只要有头疼脑热，伤风感冒，很多老百姓都会想到阿莫西林和头孢以及阿奇霉素这些药物。他们都属于抗生素，其实并不是治感冒的药，一般来说只有合并细菌感染才需要使用。阿莫西林和头孢的化学结构中均含有β-内酰胺环，属于β-内酰胺类抗生素，而阿奇霉素则属于大环内酯类药物，和前二者有本质区别。

而肺炎是肺部被细菌、真菌、非典型病原体感染后引起的炎症性疾病，他们有的具有严重的破坏性，感染上后无法通过自身的免疫力完全清楚，有的则并不会对人体造成巨大的影响，甚至在自身的免疫力的抵御下有一定的自愈性，自己会好转，但总体来说，大部分肺炎都需要用抗生素来治疗，特别是儿童，不用抗生素治疗，有可能会留下严重的后遗症，那么肺炎该如何选择抗生素呢，下面来介绍一下大人儿童都能用的阿莫西林、头孢霉素和阿奇霉素该如何选择。

头孢霉素属于杀菌药，但抗菌谱窄

头孢霉素属于β-内酰胺酶类抗生素，主要破坏细菌的细胞壁合成来杀灭增殖期细菌，大家知道，人类细胞的外面没有细胞壁，而细菌则具有细胞壁，这个细胞壁可以保护细胞，免受外界环境因素的侵害，如果细菌失去细胞壁就会自溶最终死亡，但很多细菌的细胞壁没有头孢霉素所针对的靶点，有些病原体直接没有细胞壁，所以头孢霉素对支原体，衣原体等非典型病原体没有效果。

阿莫西林是使用最广泛的抗生素之一

阿莫西林是一种最常用的青霉素类β-内酰胺抗生素，是目前应用较为广泛的口服半合成青霉素之一，也是青霉素类药物中抗菌谱比较广的一个。适用于敏感细菌所致的呼吸道感染、尿路感染、胆道感染、皮肤及软组织感染、脑膜炎、血流感染、心内膜炎等。还可以与其他抗菌药物合用杀灭幽门螺杆菌。但阿莫西林目前耐药比较厉害，对能够产生β内酰胺酶的耐药性细菌，往往作用效果不明显，如果是较严重的感染，不适合使用阿莫西林。

阿奇霉素是广谱抗生素，但它是抑菌药

阿奇霉素是一种以抑制病原体蛋白合成的抑菌药，被阿奇霉素作用后，病原体的蛋白合成下降，细菌进入被抑制的状态，对于人体的毒力下降，对人体免疫力的抵御能力也下降，最终被身体所清除，但虽然病原体的蛋白被抑制，活力下降但一般不会立即死亡，所以阿奇霉素并不是杀菌药。

副反应对比

阿莫西林的副作用，首先是胃肠道反应，比如说恶心、呕吐、腹泻以及假膜性肠炎等，其次是过敏反应，比如皮疹、药物热和哮喘等，对青霉素过敏者禁用，少数病人还伴有轻度的氨基转移酶的升高。头孢类的抗生素抗菌作用比阿莫西林强，发生过敏反应的情况少于阿莫西林，但第一代、第二代头孢有一定的肾毒性，三代以上头孢肾毒性很小。

剂型有区别

阿莫西林只有口服的剂型，为了保护阿莫西林免遭β内酰胺酶水解，提高效果，如今有复方制剂，比如口服的阿莫西林克拉维酸钾，还有静脉使用的阿莫西林他唑巴坦。头孢类抗生素种类众多，既有口服也有静脉制剂，三代以上头孢类静脉用药较多。

