耳鼻喉专科常用药物.ppt

美国 排险有无并发其他疾病如鼻窦炎、中耳炎等（The physician should see all children and those adults who have an underlying disease, pain in the sinuses or in the ear, productive cough, or trismus. ） 成人可作细菌（链球菌）测试（Adult patients can usually be examined by a nurse, who takes a streptococcal test. ） 抗生素的使用仅限于：细菌培养阳性或快速测试阳性（A型链球菌或其他链球菌但症状严重）（Antibiotics are indicated only for patients with a positive culture or rapid test for either Group A streptococci, or Any streptococci if the symptoms are severe, particularly during an epidemic.） 如果症状理，可先使用1天剂量的抗生素，待细菌培养的结果，如果为阴性，则不用再用药（If the patient has severe symptoms, a one-day dose of antibiotic can be given while waiting for the result of the bacterial culture. If the result is negative, the antibiotic should be discontinued.） 首选青霉素（Penicillin V 1.5 million units x 2 x 10 ） 如青霉素过敏，可口服头孢类？？（In case of penicillin allergy: oral cephalexin 750 mg x 2 or cefadroxil 1 g x 1 (Deeter et al., 1992) [A]. ） 不需要马上使用抗生素（It is not necessary to start antibiotics immediately: a delay of 1 (-3) day(s) does not increase complications or delay the resolution of acute disease. ） 抗生素可以缩短症状的时间，降低风湿热的风险（Antibiotics shorten the duration of symptoms somewhat (Del Mar, Glasziou, Spinks, 2006) [A] and reduce the risk of rheumatic fever (Manyemba Mayosi, 2002) [C]. ） 解热镇痛药减轻症状的效果比抗生素更佳。成人可用利多卡因喷雾剂或漱口（An analgesic (Thomas, Del Mar, Glasziou, 2000; Del Mar Glasziou, 2005) [B] (paracetamol and ibuprofen are the safest) is more effective than antibiotics against symptoms. In adults, pain at swallowing can even be treated with lidocaine spray or gargling solution. ） 培养非A型链球菌，如症状严重，或在流行季节，抗生素使用原则同上。（Non-A streptococci: in patients with severe symptoms and during epidemics, the same medication as for group A streptococci. ） 不需要反复细菌培养，除非症状复发。（Repeated throat culture is not necessary unless the symptoms recur. ） 治疗（英国） 主要治疗为营养支持、维持电解质平衡、退热等对症治疗。 建议休息和口服体液补充。 抗生的使用指征： 症状加重，有免疫功能不全、有风湿热病史，单侧扁桃体炎 首选青霉素类，疗程10天，如果对青霉素过敏，可选用大环内酯类抗生素。 如果患者症状重，要排除脱水、扁周脓肿及气道阻塞的可能。 如果使用抗生素后患者症状不缓解，可使用头孢菌