{"id":22823,"date":"2023-04-19T16:57:30","date_gmt":"2023-04-19T09:57:30","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=22823"},"modified":"2023-04-20T16:31:18","modified_gmt":"2023-04-20T09:31:18","slug":"phac-do-dieu-tri-lao-khang-thuoc","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/phac-do-dieu-tri-lao-khang-thuoc\/","title":{"rendered":"Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb lao kh\u00e1ng thu\u1ed1c"},"content":{"rendered":"

Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb<\/a> lao kh\u00e1ng thu\u1ed1c l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh lao cho nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc ph\u1ea3i c\u00e1c ch\u1ee7ng vi khu\u1ea9n lao kh\u00e1ng thu\u1ed1c, ngh\u0129a l\u00e0 c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1ng lao th\u00f4ng th\u01b0\u1eddng kh\u00f4ng c\u00f2n hi\u1ec7u qu\u1ea3 trong vi\u1ec7c ti\u00eau di\u1ec7t vi khu\u1ea9n lao. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb lao kh\u00e1ng thu\u1ed1c th\u01b0\u1eddng kh\u00f3 kh\u0103n v\u00e0 k\u00e9o d\u00e0i h\u01a1n so v\u1edbi \u0111i\u1ec1u tr\u1ecb b\u00ecnh th\u01b0\u1eddng, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi ph\u1ea3i s\u1eed d\u1ee5ng c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1ng lao m\u1edbi v\u00e0 \u0111\u1eaft ti\u1ec1n.\u00a0<\/strong><\/p>\n

\"Ph\u00e1c
Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb lao kh\u00e1ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb b\u1ec7nh lao c\u1ee7a c\u00e1c ch\u1ee7ng vi khu\u1ea9n lao kh\u00e1ng thu\u1ed1c<\/figcaption><\/figure>\n

1. C\u00e1c khuy\u1ebfn c\u00e1o c\u1eadp nh\u1eadt ch\u00ednh c\u1ee7a WHO v\u1ec1 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb lao kh\u00e1ng thu\u1ed1c:<\/b><\/h2>\n

Thu\u1ed1c ti\u00eam kh\u00f4ng c\u00f2n \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng n\u1eefa, thay v\u00e0o \u0111\u00f3 l\u00e0 thu\u1ed1c u\u1ed1ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng cho ph\u1ea7n l\u1edbn ng\u01b0\u1eddi b\u1ec7nh. Hi\u1ec7n c\u00f3 hai lo\u1ea1i ph\u00e1c \u0111\u1ed3 \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb cho ng\u01b0\u1eddi b\u1ec7nh c\u00f3 vi khu\u1ea9n lao kh\u00e1ng R\/MDR-TB bao g\u1ed3m:<\/p>\n

– Ph\u00e1c \u0111\u1ed3 d\u00e0i h\u1ea1n k\u00e9o d\u00e0i t\u1eeb 18-20 th\u00e1ng, c\u00f3 th\u1ec3 l\u00e0 ph\u00e1c \u0111\u1ed3 chu\u1ea9n ho\u1eb7c ph\u00e1c \u0111\u1ed3 c\u00e1 th\u1ec3. Ph\u00e1c \u0111\u1ed3 n\u00e0y \u0111\u01b0\u1ee3c x\u00e2y d\u1ef1ng tr\u00ean nguy\u00ean t\u1eafc l\u1ef1a ch\u1ecdn c\u00e1c thu\u1ed1c sao cho s\u1ed1 lo\u1ea1i thu\u1ed1c c\u1ea7n s\u1eed d\u1ee5ng l\u00e0 \u00edt nh\u1ea5t nh\u01b0ng v\u1eabn \u0111\u1ea3m b\u1ea3o hi\u1ec7u l\u1ef1c c\u1ee7a ph\u00e1c \u0111\u1ed3 c\u0103n c\u1ee9 v\u00e0o k\u1ebft qu\u1ea3 kh\u00e1ng sinh \u0111\u1ed3 c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