阿奇霉素具有一些神奇的特性

阿奇霉素虽然只能起到抑菌作用，一般单独使用时只用于轻度感染，但它有一些神奇的特性，比如所谓的抗菌后效应，这个效应是指用药一段时间即使停药，抑菌的效应仍然能够维持很长时间，甚至在有些慢性疾病可以吃三天停四天，在这停药的四天中细菌仍然处于被抑制的状态。除了抗菌活性比较特别外，它还能破坏有些微生物的保护层，比如铜绿假单胞菌，这种细菌很容易在外表面形成一层粘液层，即使最有效的抗生素被阻挡在这层粘液层外也是起不到作用的，但阿奇霉素可以破坏并阻止这层粘液层的形成，让其他抗生素进入细菌内部对其进行杀灭，虽然阿奇霉素本身对铜绿假单胞菌没有杀灭作用，但用上它就能帮助其他抗生素更好的杀灭它，是不是相当于于谦的神助攻呢。

阿奇霉素可以治好一些其他抗生素治不好的疾病

有一种肺部疾病我不止一次的在以往的文章中介绍过，叫做弥漫性泛细支气管炎，这种疾病通常和鼻窦炎相伴随，肺上都是大大小小的结节，这些结节一般附着在支气管附近，神似树枝上长的树芽，因此称为“树芽征”。这种疾病的症状主要是咳嗽、咳黄浓痰，并伴随进行性加重的气喘，在一些不认识这个疾病的地方，常常被误诊为慢性阻塞性肺病，无论怎么治疗，其他的抗生素都用尽，哪怕是最强最霸道的抗生素都不能起到控制的效果，但阿奇霉素等大环内酯类抗生素用上后常常可以获得奇效，如果早期发现的话，甚至可以治愈。哪怕服用的剂量在杀菌所需的剂量以下，都能对疾病起到很好的控制效果，研究认为和阿奇霉素的免疫调节作用相关，而这一作用是其他抗生素所没有的。

无论是阿莫西林还是头孢类，长时间使用都存在耐药的问题，甚至会出现二重真菌感染可能，所以抗生素使用要求非常严格，尤其是呼吸道感染，大部分情况下由病毒感染所致并不需要使用，合并细菌感染才需要，使用后要足量足疗程，不可三天打鱼两天晒网，容易诱发耐药菌产生。普通感染一般5-7天即可，不可长期使用，防止二重感染。

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#07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px){body:not(.pages_skin_pc) .wx-root[data-weui-theme=dark],body:not(.pages_skin_pc) body[data-weui-theme=dark]{--appmsgExtra-BG: #121212}}@media screen and (min-width:1024px){body:not(.pages_skin_pc)body:not(.pages_skin_pc){background:var(--weui-BG-2)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) .wx-root[data-weui-mode=care]:not([data-weui-theme=light]),body:not(.pages_skin_pc) body[data-weui-mode=care]:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .85);--weui-FG-HALF: rgba(255, 255, 255, .65);--weui-FG-1: rgba(255, 255, 255, .55);--weui-FG-2: rgba(255, 255, 255, .35);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) .wx-root:not([data-weui-theme=light]),body:not(.pages_skin_pc) body:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 255, 255, .3);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: #ff6146;--weui-ORANGE: #c87d2f;--weui-YELLOW: #cc9c00;--weui-GREEN: #74a800;--weui-LIGHTGREEN: #3eb575;--weui-BRAND: #07c160;--weui-BLUE: #10aeff;--weui-INDIGO: #1196ff;--weui-PURPLE: #8183ff;--weui-WHITE: rgba(255, 255, 255, .8);--weui-LINK: #7d90a9;--weui-TEXTGREEN: #259c5c;--weui-FG: #fff;--weui-BG: #000;--weui-TAG-TEXT-RED: rgba(250, 81, 81, .6);--weui-TAG-BACKGROUND-RED: rgba(250, 81, 81, .1);--weui-TAG-TEXT-ORANGE: rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) 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59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--discussInput-BG: rgba(255, 255, 255, .03)}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--nickName-FG: #959595}}@media(prefers-color-scheme:dark){.wx-root:not([data-weui-theme=light]),body:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 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div.autoTypeSetting24psection > p,div.autoTypeSetting24psection > section{margin-bottom: 24px;}