{"id":26393,"date":"2023-04-22T13:08:58","date_gmt":"2023-04-22T06:08:58","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26393"},"modified":"2023-04-22T13:08:58","modified_gmt":"2023-04-22T06:08:58","slug":"piperacillin-tazobactam-va-cac-khang-sinh-trong-viem-noi-tam-mac","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/piperacillin-tazobactam-va-cac-khang-sinh-trong-viem-noi-tam-mac\/","title":{"rendered":"Piperacillin\/tazobactam v\u00e0 c\u00e1c kh\u00e1ng sinh trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c"},"content":{"rendered":"

Piperacillin\/tazobactam l\u00e0 k\u1ebft h\u1ee3p gi\u1eefa beta-lactam v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf betalactamase v\u1edbi t\u1ef7 l\u1ec7 8:1. K\u1ebft h\u1ee3p n\u00e0y l\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c \u0111\u0103ng k\u00fd v\u00e0o n\u0103m 1993, cefepime \u0111\u01b0\u1ee3c<\/strong> \u0111\u0103ng k\u00fd b\u1eb1ng s\u00e1ng ch\u1ebf n\u0103m 1982 v\u00e0 \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn d\u00f9ng trong l\u0129nh v\u1ef1c y h\u1ecdc t\u1eeb n\u0103m 1994.<\/strong><\/p>\n

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

V\u1ecb tr\u00ed vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/a><\/strong><\/p>\n

1.Piperacillin\/tazobactam<\/h2>\n

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

Piperacillin\/tazobactam l\u00e0 k\u1ebft h\u1ee3p gi\u1eefa beta-lactam v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf betalactamase v\u1edbi t\u1ef7 l\u1ec7 8:1. K\u1ebft h\u1ee3p Piperacillin\/tazobactam l\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c \u0111\u0103ng k\u00fd v\u00e0o n\u0103m 1993. Tuy nhi\u00ean, piperacillin l\u00e0 m\u1ed9t aminobenzyl penicillin \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u0103ng k\u00fd b\u1eb1ng s\u00e1ng ch\u1ebf t\u1eeb n\u0103m 1974 v\u00e0 s\u1eed d\u1ee5ng trong y khoa t\u1eeb n\u0103m 1981. Hi\u1ec7n nay piperacillin h\u1ea7u nh\u01b0 kh\u00f4ng c\u00f2n s\u1eed d\u1ee5ng \u0111\u01a1n \u0111\u1ed9c n\u1eefa m\u00e0 ch\u1ec9 c\u00f3 m\u1eb7t trong d\u1ea1ng k\u1ebft h\u1ee3p v\u1edbi tazobactam.
\nC\u1ea5u tr\u00fac mang chu\u1ed7i nh\u00e1nh ph\u00e2n c\u1ef1c l\u00e0m cho piperacillin d\u1ec5 ng\u1ea5m v\u00e0o trong vi khu\u1ea9n Gram \u00e2m v\u00e0 gi\u1ea3m kh\u1ea3 n\u0103ng ph\u00e1 h\u1ee7y b\u1edfi enzyme beta-lactamase c\u1ee7a vi khu\u1ea9n Gram \u00e2m. Nh\u1edd \u0111\u1eb7c \u0111i\u1ec3m n\u00e0y m\u00e0 thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng m\u1ea1nh \u0111\u1ed1i v\u1edbi tr\u1ef1c khu\u1ea9n m\u1ee7 xanh Pseudomonas aeruginosa n\u00ean c\u00f2n \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u201cpenicillin ch\u1ed1ng tr\u1ef1c khu\u1ea9n m\u1ee7 xanh\u201d.<\/p>\n