– Ph\u00e1c \u0111\u1ed3 ng\u1eafn h\u1ea1n t\u1eeb 9-11 th\u00e1ng. \u0110\u00e2y l\u00e0 ph\u00e1c \u0111\u1ed3 v\u1edbi th\u00e0nh ph\u1ea7n thu\u1ed1c v\u00e0 th\u1eddi gian \u0111i\u1ec1u tr\u1ecb \u0111\u00e3 x\u00e2y d\u1ef1ng th\u1ed1ng nh\u1ea5t.<\/p>\n

2. Ph\u00e1c \u0111\u1ed3 d\u00e0i h\u1ea1n<\/b>:<\/h2>\n

2.1. C\u00e1c khuy\u1ebfn c\u00e1o<\/b><\/h3>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 1:\u00a0<\/i>L\u1ef1a ch\u1ecdn thu\u1ed1c \u0111\u1ec3 x\u00e2y d\u1ef1ng ph\u00e1c \u0111\u1ed3 d\u00e0i h\u1ea1n d\u1ef1a tr\u00ean nguy\u00ean t\u1eafc sau<\/p>\n

\u25cb L\u1ef1a ch\u1ecdn c\u1ea3 3 thu\u1ed1c nh\u00f3m A (Bdq, Mfx\/Lfx, Lzd) v\u00e0 \u00edt nh\u1ea5t 1 thu\u1ed1c nh\u00f3m B (Cfz ho\u1eb7c Cs). \u0110\u1ea3m b\u1ea3o ph\u00e1c \u0111\u1ed3 v\u1eabn c\u00f2n \u00edt nh\u1ea5t 3 thu\u1ed1c sau khi ng\u1eebng BDQ<\/p>\n

