Chapter 1. Antibiotics: What They Are
and How to Use Them
When used correctly, antibiotics are extremely useful and important medicines. They fight certaininfections and diseases caused by bacteria. Well-known antibiotics are penicillin, tetracycline, strep-tomycin, chloramphenicol, and the sulfa drugs, or sulfonamides.
Cuando se usan correctamente, 10s antibioticos son medicinas rnuy cjtiles e importantes. Combatenciertas infecciones y enfermedades causadas por bacterias. Ejemplos de antibioticos muy conocidosson: penicilina, tetraciclina, estreptomicina, cloranfenicol y las sulfas o sulfonamidas.
The different antibiotics work in different ways against specific infections. All antibioticshave dangers in their use, but some are far more dangerous than others. Take great care inchoosing and using antibiotics.
Los diferentes antibioticos funcionan de distintos modos contra infecciones especificas.
Uno corre diferentes peligros al usar cualquier antibiotico, per0 algunos antibioticos sonmas peligrosos que otros. Hay que tener gran cuidado al escoger y usar estas medicinas.
There are many kinds of antibiotics, and each kind is sold under several ‘brand names’ This can beconfusing. However, the most important antibiotics fall into a few major groups:
Hay muchos tipos de antibioticos, y cada tip0 se vende bajo varias 'marcas' o nombres comerciales.
Esto puede causar gran confusion. Pero 10s antibioticos mas importantes pertenecen a unos pocosgrupos principales:
Table 1.1. Antibiotics
aNote: Ampicillin is a type of penicillin that kills more kinds of bacteria than do ordinary penicillins.
If you have a brand-name antibiotic and do not know to which group it belongs, read the fine printon the bottle or box. For example, if you have some Paraxin ‘S’ but do not know what is in it, readthe fine print. It says ‘chloramphenicol’. Look up chloramphenicol in the GREEN PAGES (p. 357).
You will find it must be used only for a few very serious illnesses, like typhoid, and is especiallydangerous when given to the newborn.
Never use an antibiotic unless you know to what group it belongs, what diseases it fights,and the precautions you must take to use it safely.
Information on the uses, dosage, risks, and precautions for the antibiotics recommended in this bookcan be found in the GREEN PAGES. Look for the name of medicine in the alphabetical list at thebeginning of those pages.
Antibiotics: What They Are and How to Use
GUIDELINES FOR THE USE OF ALL ANTIBIOTICS
1. If you do not know exactly how to use the antibiotic and what infections it can be used for, do
2. Use only an antibiotic that is recommended for the infection you wish to treat. (Look for the ill-
3. Know the risks in using the antibiotic and take all the recommended precautions (see the GREEN
4. Use the antibiotic only in the recommended does—no more, no less. The does depends on the ill-
ness and the age or weight of the sick person.
5. Never use injections of antibiotics if taking them by mouth is likely to work as well. Inject only
6. Keep using the antibiotics until the illness is completly cured, or for at least 2 days after the fever
and other signs of infection have gone. (Some illnesses, like tuberculosis and leprosy, need to betreated for many months or years after the person feels better. Follow the instructions for each ill-ness.)
7. If the antibiotic causes a skin rash, itching, difficult breathing, or any serious reactions, the per-
son must stop using it and never use it again (see p. 70)
8. Only use antibiotics when the need is great.
When antibiotics are used too much they begin not to
GUIDELINES FOR THE USE OF CERTAIN ANTIBIOT-
1. Before you inject penicillin or ampicillin, always have ready ampules of Adrenalin (epinephrine)
to control an allergic reaction if one occurs (p. 70).
2. For persons who are allergic to penicillin, use another antibiotic such as erythromycin or a sulfa
3. Do not use tetracycline, ampicillin, or another broad-spectrum antibiotic for an illness that can
probably be controlled with penicillin or another narrow-spectrum antibiotic (see p. 58). Broad-spectrum antibiotics attack many more kinds of bacteria than narrow-spectrum antibiotics.
4. As a rule, use chloramphenicol only for certain severe or life-threatening illnesses like typhoid. It
is a dangerous drug. Never
use it for mild illness. And never give it to newborn children (exceptperhaps for whooping cough, p. 313).
