they may not be necessary. Parents, as a group, have become less likely to demand them.
    "It’s actually been a remarkable change in practice from the mid-’90s on," said Dr. Jonathan Finkelstein, a pediatrician at Boston Children’s Hospital who studies antibiotic use and antibiotic resistance, "and we did that by physicians and patients recognizing that antibiotics are quite effective, quite safe, but there’s no such thing as a free lunch, and as with any other medical decision, we have to weigh the risks and benefits of every treatment."
    There has been a lot of discussion about whether ear infections should always be treated with antibiotics, or whether in some situations(older child, less ill)"watchful waiting" might be appropriate—but it’s also true that many of us have become much more reluctant to diagnose ear infections in borderline cases.
    In a study that Dr. Finkelstein and his colleagues published this year, looking at antibiotic use in children in Massachusetts, the rate at which antibiotics were dispensed to the youngest group(3 to 24 months)had decreased 24 percent by 2008 - 2009 from 2000 - 2001. That drop was largely driven by a declining rate of diagnosis of ear infections.
    We always knew there were immediate risks to antibiotics. Children could have allergic reactions. They could get diarrhea. Babies could get unpleasant yeast infections—severe diaper rash, thrush in the mouth. But still, the thinking back when I trained was that after the antibiotics, the body would return to normal.
    "When antibiotics were developed, they were miraculous for all the reasons that you know," said Dr. Martin J. Blaser, the chairman of medicine at New York University School of Medicine. "With few exceptions, there was almost no long-term toxicity that was identifiable, and so everybody thought that if you took an antibiotic, it could produce some immediate upset—it could produce a rash, loose bowels—and then everything would return to normal, bounce back to normal. But in fact there was no real exploration of that. It just became an article of faith."
    Dr. Blaser has devoted himself to a study of what is now called the microbiome, the bacterial population that lives on us and in us, and the effects of perturbing that population by antibiotic use. He and other researchers are asking questions about whether alterations in the microbiome may be linked to many different patterns of health, growth and disease. It’s an area of investigation that is still new, but changing quickly.
    Last summer, Dr.Blaser’s group published a study in The International Journal of Obesity in which they analyzed growth data from a large group of British children: those treated with antibiotics when very young(under 6 months)showed increased weight gain by a year of age, and were 22 percent more likely to be overweight at age 3.
    The influence of early antibiotics on the lungs has also been examined. A study in last month’s issue of the journal Pediatrics looked epidemiologically at another large population of children, and found an association between childhood antibiotic treatment and the later development of inflammatory bowel disease.
    Every one of these researchers started with an antibiotic pledge of allegiance. "We clearly have to use antibiotics and are lucky to have them around," said Dr. Matthew P. Kronman, lead author on the bowel disease study, who is a specialist in pediatric infectious diseases at the Seattle Children’s Hospital. "It’s just that we are still learning what all of their effects are." [br] The immediate risks of using antibiotics DO NOT include
选项 A、ear infections.
B、allergic reactions.
C、severe diaper rash.
D、loose bowels.
答案 A
解析 细节题。由关键词“ear infections”定位到第六段，而这是一种病情，医生要决定到底是否使用抗生素，而不是抗生素的副作用，故选[A]。
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