\u25cb N\u1ebfu ch\u1ec9 ch\u1ecdn 1 ho\u1eb7c 2 thu\u1ed1c c\u1ee7a nh\u00f3m A th\u00ec ph\u1ea3i c\u00f3 \u0111\u1ee7 c\u1ea3 2 thu\u1ed1c nh\u00f3m B. Tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng th\u1ec3 x\u00e2y d\u1ef1ng ph\u00e1c \u0111\u1ed3 ch\u1ec9 bao g\u1ed3m nh\u00f3m A v\u00e0 B, c\u00f3 th\u1ec3 b\u1ed5 sung nh\u00f3m C \u0111\u1ec3 ph\u00e1c \u0111\u1ed3 \u0111\u1ee7 hi\u1ec7u l\u1ef1c<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 2:<\/i>\u00a0Km v\u00e0 Cm kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng n\u1eefa.<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 3<\/i>: N\u00ean s\u1eed d\u1ee5ng Levofloxacin ho\u1eb7c Moxifloxacin trong ph\u00e1c \u0111\u1ed3 d\u00e0i h\u1ea1n (khuy\u1ebfn c\u00e1o m\u1ea1nh m\u1ebd)<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 4:<\/i>\u00a0N\u00ean s\u1eed d\u1ee5ng Bedaquiline trong ph\u00e1c \u0111\u1ed3 d\u00e0i h\u1ea1n cho ng\u01b0\u1eddi b\u1ec7nh tr\u00ean 18 tu\u1ed5i (khuy\u1ebfn c\u00e1o m\u1ea1nh m\u1ebd), tuy nhi\u00ean c\u0169ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng cho tr\u1ebb t\u1eeb 6-17 tu\u1ed5i (khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n).<\/i><\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 5:\u00a0<\/i>N\u00ean s\u1eed d\u1ee5ng Linezolid trong ph\u00e1c \u0111\u1ed3 d\u00e0i h\u1ea1n (khuy\u1ebfn c\u00e1o m\u1ea1nh m\u1ebd)<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 6:<\/i>\u00a0<\/i><\/b>Clofazimine v\u00e0 Cycloserine Cs c\u00f3 th\u1ec3\u00a0b\u1ed5 sung v\u00e0o ph\u00e1c \u0111\u1ed3 (khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n)<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 7:<\/i>\u00a0<\/i><\/b>Ethambutol c\u00f3 th\u1ec3\u00a0b\u1ed5 sung v\u00e0o ph\u00e1c \u0111\u1ed3 (khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n)<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 8:<\/i>\u00a0<\/i><\/b>Delamanid c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong ph\u00e1c \u0111\u1ed3 d\u00e0i h\u1ea1n cho tr\u1ebb t\u1eeb 3 tu\u1ed5i tr\u1edf l\u00ean (khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n)<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 9:<\/i>\u00a0<\/i><\/b>Pyrazinamid c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong ph\u00e1c \u0111\u1ed3 d\u00e0i h\u1ea1n (khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n)<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 10:<\/i>\u00a0<\/i><\/b>Imipenem-cilastatin ho\u1eb7c meropenem c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng trong ph\u00e1c \u0111\u1ed3 d\u00e0i h\u1ea1n (khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n)<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 11:<\/i>\u00a0<\/i><\/b>Amikacin c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng cho ng\u01b0\u1eddi b\u1ec7nh t\u1eeb 18 tu\u1ed5i tr\u1edf l\u00ean khi c\u00f2n nh\u1ea1y c\u1ea3m v\u00e0 c\u00f3 \u0111\u1ee7 \u0111i\u1ec1u ki\u1ec7n theo d\u00f5i th\u00ednh l\u1ef1c. N\u1ebfu kh\u00f4ng c\u00f3 Am c\u00f3 th\u1ec3 d\u00f9ng S\u00a0(khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n)<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 12:<\/i>\u00a0<\/i><\/b>Pto c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng tuy nhi\u00ean ch\u1ec9 khi ph\u00e1c \u0111\u1ed3 kh\u00f4ng c\u00f3 \u0111\u1ee7 c\u00e1c thu\u1ed1c hi\u1ec7u l\u1ef1c kh\u00e1c (Bdq, Lzd, Cfz, Dlm) ho\u1eb7c khi kh\u00f4ng c\u00f3 l\u1ef1a ch\u1ecdn n\u00e0o kh\u00e1c (khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n)<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 13:<\/i>\u00a0<\/i><\/b>PAS c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng tuy nhi\u00ean ch\u1ec9 khi ph\u00e1c \u0111\u1ed3 kh\u00f4ng c\u00f3 \u0111\u1ee7 c\u00e1c thu\u1ed1c hi\u1ec7u l\u1ef1c kh\u00e1c (Bdq, Lzd, Cfz, Dlm) ho\u1eb7c khi kh\u00f4ng c\u00f3 l\u1ef1a ch\u1ecdn n\u00e0o kh\u00e1c (khuy\u1ebfn c\u00e1o c\u00f3 \u0111i\u1ec1u ki\u1ec7n)<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 14:<\/i>\u00a0<\/i><\/b>Kh\u00f4ng s\u1eed d\u1ee5ng Clavulanic acid\u00a0\u0111\u01a1n \u0111\u1ed9c nh\u01b0 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb lao (khuy\u1ebfn c\u00e1o m\u1ea1nh m\u1ebd)<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 15:\u00a0<\/i>T\u1ed5ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1eeb 18-20\u00a0th\u00e1ng<\/span>\u00a0\u0111\u1ed1i v\u1edbi h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p,\u00a0c\u00f3 th\u1ec3\u00a0<\/span>\u0111i\u1ec1u ch\u1ec9nh\u00a0theo \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb c\u1ee7a<\/span>\u00a0ng\u01b0\u1eddi b\u1ec7nh<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 16:\u00a0<\/i>Th\u1eddi gian sau khi \u00e2m h\u00f3a nu\u00f4i c\u1ea5y 15-17 th\u00e1ng \u0111\u1ed1i v\u1edbi h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p,\u00a0c\u00f3 th\u1ec3\u00a0<\/span>\u0111i\u1ec1u ch\u1ec9nh\u00a0theo \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb c\u1ee7a<\/span>\u00a0ng\u01b0\u1eddi b\u1ec7nh<\/p>\n

\u2022\u00a0Khuy\u1ebfn c\u00e1o 17:\u00a0<\/i>N\u1ebfu ph\u00e1c \u0111\u1ed3\u00a0c\u00f3\u00a0<\/span>thu\u1ed1c ti\u00eam (Am\/S), th\u1eddi gian t\u1ea5n c\u00f4ng\u00a06-7 th\u00e1ng<\/span>\u00a0\u0111\u1ed1i v\u1edbi h\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p,\u00a0c\u00f3 th\u1ec3\u00a0<\/span>\u0111i\u1ec1u ch\u1ec9nh\u00a0theo \u0111\u00e1p \u1ee9ng \u0111i\u1ec1u tr\u1ecb c\u1ee7a<\/span>\u00a0ng\u01b0\u1eddi b\u1ec7nh<\/p>\n

