感冒，就要食抗生素?

醫健寶庫：傷風感冒 毋須服抗生素

上呼吸道感染是香港其中一種最普遍的疾病，約佔家庭醫生求診個案三分之一。患者一般只要多作休息，服用一些紓緩的藥物即可，但在日常診症中，不少傷風感冒的病人仍希望醫生開出抗生素。他們誤解抗生素等同消炎藥，以為可以治療一切炎症。事實上，抗生素是專門對付細菌，對於治療傷風感冒及喉嚨發炎這類通常由病毒引起的症狀，沒有明顯作用。

反令細菌更抗藥

錯誤使用抗生素，不但對病情沒有幫助，部分病人更會出現副作用，例如肚瀉及出疹等，更嚴重的是令部分細菌轉變基因，成為具抗藥性的超級細菌，令一般抗生素再難發揮效用。香港自2004年已出現在社區感染抗藥性金黃葡萄球菌的個案，有機會致命，情況不容忽視。濫用抗生素一直是全球關注的問題，香港政府近年開始透過宣傳和教育，希望扭轉大眾過往對抗生素的依賴和誤解，以及令大眾明白濫用抗生素所帶來的禍害。

我們最近的一項研究發現，超過一半受訪市民覺得自己沒有能力預防抗藥性惡菌在社區出現。我認為市民不應輕視自己的角色，如果大家都能夠避免濫用抗生素，對防止抗藥性惡菌出現有莫大幫助。除此之外，市民如因其他病症需要服用抗生素，也應該按照醫療專業人員的指示完成整個療程，不要留起餘下的抗生素再服用。[...]

(香港大學李嘉誠醫學院家庭醫學及基層醫療學系臨床教授林大邦教授, 東方日報，2011年11月6日)

星期日，囡囡傷風了一個星期，咳時有好多痰，看見她淚水汪汪，開始嚴重，不像之前般「跳跳紮」，手頭上又無適合她這個細小年紀的中西成藥，囝囝看開的中醫今日又沒有開診。看見街口有位兒科醫生，有很多銜頭，全科醫學士、內科院士、兒科院士、兒科文憑等等，心想應該是一名可信賴的專業人士，故即管試試。

(可惜這位「兒科聖手」的手勢很差，他應該吩咐護士幫手啊！探耳溫時弄得囡囡呱呱大叫，又似乎不懂得與小朋友溝通的技巧，臉上沒有半點笑容，與我們以前看過的一些兒科醫生很不同，整個診斷過程囡囡很驚慌不斷大哭，不過這不是本文的重點)

我: 醫生，請問你開了些什麼藥?
醫生：有收鼻水、退燒、化痰之類......
我: 請問醫生有無開抗生素呢? 如果可以，希望你不要開抗生素 (這是我每次帶有感冒的兒子看醫生時必會問的事, 因我知道這些藥對身體有很大的副作用、我的兒子(和女兒) 自出生以來從未吃過一口抗生素。)
醫生：佢有「上呼吸道感染」，要食抗生素。
我: 「上呼吸道感染」，即是「感冒」是嗎 ? 請問她有無其他炎症，例如中耳炎、肺炎、氣管炎或鼻竇炎之類呢?
醫生：佢有喉嚨發炎, 可能受到細菌感染，所以要食抗生素......
我: 我從讀書得知，病毒感染都可導致喉嚨發炎的，而抗生素只能對付細菌，不能對付病毒，請問醫生，你怎知她受到細菌感染呢?
醫生：......，咁你去睇第二位醫生囉。

(電視廣告每一天都有宣傳，呼籲市民不要濫用抗生素，可是一般升斗市民，沒有牌照, 也沒有證件，又怎樣可以在藥房購買到抗生素呢? 可能一個原因就是部份港式西醫在沒有需要的情況下，胡亂處方這些無論對人體而言是好細菌又好，壞細菌也好，一律「有殺錯無放過」、有強烈副作用的抗生素。)

回到家裡，打開藥袋一看，原來除了有收鼻水、退燒、化痰藥之外，還有止咳藥 (同醫生「對完話」後，心情有些激動，心不在焉，只記得診所姑娘吩咐我把四隻藥一齊給囡囡服食)。