5. Never inject tetracycline or chloramphenicol. They are safer, less painful, and do as much or
6. Do not give tetracycline to pregnant women or to children under 8 years old. It can damage new
7. As a general rule, use streptomycin, and products that contain it, only for tuberculosis—and al-
ways together with other anti–tuberculosis medicines (see p. 363). Streptomycin in combinationwith penicillin can be used for deep wounds to the gut, appendicitis, and other specific infectionswhen ampicillin is not available (or is too costly). but should never be used for colds, flu, andcommon respiratory infections.
8. All medicines in the streptomycin group (including kanamycin and gentamicin) are quite toxic
(poisonous). Too often they are prescribed for mild infections where they may do more harm
Antibiotics: What They Are and How to Use
than good. Use only for certain very serious infections for which these medicines are recommen-ded.
9. Eating yogurt or curdled milk helps to replace necessary bacteria killed by antibiotics like ampi-
cillin and to return the body’s natural balance to normal (see next page).
WHAT TO DO IF AN ANTIBIOTIC DOES NOT SEEM TO
For most common infections antibiotics begin to bring improvement in a day or two. If the antibioticyou are using does not seem to help, it is possible that:
1. The illness is not what you think. You may be using the wrong medicine. Try to find out more
exactly what the illness is—and use the right medicine.
2. The dose of the antibiotic is not correct. Check it.
3. The bacteria have become resistant to this antibiotic (they no longer are harmed by it). Try anoth-
er one of the antibiotics recommended for that illness.
4. You may not know enough to cure the illness. Get medical help, especially if the condition is ser-
Antibiotics do no good for the common cold.
Use antibiotics only for infections they are know to help.
IMPORTANCE OF LIMITED USE OF ANTIBIOTICS
The use of all medicines should be limited. But this is especially true of antibiotics, for the follow-ing reasons:
1. Poisoning and reactions.
Antibiotics not only kill bacteria, they can also harm the body, either by
poisoning it or by causing allergic reactions. Many people die each year because they take antibi-otics they do not need.
2. Upsetting the natural balance.
Not all bacteria in the body are harmful. Some are necessary for
the body to function normally. Antibiotics often kill the good bacteria along with the harmfulones. Babies who are given antibiotics sometimes develop fungus or yeast infections of the
Antibiotics: What They Are and How to Use
mouth (thrush, p. 232) or skin (moniliasis, p. 242). This is because the antibiotics kill the bacteriathat help keep fungus under control. For similar reasons, persons who take ampicillin and otherbroad-spectrum antibiotics for several days may develop diarrhea. Antibiotics may kill somekinds of bacteria necessary for digestion, upsetting the natural balance of bacteria in the gut.
3. Resistance to treatment.
In the long run, the most important reason the use of antibiotics should
be limited, is that WHEN ANTIBIOTICS ARE USED TOO MUCH, THEY BECOME LESSEFFECTIVE.
When attacked many times by the same antibiotic, bacteria become stronger and are no longer killedby it. They become resistant to the antibiotic. For this reason, certain dangerous diseases liketyphoid are becoming more difficult to treat than they were a few years ago.
In some places typhoid has become resistant to chloramphenicol, normally the best medicine fortreating it. Chloramphenicol has been used far too much for minor infections, infections for whichother antibiotics would be safer and work as well, or for which no antibiotic at all is needed.
Throughout the world important diseases are becoming resistant to antibiotics— largely because an-tibiotics are used too much for minor infections. If antibiotics are to continue to save lives, their usemust be much more limited than it is at present.
This will depend on their wise use by doctors,health workers, and the people themselves.
For most minor infections antibiotics are not needed and should not be used. Minor skin infectionscan usually be successfully treated with mild soap and water, or hot soaks, and perhaps paintingthem with gentian violet (p. 371). Minor respiratory infections are best treated by drinking lots of li-quids, eating good food, and getting plenty of rest. For most diarrheas, antibiotics are not necessaryand may even be harmful.
What is most important is to drink lots of liquids (p. 155), and provideenough food as soon as the child will eat.
Do not use antibiotics for infections the body can fight successfully by itself. Save them forwhen they are most needed.
For more information on learning to use antibiotics sensibly, see Helping Health Workers Learn,Chapter 19.
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