2.2.<\/b>\u00a0L\u01b0u \u00fd tr\u00ean c\u00e1c nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng<\/b><\/h3>\n

\u2022 Tr\u1ebb em: Kh\u00f4ng n\u00ean d\u00f9ng thu\u1ed1c ti\u00eam cho tr\u1ebb nh\u1ecf v\u00e0 tr\u1ebb m\u1eafc lao th\u1ec3 nh\u1eb9 (kh\u00f4ng k\u00e8m suy dinh d\u01b0\u1ee1ng). Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 d\u01b0\u1edbi 18 th\u00e1ng n\u1ebfu t\u1ed5n th\u01b0\u01a1ng kh\u00f4ng r\u1ed9ng<\/p>\n

\u2022 Lao ngo\u00e0i ph\u1ed5i v\u00e0 lao m\u00e0ng n\u00e3o: L\u1ef1a ch\u1ecdn thu\u1ed1c c\u0103n c\u1ee9 v\u00e0o v\u1ecb tr\u00ed t\u1ed5n th\u01b0\u01a1ng. T\u00ednh th\u1ea5m c\u1ee7a thu\u1ed1c qua h\u00e0ng r\u00e0o m\u00e1u n\u00e3o:<\/p>\n

\u25cb Th\u1ea5m t\u1ed1t: Lfx, Mfx, Cs, Lzd, imipenem-cilastatin, meropenem, Pto<\/p>\n

\u25cb Hh v\u00e0 Z th\u01b0\u1eddng \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb trong d\u1ecbch n\u00e3o t\u1ee7y n\u00ean c\u00f3 th\u1ec3 d\u00f9ng n\u1ebfu c\u00f2n nh\u1ea1y ho\u1eb7c kh\u00f4ng kh\u00e1ng ho\u00e0n to\u00e0n. Tuy nhi\u00ean n\u1ed3ng \u0111\u1ed9 trong d\u1ecbch n\u00e3o t\u1ee7y kh\u00f4ng ph\u1ea3n \u00e1nh n\u1ed3ng \u0111\u1ed9 \u1edf m\u00e0ng n\u00e3o, n\u00e3o<\/p>\n

\u25cb Am v\u00e0 S ch\u1ec9 ng\u1ea5m t\u1ed1t trong giai \u0111o\u1ea1n vi\u00eam.<\/p>\n

\u25cb PAS v\u00e0 E ng\u1ea5m k\u00e9m, kh\u00f4ng n\u00ean xem l\u00e0 thu\u1ed1c hi\u1ec7u l\u1ef1c \u0111\u1ed1i v\u1edbi lao m\u00e0ng n\u00e3o<\/p>\n

\u25cb Hi\u1ec7n \u00edt c\u00f3 th\u00f4ng tin v\u1ec1 t\u00ednh th\u1ea5m c\u1ee7a Bdq, Dlm, Cfz<\/p>\n

\u25cb Tr\u1ebb lao m\u00e0ng n\u00e3o khi d\u00f9ng imipenem-cilastatin th\u01b0\u1eddng g\u1eb7p \u0111\u1ed9ng kinh h\u01a1n; v\u00ec v\u1eady n\u00ean d\u00f9ng meropenem<\/p>\n

\u2022 V\u1edbi ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa<\/p>\n

\u25cb Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh Am, S, Pto \u1edf ph\u1ee5 n\u1eef c\u00f3 thai<\/p>\n

\u25cb \u0110\u1ed1i v\u1edbi Bdq, Dlm: Th\u00f4ng tin tr\u00ean ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa c\u00f2n h\u1ea1n ch\u1ebf, tuy nhi\u00ean khuy\u1ebfn c\u00e1o c\u00f3 th\u1ec3 x\u00e2y d\u1ef1ng trong ph\u00e1c \u0111\u1ed3 c\u00e1 nh\u00e2n, tuy nhi\u00ean c\u1ea7n gi\u00e1m s\u00e1t t\u1ed1t bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i (bao g\u1ed3m k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, k\u1ebft qu\u1ea3 mang thai, t\u00ecnh tr\u1ea1ng sau sinh v\u00e0 d\u1ecb t\u1eadt b\u1ea9m sinh)<\/p>\n