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

C\u0169ng nh\u01b0 c\u00e1c beta-lactam kh\u00e1c, piperacillin \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p v\u00e1ch vi khu\u1ea9n do g\u1eafn v\u1edbi PBP nh\u01b0ng v\u1edbi \u00e1i l\u1ef1c cao n\u00ean ho\u1ea1t ph\u1ed5 \u0111\u01b0\u1ee3c m\u1edf r\u1ed9ng h\u01a1n. Ho\u1ea1t ph\u1ed5 c\u1ee7a piperacillin r\u1ea5t r\u1ed9ng v\u1edbi nhi\u1ec1u lo\u1ea1i tr\u1ef1c khu\u1ea9n Gram \u00e2m hi\u1ebfu kh\u00ed, trong \u0111\u00f3 c\u00f3 tr\u1ef1c khu\u1ea9n m\u1ee7 xanh. Tazobactam h\u00ecnh th\u00e0nh ph\u1ee9c \u1ed5n \u0111\u1ecbnh v\u1edbi c\u00e1c beta-lactamase nh\u00f3m A c\u1ee7a Ambler gi\u00fap b\u1ea3o v\u1ec7 piperacillin kh\u1ecfi s\u1ef1 t\u1ea5n c\u00f4ng c\u1ee7a c\u00e1c betalactamases t\u1eeb MSSA, H. influenzae, M. catarrhalis v\u00e0 B. fragilis. Sinh kh\u1ea3 d\u1ee5ng sau ti\u00eam b\u1eafp c\u1ee7a piperacillin \u0111\u1ea1t 71% v\u00e0 c\u1ee7a tazobactam \u0111\u1ea1t 84%.
\nN\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh huy\u1ebft thanh \u0111\u1ea1t \u0111\u01b0\u1ee3c 30 ph\u00fat sau truy\u1ec1n t\u0129nh m\u1ea1ch. Piperacillin\/tazobactam ph\u00e2n b\u1ed1 t\u1ed1t \u0111\u1ebfn c\u00e1c m\u00f4 ph\u1ed5i, ni\u00eam m\u1ea1c ru\u1ed9t, t\u1eed cung, bu\u1ed3ng tr\u1ee9ng, v\u00f2i tr\u1ee9ng, d\u1ecbch k\u1ebd, t\u00fai m\u1eadt v\u00e0 d\u1ecbch m\u1eadt nh\u01b0ng ng\u1ea5m k\u00e9m v\u00e0o d\u1ecbch n\u00e3o t\u1ee7y. T\u1ef7 l\u1ec7 g\u1eafn protein th\u1ea5p (30%).
\nTh\u1eddi gian b\u00e1n th\u1ea3i c\u1ee7a piperacillin l\u00e0 0,7-1,2h, c\u00f2n c\u1ee7a tazobactam l\u00e0 0,7-0,9h. Th\u1eddi gian b\u00e1n th\u1ea3i c\u1ee7a piperacillin t\u0103ng 2 l\u1ea7n v\u00e0 c\u1ee7a tazobactam t\u0103ng 4 l\u1ea7n \u1edf b\u1ec7nh nh\u00e2n c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 20 mL\/ph\u00fat.
\nPiperacillin th\u1ea3i tr\u1eeb qua n\u01b0\u1edbc ti\u1ec3u (68% d\u01b0\u1edbi d\u1ea1ng thu\u1ed1c kh\u00f4ng bi\u1ebfn \u0111\u1ed5i) v\u00e0 ph\u00e2n (10-20%) c\u00f2n tazobactam th\u1ea3i tr\u1eeb qua n\u01b0\u1edbc ti\u1ec3u (80% d\u01b0\u1edbi d\u1ea1ng thu\u1ed1c kh\u00f4ng bi\u1ebfn \u0111\u1ed5i).<\/p>\n

