{"id":25098,"date":"2023-04-19T22:03:20","date_gmt":"2023-04-19T15:03:20","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=25098"},"modified":"2023-04-22T13:12:26","modified_gmt":"2023-04-22T06:12:26","slug":"ceftriaxon-va-ampicillin-viem-noi-tam-mac-nhiem-khuan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/19\/ceftriaxon-va-ampicillin-viem-noi-tam-mac-nhiem-khuan\/","title":{"rendered":"Ceftriaxon v\u00e0 Ampicillin trong \u0111i\u1ec1u tr\u1ecb vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n"},"content":{"rendered":"

Ceftriaxon v\u00e0 Ampicillin l\u00e0 m\u1ed9t trong nh\u1eefng thu\u1ed1c \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9<\/a>n ( VNTMNK.) B\u00e0i vi\u1ebft cung c\u1ea5p v\u1ec1 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a 2 lo\u1ea1i thu\u1ed1c n\u00e0y.<\/strong><\/p>\n

\"Vi\u00eam<\/p>\n

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/strong><\/p>\n

1.Ceftriaxone<\/h2>\n

1.1. L\u1ecbch s\u1eed<\/strong><\/h2>\n

Ceftriaxone \u0111\u01b0\u1ee3c c\u1ea5p b\u1eb1ng s\u00e1ng ch\u1ebf n\u0103m 1978 v\u00e0 \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn s\u1eed d\u1ee5ng trong y khoa t\u1eeb n\u0103m 1982. Hi\u1ec7n nay ceftriaxone v\u1eabn l\u00e0 thu\u1ed1c \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m( vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n) VNTMNK.
\nCeftriaxone l\u00e0 m\u1ed9t cephalosporine th\u1ebf h\u1ec7 3, thu\u1ed9c nh\u00f3m kh\u00e1ng sinh beta-lactam.<\/p>\n

1.2. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/strong><\/h3>\n

Ceftriaxone c\u00f3 t\u00e1c d\u1ee5ng v\u1edbi nhi\u1ec1u tr\u1ef1c khu\u1ea9n Gram \u00e2m hi\u1ebfu kh\u00ed v\u00e0 li\u00ean c\u1ea7u, ph\u1ebf c\u1ea7u, n\u00e3o m\u00f4 c\u1ea7u c\u0169ng nh\u01b0 t\u1ee5 c\u1ea7u nh\u1ea1y c\u1ea3m methicillin (MSSA). Tuy nhi\u00ean thu\u1ed1c kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3 \u0111\u1ed1i v\u1edbi Listeria sp., Enterococcus faecium, MRSA, tr\u1ef1c khu\u1ea9n m\u1ee7 xanh P. aeruginosa v\u00e0 B. fragilis. T\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c thu\u1ed1c kh\u00e1c trong nh\u00f3m beta-lactam, c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a ceftriaxone l\u00e0 g\u1eafn v\u00e0o protein g\u1eafn penicillin
\n(PBP) d\u1eabn \u0111\u1ebfn \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p peptidoglycan c\u1ee7a v\u00e1ch t\u1ebf b\u00e0o vi khu\u1ea9n, h\u1eadu qu\u1ea3 l\u00e0 vi khu\u1ea9n kh\u00f4ng t\u1ed5ng h\u1ee3p \u0111\u01b0\u1ee3c v\u00e1ch s\u1ebd b\u1ecb ly gi\u1ea3i. Ceftriaxone d\u1ec5 d\u00e0ng b\u1ecb b\u1ea5t ho\u1ea1t b\u1edfi c\u00e1c enzyme beta-lactamase ph\u1ed5 r\u1ed9ng (ESBL) v\u00e0 cephalosporinase nhi\u1ec5m s\u1eafc th\u1ec3.
\nThu\u1ed1c h\u1ea5p thu t\u1ed1t sau ti\u00eam b\u1eafp. Th\u1eddi gian \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh trong huy\u1ebft thanh sau ti\u00eam b\u1eafp l\u00e0 2-3h.
\nThu\u1ed1c ph\u00e2n b\u1ed1 r\u1ed9ng r\u00e3i trong c\u00e1c m\u00f4 c\u01a1 th\u1ec3 k\u1ec3 c\u1ea3 t\u00fai m\u1eadt, d\u1ecbch m\u1eadt, ph\u1ed5i, x\u01b0\u01a1ng, d\u1ecbch n\u00e3o t\u1ee7y. T\u1ec9 l\u1ec7 g\u1eafn protein cao t\u1edbi 85-95%.
\nTh\u1eddi gian b\u00e1n th\u1ea3i \u1edf ng\u01b0\u1eddi l\u1edbn c\u00f3 ch\u1ee9c n\u0103ng gan th\u1eadn b\u00ecnh th\u01b0\u1eddng l\u00e0 5-9h, \u1edf tr\u1ebb em l\u00e0 4-6,6h c\u00f2n \u1edf tr\u1ebb s\u01a1 sinh 1-4 ng\u00e0y l\u00e0 16h, tr\u1ebb s\u01a1 sinh 9-30 ng\u00e0y l\u00e0 9h. \u1ede ng\u01b0\u1eddi l\u1edbn suy th\u1eadn th\u1eddi gian b\u00e1n th\u1ea3i l\u00e0 12-16h. Thu\u1ed1c th\u1ea3i tr\u1eeb qua n\u01b0\u1edbc ti\u1ec3u (33-67% \u1edf d\u1ea1ng kh\u00f4ng bi\u1ebfn \u0111\u1ed5i) v\u00e0 ph\u00e2n (d\u01b0\u1edbi d\u1ea1ng
\nthu\u1ed1c kh\u00f4ng c\u00f2n ho\u1ea1t t\u00ednh).<\/p>\n

