【解惑】庆大霉素喷喉问题

我查资料说6岁以下儿童禁用庆大，现在有个问题就是说五官科拿庆大给4岁儿童喷喉算不算。。。医生的理由就是说他是局部用药吸收不了多少。还说用庆大喷喉是五官科常规用药。。还有个问题就是抗菌素尽量避免局部用药。。。医生说喷喉是粘膜吸收和滴眼液是同一个道理所以可以用。。请前辈请教，谢谢！！！

对此本人也很疑惑，期待高人指点

氨基糖苷类原则上不作为儿童的一线用药

以下信息来自 MICROMEDEX。。

2.3.1   Absorption
A)  Bioavailability
1)  AEROSOL: 1.5% to 34% (Crosby et al, 1987).
a)  Systemic absorption of gentamicin instilled into the endotracheal tube varies averages 16.7%. Even though absorption was significant in some patients, serum levels were less than 1 mcg/ml in all patients indicating that clearance of the aminoglycoside was sufficient to prevent accumulation (Crosby et al, 1987).

3)  ORAL: 0.2% (Kucers & Bennett, 1975).
a)  In infants receiving oral GENTAMICIN (10 to 200 mg/kg/day) for either the treatment of diarrhea or to prevent necrotizing enterocolitis, the serum concentrations of GENTAMICIN were considered negligible usually in the range of 0.3 to 0.4 micrograms/milliliter (mcg/mL) (Bhat & Meny, 1984; Miranda et al, 1984; Berkovitch et al, 1993; Gemer et al, 1983)

没有喷喉相关生物利用度数据
虽然口服庆大霉素生物利用度很低，但其气雾剂的生物利用度不可忽视1.5% to 34%。
还要考虑用量吧。。。
综合考虑，为什么要用，有没有其他替代的好方法。。。