「止咳和化痰的藥理完全相反，止咳原理是抑制中樞神經，減低氣管敏感度；化痰則是刺激氣管釋出水分稀釋痰液，患者便容易咳出積存的痰液，所以兩種功效根本不可能並存。」
「如果咳嗽時痰液極少，亂食化痰藥會刺激氣管釋出更多水分，反而愈咳愈多痰；但如果咳嗽時帶有濃痰，食止咳藥令氣管敏感度下降，反而會阻礙痰液排出，令細菌積存在氣管，可能引發氣管炎、肺炎等。」 (香港醫院藥劑師學會會董賴愛倫，《壹週刊》, 1136期)

成藥同時含有止咳 (Suppressant) 同化痰 (Expectorant) 成份，因為廠商要營利賺錢。 但是囡囡今次咳時好多痰，是否應該先選擇化痰藥，而非止咳藥呢? 或者請醫生教育市民服用的條件好嗎? 正如有藥劑師指出，「止咳」、「化痰」藥理完全相反，一齊服食可能無效之餘， 隨時止咳不成，反而有機會導致氣管炎或肺炎，到時恐怕真的需要服食抗生素了。唉。

補充: 其實我、太太和兒子也是主要看中醫的, 今次妹妹看西醫, 正如文首所說, 也是迫不得已。孩子患感冒時, 我只會在以下情況給予哥哥和妹妹西藥: 就是他們的病況嚴重影響睡眠時，因為我認為睡眠是十分重要的, 睡不好, 就會百病叢生, 所以一定要斬斷這個惡性循環。平時小朋友傷風感冒, 在日間大部份時間我都是採用「自家」治療法(浸浴退燒、拍背去痰、放濕通鼻、按摩減咳、喝水吃粥、戒口等等...)+ 中成藥, 還未痊癒就看中醫。不過, 好/「夾」的中醫師難尋, 這點卻是事實。而作為人父, 見到小朋友身體很不適致不開心, 內心真的很難過很擔心......

(兩日後) 後記: 發燒了多日，今天妹妹已退燒, 精神好了許多, 轉捩點應該是昨天服食了一小樽很優良的猴棗散 (謝謝 Ip Lai Kuen 的提醒)、多次拍痰和浸了一個很長的溫水浴 (當然可能是媽媽的母乳抗體發揮作用), 鬆一口氣。


Facebook 讀者對本文的回應:
Yi Yi Debby oh 唔只揭發了庸醫的惡行, 止咳和化痰一段好岩用! 完全解釋到點解上月咳了十多天、但吃止咳藥又唔好的問題! 謝!
Arden Wong 這不是醫生庸與不庸的問題，是整個西醫對抗症狀的思維，必然地充滿矛盾。

第一大問題，是假設「病」是身體出錯，發燒是錯，有痰是錯，咳嗽是錯，發炎是錯，所以要退燒、化痰、止咳、消炎...

但為甚麼身體要發燒、有痰、咳嗽、有炎？ 原來是有廢物要清除，所以有痰 (沖洗)，要咳嗽排出，要發燒提高機能，要發炎去修受損組織。

那廢物哪裡來？ 可以是食物，可以是空氣，但最重要未被化解的情緒，這些情緒可以是孩子自己的，也可以孩子替代父、母的。 這些都沒有錯，所有症狀都身體要排解廢物的過程。 但用西醫的思維去處方，就只會阻止身體天賦的自我療癒力，不論他是最高明、最有醫德的醫生。

Yi Yi Debby 嗯. 以往我一向貪快, 諗住睇西醫快?好, 不過都係時候要搵中醫著重調理下身子了...

Sy Onna 我星期三發燒，周身骨痛，終於去睇幾年都沒看的西醫，但一吃藥就後悔，佢話我喉嚨發痰，有抗生素，我吃了兩次藥後，晚上突然冒冷汗，暈了，這幾天還是又暈又嘔。

Clement Lee 我傷風左成個月了, 一開始就係食中藥, 結果唔掂而轉睇西醫, 到而家都仲未好返.....

Convulsion

Last evening, DD (our baby girl) suddenly had a convulsion (seizures and loss of consciousness due to unknown reasons) and DW immediately took her to the hospital and stayed there overnight. I was guilty unable to accompany them, as DS was having a fever and I had to prepare materials for the lecture in the following day.

Both kids are fine and they are now sleeping well. We had a difficult moment last evening - DD's condition was scary and we had a moment of feeling like we were losing her, but fortunately we (at least I :-) were not panic. Since her convulsion was not associated with fever and the blood test results were normal (not, e.g. meningitis) we still wondered why she suddenly lost consciousness. We only know that she had sudden abnormal discharge of electrical current in the brain.