1.3. Ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, li\u1ec1u d\u00f9ng, c\u00e1ch d\u00f9ng<\/strong><\/h3>\n

VNTMNK do li\u00ean c\u1ea7u nh\u00f3m viridans v\u00e0 S. bovis: 2 g\/24h, truy\u1ec1n t\u0129nh m\u1ea1ch ho\u1eb7c ti\u00eam b\u1eafp 1 l\u1ea7n\/24h. \u0110\u1ed1i v\u1edbi c\u00e1c ch\u1ee7ng nh\u1ea1y c\u1ea3m penicillin (MIC \u2264 0,125 \u03bcg\/mL) th\u00ec d\u00f9ng \u0111\u01a1n tr\u1ecb li\u1ec7u trong 4 tu\u1ea7n ho\u1eb7c ph\u1ed1i h\u1ee3p v\u1edbi gentamicin ho\u1eb7c neltimicin \u0111i\u1ec1u tr\u1ecb trong 2 tu\u1ea7n. \u0110\u1ed1i v\u1edbi c\u00e1c ch\u1ee7ng \u0111\u1ec1 kh\u00e1ng penicillin (MIC 0,25 \u2013 2 \u03bcg\/mL) th\u00ec \u0111i\u1ec1u tr\u1ecb 4 tu\u1ea7n, trong \u0111\u00f3 2 tu\u1ea7n \u0111\u1ea7u ph\u1ed1i h\u1ee3p v\u1edbi gentamicin. VNTMNK do Granulicatella v\u00e0 Abiotrophia: 2 g\/24h truy\u1ec1n t\u0129nh m\u1ea1ch ho\u1eb7c ti\u00eam
\nb\u1eafp 1 l\u1ea7n\/24h, \u0111i\u1ec1u tr\u1ecb trong 6 tu\u1ea7n, trong \u0111\u00f3 2 tu\u1ea7n \u0111\u1ea7u k\u1ebft h\u1ee3p v\u1edbi gentamicin ho\u1eb7c neltimicin.
\nVNTMNK do Enterococcus faecalis c\u00f2n nh\u1ea1y c\u1ea3m penicillin: 4 g\/24h truy\u1ec1n t\u0129nh m\u1ea1ch ho\u1eb7c ti\u00eam b\u1eafp chia 2 l\u1ea7n, k\u1ebft h\u1ee3p v\u1edbi ampicillin, \u0111i\u1ec1u tr\u1ecb trong 6 tu\u1ea7n. \u0110\u00e2y l\u00e0 k\u1ebft h\u1ee3p hi\u1ec7p \u0111\u1ed3ng hai thu\u1ed1c \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p v\u00e1ch vi khu\u1ea9n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nh\u1eefng ch\u1ee7ng c\u00f2n nh\u1ea1y c\u1ea3m v\u1edbi beta-lactam. VNTMNK do c\u00e1c vi khu\u1ea9n HACEK (Haemophilus, Aggregatibacter\/Actinobacillus, Cardiobacterium, Eikenella, Kingella): 2 g\/24h truy\u1ec1n t\u0129nh m\u1ea1ch ho\u1eb7c ti\u00eam b\u1eafp 1 l\u1ea7n\/24h trong 4 tu\u1ea7n (van t\u1ef1 nhi\u00ean) ho\u1eb7c 6 tu\u1ea7n (van nh\u00e2n t\u1ea1o).