\u2022 V\u1edbi ng\u01b0\u1eddi c\u00f3 HIV (+): L\u01b0u \u00fd t\u01b0\u01a1ng t\u00e1c thu\u1ed1c lao v\u1edbi ARV (\u0111\u1eb7c bi\u1ec7t Bdq). Chi ti\u1ebft tham kh\u1ea3o b\u1ea3ng t\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u1ee7a m\u1ed9t s\u1ed1 thu\u1ed1c ch\u1ed1ng lao v\u00e0 trang t\u00e0i li\u1ec7u tra c\u1ee9u t\u01b0\u01a1ng t\u00e1c thu\u1ed1c (B\u1ea3ng 1, 2- t\u01b0\u01a1ng t\u00e1c gi\u1eefa Bdq v\u00e0 c\u00e1c thu\u1ed1c lao h\u00e0ng hai v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c bao g\u1ed3m ARV- L\u01b0u \u00fd s\u1ed1 9)<\/p>\n

\u2022\u00a0Ng\u01b0\u1eddi b\u1ec7nh c\u00f3 vi khu\u1ea9n lao kh\u00e1ng R c\u00f3 hay kh\u00f4ng kh\u00e1ng H: Tuy Hh kh\u00f4ng c\u00f3 trong danh m\u1ee5c, v\u1eabn c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng n\u1ebfu KS\u0110 c\u00f2n nh\u1ea1y H, ho\u1eb7c KS\u0110 kh\u00f4ng kh\u00e1ng H ho\u00e0n to\u00e0n (ch\u1ec9 kh\u00e1ng inhA). Vi\u1ec7c s\u1eed d\u1ee5ng H li\u1ec1u cao cho th\u1ea5y c\u00f3 hi\u1ec7u qu\u1ea3 trong \u0111i\u1ec1u tr\u1ecb lao tr\u1ebb em<\/p>\n

\u2022 V\u1edbi NB c\u00f3 t\u1ed5n th\u01b0\u01a1ng r\u1ed9ng: C\u1ea7n l\u01b0u \u00fd h\u01a1n khi quy\u1ebft \u0111\u1ecbnh th\u1eddi gian \u0111i\u1ec1u tr\u1ecb sau \u00e2m h\u00f3a nu\u00f4i c\u1ea5y t\u00f9y thu\u1ed9c \u0111\u00e1p \u1ee9ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh<\/p>\n

\u2022 V\u1edbi BN lao c\u00f3 k\u1ebft qu\u1ea3 nu\u00f4i c\u1ea5y \u00e2m t\u00ednh:<\/p>\n

\u25cb Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb kh\u00f4ng th\u1ec3 \u00e1p d\u1ee5ng khuy\u1ebfn c\u00e1o s\u1ed1 16 (sau \u00e2m h\u00f3a 15-17 th\u00e1ng), v\u00ec v\u1eady n\u00ean l\u00e0 18-20 th\u00e1ng, theo d\u00f5i d\u1ef1a v\u00e0o \u0111\u00e1p \u1ee9ng l\u00e2m s\u00e0ng<\/p>\n

\u25cb L\u01b0u \u00fd ch\u1ea5t l\u01b0\u1ee3ng nu\u00f4i c\u1ea5y \u0111\u1ec3 lo\u1ea1i tr\u1eeb nguy\u00ean nh\u00e2n \u00e2m t\u00ednh do th\u1ef1c hi\u1ec7n sai quy tr\u00ecnh<\/p>\n

3. Ph\u00e1c \u0111\u1ed3 ng\u1eafn h\u1ea1n<\/b><\/h2>\n

3.1. Khuy\u1ebfn c\u00e1o:<\/b><\/h3>\n

Thay Bdq cho thu\u1ed1c ti\u00eam trong ph\u00e1c \u0111\u1ed3 ng\u1eafn h\u1ea1n tr\u01b0\u1edbc \u0111\u00e2y. T\u1ed5ng th\u1eddi gian \u0111i\u1ec1u tr\u1ecb dao \u0111\u1ed9ng 9-11 th\u00e1ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh t\u00f9y thu\u1ed9c t\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh; tuy nhi\u00ean Bdq v\u1eabn c\u1ea7n d\u00f9ng \u0111\u1ee7 6 th\u00e1ng<\/p>\n