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

VNTMNK do tr\u1ef1c khu\u1ea9n Gram \u00e2m: 4,5 g piperacillin\/tazobactam truy\u1ec1n t\u0129nh m\u1ea1ch c\u00e1ch 6h, ph\u1ed1i h\u1ee3p v\u1edbi tobramycin, th\u1eddi gian \u0111i\u1ec1u tr\u1ecb \u00edt nh\u1ea5t 6 tu\u1ea7n. Th\u00f4ng th\u01b0\u1eddng truy\u1ec1n t\u0129nh m\u1ea1ch trong 30 ph\u00fat nh\u01b0ng c\u0169ng c\u00f3 th\u1ec3 truy\u1ec1n k\u00e9o d\u00e0i 4h \u0111\u1ec3 t\u0103ng c\u01b0\u1eddng t\u1ed1i \u01b0u hi\u1ec7u qu\u1ea3 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc\/d\u01b0\u1ee3c l\u1ef1c h\u1ecdc.
\nKh\u00f4ng n\u00ean d\u00f9ng piperacillin\/tazobactam cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p tr\u1ef1c khu\u1ea9n Gram \u00e2m hi\u1ebfu kh\u00ed sinh beta-lactamase ph\u1ed5 r\u1ed9ng (ESBL).
\n\u0110i\u1ec1u ch\u1ec9nh li\u1ec1u khi suy th\u1eadn:<\/p>\n

    \n
  • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn > 40 mL\/ph\u00fat: kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u.<\/li>\n
  • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn 20-40 mL\/ph\u00fat: gi\u1ea3m c\u00f2n 3,375 g m\u1ed7i 6h.<\/li>\n
  • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 20 mL\/ph\u00fat: gi\u1ea3m c\u00f2n 2,25 g m\u1ed7i 6h.<\/li>\n
  • N\u1ebfu truy\u1ec1n k\u00e9o d\u00e0i th\u00ec khi m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 20 mL\/ph\u00fat, c\u1ee9 c\u00e1ch 12h l\u1ea1i truy\u1ec1n t\u0129nh m\u1ea1ch 3,375 g trong 4h.<\/li>\n<\/ul>\n

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

    C\u0169ng nh\u01b0 c\u00e1c kh\u00e1ng sinh beta-lactam, khi s\u1eed d\u1ee5ng piperacillin\/tazobactam c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n ph\u1ea3n \u1ee9ng d\u1ecb \u1ee9ng c\u0169ng nh\u01b0 c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n nh\u01b0 s\u1ed1t, ph\u00e1t ban, bu\u1ed3n n\u00f4n\/n\u00f4n, ti\u00eau ch\u1ea3y, \u0111au \u0111\u1ea7u, gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh, t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan, gi\u1ea3m ti\u1ec3u c\u1ea7u, t\u0103ng men gan\u2026
    \nM\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u quan s\u00e1t cho th\u1ea5y d\u01b0\u1eddng nh\u01b0 nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p t\u0103ng l\u00ean khi d\u00f9ng piperacillin\/tazobactam. Tuy nhi\u00ean, b\u1eb1ng ch\u1ee9ng c\u00f2n ch\u01b0a ch\u1eafc ch\u1eafn v\u00e0 hi\u1ec7n c\u00f2n ch\u01b0a r\u00f5 c\u01a1 ch\u1ebf g\u00ec c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng th\u1eadn.
    \nKhi d\u00f9ng \u0111\u1ed3ng th\u1eddi methotrexat th\u00ec l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 methotrexat.<\/p>\n

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

    M\u1eb7c d\u00f9 tazobactam l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf beta-lactamase m\u1ea1nh h\u01a1n sulbactam, nh\u01b0ng vi\u1ec7c b\u1ed5 sung tazobactam kh\u00f4ng l\u00e0m t\u0103ng ho\u1ea1t t\u00ednh ch\u1ed1ng tr\u1ef1c khu\u1ea9n m\u1ee7 xanh c\u1ee7a piperacillin.
    \nXu h\u01b0\u1edbng s\u1eed d\u1ee5ng kh\u00e1ng sinh xu\u1ed1ng thang v\u00e0 \u0111i\u1ec1u tr\u1ecb bao v\u00e2y hi\u1ec7n nay \u0111\u00e3 l\u00e0m lu m\u1edd v\u1ecb tr\u00ed v\u1ed1n c\u00f3 c\u1ee7a piperacillin\/tazobactam trong danh s\u00e1ch c\u00e1c kh\u00e1ng sinh nh\u1eb1m v\u00e0o tr\u1ef1c khu\u1ea9n m\u1ee7 xanh n\u00f3i ri\u00eang c\u0169ng nh\u01b0 tr\u1ef1c khu\u1ea9n Gram \u00e2m n\u00f3i chung.<\/p>\n