\n\u0110i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m cho VNTMNK tr\u00ean van t\u1ef1 nhi\u00ean: 2g\/24h truy\u1ec1n t\u0129nhm\u1ea1ch, k\u1ebft h\u1ee3p v\u1edbi vancomycin. L\u01b0u \u00fd kh\u00f4ng d\u00f9ng ceftriaxone cho tr\u1ebb s\u01a1 sinh t\u0103ng bilirubin do thu\u1ed1c c\u00f3 t\u1ef7 l\u1ec7 g\u1eafn protein cao s\u1ebd l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam t\u00ecnh tr\u1ea1ng t\u0103ng bilirubin. Thu\u1ed1c kh\u00f4ng ph\u1ea3i \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u khi suy th\u1eadn. Tuy nhi\u00ean, khi d\u00f9ng cho b\u1ec7nh nh\u00e2n \u0111\u1ed3ng th\u1eddi suy gan v\u00e0 suy th\u1eadn th\u00ec li\u1ec1u d\u00f9ng h\u1eb1ng ng\u00e0y kh\u00f4ng n\u00ean v\u01b0\u1ee3t qu\u00e1 2 g. Ceftriaxone kh\u00f4ng t\u01b0\u01a1ng h\u1ee3p v\u1edbi canxi g\u00e2y k\u1ebft t\u1ee7a. Do c\u00f3 nh\u1eefng b\u00e1o c\u00e1o t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i v\u00e0 th\u1eadn g\u00e2y t\u1eed vong li\u00ean quan k\u1ebft t\u1ee7a canxi-ceftriaxone \u1edf tr\u1ebb s\u01a1 sinh, kh\u00f4ng \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng c\u00e1c dung d\u1ecbch c\u00f3 ch\u1ee9a canxi (v\u00ed d\u1ee5 nh\u01b0 Ringer lactat) \u0111\u1ec3 pha ho\u1eb7c truy\u1ec1n c\u00f9ng ceftriaxone.<\/p>\n

1.4. T\u00e1c d\u1ee5ng ph\u1ee5 v\u00e0 x\u1eed tr\u00ed<\/strong><\/h3>\n


\n<\/strong>Gi\u1ea3 s\u1ecfi m\u1eadt do b\u00f9n t\u00fai m\u1eadt: ch\u1ee7 y\u1ebfu ph\u00e1t hi\u1ec7n tr\u00ean si\u00eau \u00e2m m\u00e0 \u00edt c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng. Nguy c\u01a1 xu\u1ea5t hi\u1ec7n khi d\u00f9ng \u2265 2 g\/24h \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng \u0103n, nu\u00f4i d\u01b0\u1ee1ng t\u0129nh m\u1ea1ch.
\nD\u00f9ng \u0111\u1ed3ng th\u1eddi lansoprazole g\u00e2y k\u00e9o d\u00e0i kho\u1ea3ng QTc.<\/p>\n