4-6 Bdq[6]-Lfx[Mfx]-Eto-E-Z-Hh-Cfz \/ 5 Lfx[Mfx]-Cfz-Z-E<\/b><\/p>\n

\u0110\u1ed1i t\u01b0\u1ee3ng \u00e1p d\u1ee5ng:<\/i><\/p>\n

\u25cb Kh\u00e1ng R\/ MDR-TB<\/p>\n

\u25cb Kh\u00f4ng kh\u00e1ng v\u1edbi FQs<\/p>\n

\u25cb Kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed d\u00f9ng thu\u1ed1c lao h\u00e0ng hai tr\u00ean 1 th\u00e1ng<\/p>\n

\u25cb Kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng r\u1ed9ng ho\u1eb7c lao ngo\u00e0i ph\u1ed5i nghi\u00eam tr\u1ecdng (*)<\/p>\n

(*)\u00a0Theo t\u00e0i li\u1ec7u c\u1eadp nh\u1eadt c\u1ee7a TCYTTG 2020:\u00a0<\/i>T\u1ed5n th\u01b0\u01a1ng r\u1ed9ng:<\/i>\u00a0Vai tr\u00f2 c\u1ee7a XQ l\u00e0 quan tr\u1ecdng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1. T\u1ed5n th\u01b0\u01a1ng r\u1ed9ng khi c\u00f3 hang\u00a0hai b\u00ean ho\u1eb7c t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4<\/span>\u00a0di\u1ec7n\u00a0r\u1ed9ng. \u1ede tr\u1ebb em d\u01b0\u1edbi 15 tu\u1ed5i,\u00a0<\/span>t\u1ed5n th\u01b0\u01a1ng r\u1ed9ng l\u00e0 khi c\u00f3 t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i hai b\u00ean ho\u1eb7c c\u00f3 c\u00e1c hang<\/p>\n

3.2. L\u01b0u \u00fd:<\/b><\/h3>\n

\u2022 Th\u00e0nh ph\u1ea7n ph\u00e1c \u0111\u1ed3: Hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng gi\u1eefa Lfx v\u00e0 Mfx (Mfx li\u1ec1u th\u00f4ng th\u01b0\u1eddng). Trong P\u0110 ng\u1eafn h\u1ea1n c\u00f3 thu\u1ed1c ti\u00eam th\u00ec Mfx \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn nhi\u1ec1u h\u01a1n, tuy nhi\u00ean v\u1edbi P\u0110 thu\u1ed1c u\u1ed1ng c\u00f3 Bdq th\u00ec Lfx \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o h\u01a1n v\u00ec l\u00fd do \u00edt \u1ea3nh h\u01b0\u1edfng h\u01a1n t\u1edbi QT; tuy nhi\u00ean Lfx c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng t\u1edbi ph\u00e1t tri\u1ec3n h\u1ec7 th\u1ed1ng c\u01a1 x\u01b0\u01a1ng kh\u1edbp c\u1ee7a tr\u1ebb em<\/p>\n

\u2022 C\u00e1c nh\u00f3m \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u1eb7c bi\u1ec7t:<\/p>\n

\u25cb Ng\u01b0\u1eddi c\u00f3 HIV (+) c\u1ea7n l\u01b0u \u00fd t\u01b0\u01a1ng t\u00e1c ARV v\u00e0 thu\u1ed1c lao (\u0111\u1eb7c bi\u1ec7t l\u00e0 Bdq. Bdq v\u00e0 efavirenz kh\u00f4ng n\u00ean d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u00ec l\u00e0m gi\u1ea3m n\u1ed3ng \u0111\u1ed9 Bdq, c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf protease l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 Bdq)<\/p>\n

\u25cb Tr\u1ebb em: ch\u1ec9 \u00e1p d\u1ee5ng cho tr\u1ebb > 6 tu\u1ed5i (ch\u1ec9 \u0111\u1ecbnh c\u1ee7a Bdq)<\/p>\n

