What’s meaning of first-line drugs?
When doctors or veterinarians choose drugs for the treatment or the prevention of diseases, they initially use the first-line drugs. First-line drugs are first administered for diseases, and are usually chosen due to less side effects and high clinical effectiveness. Then what are second-line drugs? They are used when first-line drugs show no effect for the disease or when it is difficult to continue the treatment owing to the side effect.
Now, let’s think about the administration of antibiotics. The treatment for infectious diseases by antibiotics is called Antimicrobial Chemotherapy. The way of thinking about first-line drugs is different between doctors and veterinarians. Doctors focus on the effective recovery from the infectious disease as early as possible when they choose first-line drugs. Grades of Recommendations corresponding to the levels of evidence are shown in clinical practice guidelines by scientific societies such as the Japanese Society of Chemotherapy or the Japanese Association for Infectious Diseases. However first-line drugs in veterinary medicine are required to be not only effective, but also veterinarians should choose antibiotics not including the first-line drugs list defined as important in human medicine. This purpose is to prevent the effect of antibiotics on human health, because the administration of antibiotics for animals cause the selection of antimicrobial resistance against antibiotics considered important in human medicine. Thus, first-line drugs used by doctors, such as fluoroquinolones, the third-generation cephalosporin, 15-membered macrolides, and colistin sulfate, are regarded as second-line drugs for animals. First-line drugs for animals are historical and have less importance in human medicine. I don’t think that the importance of life is essentially different between humans and animals, however, that indicates we value human life more than animal life.
written by Yutaka Tamura