1.5. \u00dd ngh\u0129a l\u00e2m s\u00e0ng<\/strong><\/h3>\n


\n<\/strong>Do \u0111\u1eb7c \u0111i\u1ec3m ph\u00e2n b\u1ed1 t\u1ed1t t\u1edbi c\u00e1c m\u00f4, kh\u00f4ng ph\u1ea3i \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u khi suy th\u1eadn, ch\u1ec9 ph\u1ea3i d\u00f9ng 1-2 l\u1ea7n\/24h v\u00e0 ph\u1ed5 kh\u00e1ng khu\u1ea9n bao ph\u1ee7 \u0111\u01b0\u1ee3c nhi\u1ec1u lo\u1ea1i vi khu\u1ea9n th\u01b0\u1eddng g\u1eb7p trong VNTMNK, ceftriaxone hay \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m c\u0169ng nh\u01b0 \u0111i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u sau khi ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c m\u1ea7m b\u1ec7nh.<\/p>\n

2. Ampicillin<\/h2>\n


\n2.1. L\u1ecbch s\u1eed<\/strong><\/h3>\n


\n<\/strong>Ampicillin l\u00e0 kh\u00e1ng sinh penicillin b\u00e1n t\u1ed5ng h\u1ee3p \u0111\u01b0\u1ee3c kh\u00e1m ph\u00e1 n\u0103m 1958 v\u00e0 \u0111\u01b0a ra th\u1ecb tr\u01b0\u1eddng t\u1eeb n\u0103m 1961. \u0110\u00e2y l\u00e0 m\u1ed9t trong c\u00e1c kh\u00e1ng sinh hi\u1ec7n v\u1eabn c\u00f2n s\u1eed d\u1ee5ng v\u1edbi gi\u00e1 th\u00e0nh \u0111i\u1ec1u tr\u1ecb r\u1ea5t th\u1ea5p.<\/p>\n

2.2. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc v\u00e0 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc<\/h3>\n


\n<\/strong>Thu\u1ed1c t\u00e1c d\u1ee5ng ch\u1ee7 y\u1ebfu tr\u00ean c\u00e1c li\u00ean c\u1ea7u, ph\u1ea7n l\u1edbn c\u00e1c Enterococcus, Listeria, Clostridium v\u00e0 m\u1ed9t s\u1ed1 c\u00e1c vi khu\u1ea9n k\u1ef5 kh\u00ed kh\u00e1c. L\u00e0 m\u1ed9t aminopenicillin, c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a ampicillin t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u1ee7a c\u00e1c kh\u00e1ng sinh kh\u00e1c thu\u1ed9c nh\u00f3m betalactam l\u00e0 \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p v\u00e1ch vi khu\u1ea9n. Sinh kh\u1ea3 d\u1ee5ng \u0111\u01b0\u1eddng u\u1ed1ng ch\u1ec9 kho\u1ea3ng 50% n\u00ean thu\u1ed1c ch\u1ee7 y\u1ebfu s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng ti\u00eam t\u0129nh m\u1ea1ch. Ph\u00e2n b\u1ed1 \u0111\u01b0\u1ee3c v\u00e0o d\u1ecbch m\u1eadt. Tr\u01b0\u1eddng h\u1ee3p m\u00e0ng n\u00e3o vi\u00eam thu\u1ed1c ph\u00e2n b\u1ed1 \u0111\u01b0\u1ee3c v\u00e0o d\u1ecbch n\u00e3o t\u1ee7y v\u1edbi t\u1ef7 s\u1ed1 n\u1ed3ng \u0111\u1ed9 d\u1ecbch n\u00e3o t\u1ee7y\/m\u00e1u 13-14%. Th\u1eddi gian b\u00e1n th\u1ea3i t\u1eeb 1-1,8h. \u1ede b\u1ec7nh nh\u00e2n v\u00f4 ni\u1ec7u th\u1eddi gian n\u00e0y l\u00e0 8-20h, c\u00f2n \u1edf tr\u1ebb s\u01a1 sinh 2-7 ng\u00e0y tu\u1ed5i th\u1eddi gian b\u00e1n th\u1ea3i l\u00e0 4h, 8-14 ng\u00e0y tu\u1ed5i th\u1eddi gian b\u00e1n th\u1ea3i l\u00e0 2,8h.
\nThu\u1ed1c th\u1ea3i tr\u1eeb qua n\u01b0\u1edbc ti\u1ec3u (kho\u1ea3ng 90% d\u01b0\u1edbi d\u1ea1ng kh\u00f4ng bi\u1ebfn \u0111\u1ed5i trong v\u00f2ng 24h) v\u00e0 ph\u00e2n.<\/p>\n