Yet, both the doctor and we suspect that she has epilepsy, but it can only be confirmed by brain scan which will be conducted in a public hospital later. And we know that if this happens again, we need to place her safely on the floor and protect her from bumping into the ground. It may be a blessing in disguise, because Socrates, Caesar, Napoleon, the composer G. Gershwin, the singer Prince, and Beethoven and Newton were all said to have epilepsy :-)

DD's first month

1. DW has been breastfeeding so well that the baby redeemed her birth weight in a week and her jaundice went away without any need to follow up medically! This surprised doctors and nurses in the Public Maternal and Child Health Centre a lot because they had insisted us to send the baby to the hospital for phototherapy (this would result in mother-baby seperaton - this is another example showing that professionals in HK are not supportive of breastfeeding ( see Jack Newman, M.D., and Teresa Pitman [2006], The Ultimate Breastfeeding Book of Answers.NY: Three Rivers Press.)

2. When the baby's jaundice was still worrying DS suddenly developed a high fever and we were hesitated whether to send him to the private hospital (it was on the weekend). Then we made a wise decision - bringing him to a good Chinese doctor. DS completely recovered after only two days (he can drink Chinese herbs better than many adults). Unlike many children of his age, he still hasn't "tasted" any antibiotics since birth. I hope he never has to suffer the side-effects of antibiotics!

3. Compared to DS, DD is a very good sleeper - she can sleep on my arms without my moving them. And no wake up even putting on the bed then. Because DS has taught us too much :-) how to deal with sleep problems of babies, taking care of DD is (a little bit) easier than we expected - at least during these few weeks - though I hope DW can have a few hours personal time every week later - she is attending to the baby almost 21.5 hours a day (the other 2.5 hours are for DS).

4. DS adjusts very well - we can't demand him more! He has begun to exhibit very loving and caring behaviors to his sister. We have taken some interesting pictures showing the interactons between the two. Hope each day has 26 hours so I can upload them asap!

On Giving Chinese Medicine

Very frustrated giving Chinese medicine to DS. The intense child just spits out the medicine even it has been mixed with honey. (To those who are not familiar with Chinese herbal medicine: the decoction [the prepared liquid] is dosed in a rice bowl [size smaller for children], not in spoons.) I HATE dropping the decoction into his cheek pocket every time - we are both emotionally exhausted!!!

Q: Why don't use syringe? You can cool down the herbal tea and inject it to his mouth by the syringe. You can buy the syringe (of course without needle version) in any local dispensary stores. Just like many children also use syringe to have the syrup.

Thanks but actually we have been using the syringe (when all other more respectable means fail)!

I guess few children's syrups will require the parents to administer 150ml (a children's rice bowl=one dose of decoction) or even a half portion of it at one time!

Tonight (just like all other nights) DS protested against the syringe hysterically, gagged heavily and hurt his mouth corner....We were both very scared.

Forgot to say, with the syringe method we at most can give ~20ml at one time (INCluding the spit-out) before we break down. It's just like a torture to every one.

In fact, even giving 2.5ml of acetaminophen will make DS mad.

Eczema

DS was suffering from eczema. Although his symptoms were just mild (compared with other poor babies's), they were enough to cause him frequent night-waking. We thought that he might be allergic to the dust mites or flea of the bed /bed frame or the recent high humidity. So we have tried to lower the humidity level (which also deactivates the dust mites) in the bedroom and spread some galangal powder around the bed to deter the flea. We have also bathed him at first with dead sea salt and later a moisturizing cleanser, and apply a moisturing lotion to his skin. Now his problem has largely been improved! I think the antibodies in breastmilk may have also prevented him from being too serious.

Doctors are used to prescribe steroids to treat eczema so readily. Don't they know that relying on it without treating the cause leads to serious complications?

Although the ointment given to us by the doctors is only very mild cortison (< 1%), we still use it very very carefully - only for breaking the itching and scratching cycle when it really itches. Most of the time we used cortison-free alternatives, like ointment made of Chinese Herbral medicine. The picture shows dead sea mud.

On Vaccination

DS was having a fever after a vaccination. We were worried.

There are controversies surrounding the safety and /real/ benefits of vaccines. I am thinking whether to let DS risk adverse reactions again.