\u25cb Ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa: Kh\u00f4ng s\u1eed d\u1ee5ng ph\u00e1c \u0111\u1ed3 n\u00e0y<\/p>\n

\u25cb Lao ngo\u00e0i ph\u1ed5i: Ch\u1ec9 d\u00f9ng cho lao ngo\u00e0i ph\u1ed5i th\u00f4ng th\u01b0\u1eddng, kh\u00f4ng d\u00f9ng cho c\u00e1c th\u1ec3 b\u1ec7nh nghi\u00eam tr\u1ecdng<\/p>\n

\u2022 Vai tr\u00f2 c\u1ee7a KS\u0110: Kh\u00f4ng s\u1eed d\u1ee5ng P\u0110 n\u00e0y khi c\u00f3 kh\u00e1ng ho\u1eb7c kh\u00f4ng c\u00f3 hi\u1ec7u l\u1ef1c v\u1edbi b\u1ea5t k\u1ef3 thu\u1ed1c n\u00e0o trong ph\u00e1c \u0111\u1ed3, tr\u1eeb H. Tuy nhi\u00ean \u0111\u1eb7c bi\u1ec7t l\u01b0u \u00fd:<\/p>\n

\u25cb C\u1ea7n LPA v\u1edbi thu\u1ed1c lao h\u00e0ng hai (MTBDRsl) \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 lo\u1ea1i tr\u1eeb kh\u00e1ng FQs<\/p>\n

\u25cb C\u1ea7n LPA v\u1edbi thu\u1ed1c lao h\u00e0ng m\u1ed9t (MTBDRplus) \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c v\u1ecb tr\u00ed kh\u00e1ng H; Kh\u00e1ng H do \u0111\u1ed9t bi\u1ebfn \u0111\u1ed3ng th\u1eddi c\u1ea3 2 v\u1ecb tr\u00ed inhA v\u00e0 KatG lo\u1ea1i tr\u1eeb kh\u1ecfi P\u0110<\/p>\n

\u25cb KS\u0110 v\u1edbi E v\u00e0 Pto kh\u00f4ng tin c\u1eady, c\u1ea7n c\u00e2n nh\u1eafc khi xem x\u00e9t k\u1ebft qu\u1ea3 trong quy\u1ebft \u0111\u1ecbnh l\u1ef1a ch\u1ecdn ph\u00e1c \u0111\u1ed3<\/p>\n

T\u00f3m l\u1ea1i, Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb lao kh\u00e1ng thu\u1ed1c l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c l\u1edbn \u0111\u1ed1i v\u1edbi c\u00e1c chuy\u00ean gia y t\u1ebf, y\u00eau c\u1ea7u s\u1ef1 ch\u0103m s\u00f3c v\u00e0 gi\u00e1m s\u00e1t ch\u1eb7t ch\u1ebd c\u1ee7a b\u00e1c s\u0129 v\u00e0 c\u00e1c nh\u00e2n vi\u00ean y t\u1ebf.<\/p>\n

Ngu\u1ed3n tham kh\u1ea3o: B\u1ed9 Y t\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"

Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb lao kh\u00e1ng thu\u1ed1c l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh lao cho nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc ph\u1ea3i c\u00e1c ch\u1ee7ng vi khu\u1ea9n lao kh\u00e1ng thu\u1ed1c, ngh\u0129a l\u00e0 c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1ng lao th\u00f4ng th\u01b0\u1eddng kh\u00f4ng c\u00f2n hi\u1ec7u qu\u1ea3 trong vi\u1ec7c ti\u00eau di\u1ec7t vi khu\u1ea9n lao. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb lao kh\u00e1ng thu\u1ed1c th\u01b0\u1eddng […]<\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[3],"yoast_head":"\nPh\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb lao kh\u00e1ng thu\u1ed1c - Vinmec<\/title>\n<meta name=\"description\" content=\"Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb lao kh\u00e1ng thu\u1ed1c l\u00e0 m\u1ed9t ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1ec7nh lao cho nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc ph\u1ea3i c\u00e1c ch\u1ee7ng vi khu\u1ea9n lao kh\u00e1ng ...\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb lao kh\u00e1ng thu\u1ed1c - 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