2.3. Ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, li\u1ec1u d\u00f9ng, c\u00e1ch d\u00f9ng<\/h3>\n


\n<\/strong>VNTMNK do Enterococcus faecalis c\u00f2n nh\u1ea1y c\u1ea3m penicillin: 2g m\u1ed7i 4h ti\u00eam t\u0129nh m\u1ea1ch, ph\u1ed1i h\u1ee3p v\u1edbi ceftriaxon ho\u1eb7c gentamicin. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng l\u00e0 6 tu\u1ea7n. N\u1ebfu van t\u1ef1 nhi\u00ean v\u00e0 tri\u1ec7u ch\u1ee9ng d\u01b0\u1edbi 3 th\u00e1ng th\u00ec \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p ampicillin v\u00e0 gentamicin c\u00f3 th\u1ec3 ch\u1ec9 c\u1ea7n 4 tu\u1ea7n. L\u1ef1a ch\u1ecdn k\u1ebft h\u1ee3p ampicillin v\u1edbi ceftriaxon \u0111\u01b0\u1ee3c \u01b0u ti\u00ean h\u01a1n cho nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 suy th\u1eadn.
\nVNTMNK do c\u00e1c vi khu\u1ea9n HACEK (Haemophilus, Aggregatibacter\/Actinobacillus, Cardiobacterium, Eikenella, Kingella): 2g m\u1ed7i 4h ti\u00eam t\u0129nh m\u1ea1ch trong 4 tu\u1ea7n (van t\u1ef1 nhi\u00ean) ho\u1eb7c 6 tu\u1ea7n (van nh\u00e2n t\u1ea1o).
\nVNTMNK do li\u00ean c\u1ea7u nh\u00f3m viridans v\u00e0 S. bovis: 2 g m\u1ed7i 4h ti\u00eam t\u0129nh m\u1ea1ch. \u0110\u1ed1i v\u1edbi van t\u1ef1 nhi\u00ean, vi khu\u1ea9n r\u1ea5t nh\u1ea1y penicillin (MIC \u2264 0,12 \u03bcg\/ml) th\u00ec \u0111i\u1ec1u tr\u1ecb trong 4 tu\u1ea7n, c\u00f2n vi khu\u1ea9n t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ec1 kh\u00e1ng penicillin (MIC t\u1eeb 0,12-0,5 \u03bcg\/mL) th\u00ec c\u0169ng \u0111i\u1ec1u tr\u1ecb trong 4 tu\u1ea7n nh\u01b0ng k\u1ebft h\u1ee3p gentamicin trong 2 tu\u1ea7n \u0111\u1ea7u. \u0110\u1ed1i v\u1edbi van nh\u00e2n t\u1ea1o, vi khu\u1ea9n r\u1ea5t nh\u1ea1y penicillin (MIC < 0,12 \u03bcg\/mL) th\u00ec \u0111i\u1ec1u tr\u1ecb trong 6 tu\u1ea7n, c\u00f2n khi vi khu\u1ea9n t\u01b0\u01a1ng \u0111\u1ed1i \u0111\u1ec1 kh\u00e1ng penicillin (MIC t\u1eeb 0,12-0,5 \u03bcg\/mL) th\u00ec \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p v\u1edbi gentamicin trong 6 tu\u1ea7n.
\n\u0110i\u1ec1u ch\u1ec9nh li\u1ec1u d\u00f9ng khi suy th\u1eadn:
\nM\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn > 50 mL\/ph\u00fat: kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u.
\nM\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn 30-50 mL\/ph\u00fat: gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u d\u00f9ng m\u1ed7i 6h.
\nM\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn 10-30 mL\/ph\u00fat: gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u d\u00f9ng m\u1ed7i 8h.
\nM\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 10 mL\/ph\u00fat: gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u d\u00f9ng m\u1ed7i 12h.<\/p>\n

2.4. T\u00e1c d\u1ee5ng ph\u1ee5 v\u00e0 x\u1eed tr\u00ed<\/h3>\n


\n<\/strong>Ph\u00e1t ban d\u00e1t s\u1ea9n, ti\u00eau ch\u1ea3y, t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan l\u00e0 nh\u1eefng bi\u1ec3u hi\u1ec7n hay g\u1eb7p khi \u0111i\u1ec1u tr\u1ecb ampicillin li\u1ec1u cao k\u00e9o d\u00e0i. \u0110\u00f4i khi xu\u1ea5t hi\u1ec7n s\u1ed1t k\u00e8m theo gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh m\u00e0 tr\u00ean l\u00e2m s\u00e0ng r\u1ea5t kh\u00f3 ph\u00e2n bi\u1ec7t v\u1edbi tri\u1ec7u ch\u1ee9ng c\u1ee7a ch\u00ednh VNTMNK.
\nKhi d\u00f9ng \u0111\u1ed3ng th\u1eddi allopurinol th\u00ec t\u0103ng nguy c\u01a1 ph\u00e1t ban.<\/p>\n

2.5. \u00dd ngh\u0129a l\u00e2m s\u00e0ng<\/h3>\n


\n<\/strong>C\u0169ng nh\u01b0 penicillin G, \u0111i\u1ec1u tr\u1ecb ampicillin chi ph\u00ed th\u1ea5p nh\u01b0ng \u0111\u00f2i h\u1ecfi \u0111\u1ea7u t\u01b0 nh\u00e2n l\u1ef1c \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o y\u00eau c\u1ea7u ti\u00eam thu\u1ed1c nhi\u1ec1u l\u1ea7n trong ng\u00e0y.
\n\u0110\u1ed1i v\u1edbi nh\u1eefng m\u1ea7m b\u1ec7nh \u0111\u1eb7c bi\u1ec7t nh\u01b0 Actinomyces, Listeria, Enterococcus th\u00ec hi\u1ec7n nay kh\u00e1ng sinh c\u1ed5 \u0111i\u1ec3n ampicillin v\u1eabn l\u00e0 thu\u1ed1c l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay.<\/p>\n","protected":false},"excerpt":{"rendered":"

Ceftriaxon v\u00e0 Ampicillin l\u00e0 m\u1ed9t trong nh\u1eefng thu\u1ed1c \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n ( VNTMNK.) B\u00e0i vi\u1ebft cung c\u1ea5p v\u1ec1 c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a 2 lo\u1ea1i thu\u1ed1c n\u00e0y. Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n 1.Ceftriaxone 1.1. L\u1ecbch s\u1eed Ceftriaxone \u0111\u01b0\u1ee3c c\u1ea5p b\u1eb1ng s\u00e1ng ch\u1ebf n\u0103m […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[],"yoast_head":"\nCeftriaxon v\u00e0 Ampicillin vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/title>\n<meta name=\"description\" content=\"Ceftriaxon v\u00e0 Ampicillin trong \u0111i\u1ec1u tr\u1ecb vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n l\u00e0 th\u01b0\u1eddng g\u1eb7p. 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