    2. Cefepime<\/h2>\n

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

    \u0110\u01b0\u1ee3c coi l\u00e0 thu\u1ed1c \u0111\u1ea1i di\u1ec7n cho kh\u00e1ng sinh cephalosporine th\u1ebf h\u1ec7 4, cefepime \u0111\u01b0\u1ee3c \u0111\u0103ng k\u00fd b\u1eb1ng s\u00e1ng ch\u1ebf n\u0103m 1982 v\u00e0 \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn d\u00f9ng trong l\u0129nh v\u1ef1c y h\u1ecdc t\u1eeb n\u0103m 1994.<\/p>\n

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

    C\u1ea5u tr\u00fac ph\u00e2n t\u1eed oxyimino beta-lactam v\u1edbi chu\u1ed7i nh\u00e1nh amino thiazolin cho ph\u00e9p cefepime xuy\u00ean th\u1ea5m t\u1ed1t v\u00e0 nhanh h\u01a1n qua th\u00e0nh t\u1ebf b\u00e0o tr\u1ef1c khu\u1ea9n Gram \u00e2m hi\u1ebfu kh\u00ed. Ho\u1ea1t ph\u1ed5 kh\u00e1ng khu\u1ea9n c\u1ee7a cefepime r\u1ea5t r\u1ed9ng, bao g\u1ed3m MSSA (m\u1ea1nh h\u01a1n c\u00e1c cephalosporine th\u1ebf h\u1ec7 3), Neisseria sp., H. influenzae v\u00e0 m\u1ed9t lo\u1ea1t c\u00e1c tr\u1ef1c khu\u1ea9n Gram \u00e2m, trong \u0111\u00f3 c\u00f3 tr\u1ef1c khu\u1ea9n m\u1ee7 xanh P. aeruginosa.
    \nCefepime c\u00f3 th\u1ec3 c\u00f3 t\u00e1c d\u1ee5ng v\u1edbi tr\u1ef1c khu\u1ea9n Gram \u00e2m hi\u1ebfu kh\u00ed sinh ESBL n\u1ebfu d\u00f9ng li\u1ec1u cao (2g m\u1ed7i 8h). Tuy nhi\u00ean, \u0111\u00e2y kh\u00f4ng ph\u1ea3i l\u00e0 kh\u00e1ng sinh l\u1ef1a ch\u1ecdn cho tr\u1ef1c khu\u1ea9n Gram \u00e2m sinh ESBL.
    \nCefepime b\u1ec1n v\u1eefng v\u1edbi ph\u1ea7n l\u1edbn beta-lactamase, nh\u1ea5t l\u00e0 c\u00e1c enzyme AmpC nhi\u1ec5m s\u1eafc th\u1ec3 v\u00e0 qua trung gian plasmid c\u1ee7a vi khu\u1ea9n Gram \u00e2m. Thu\u1ed1c h\u1ea5p thu nhanh v\u00e0 ho\u00e0n to\u00e0n sau ti\u00eam b\u1eafp. Th\u1eddi gian \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh huy\u1ebft thanh l\u00e0 1-2h sau ti\u00eam b\u1eafp, 0,5h sau truy\u1ec1n t\u0129nh m\u1ea1ch.
    \nThu\u1ed1c ph\u00e2n b\u1ed1 trong d\u1ecbch vi\u00eam v\u1edbi n\u1ed3ng \u0111\u1ed9 ~80% n\u1ed3ng \u0111\u1ed9 huy\u1ebft thanh, trong ni\u00eam m\u1ea1c ph\u1ebf qu\u1ea3n v\u1edbi n\u1ed3ng \u0111\u1ed9 ~60% n\u1ed3ng \u0111\u1ed9 huy\u1ebft t\u01b0\u01a1ng v\u00e0 qua \u0111\u01b0\u1ee3c h\u00e0ng r\u00e0o m\u00e1u n\u00e3o. Thu\u1ed1c \u00edt g\u1eafn protein (20%) v\u00e0 \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a t\u1ed1i thi\u1ec3u \u1edf gan. Th\u1eddi gian b\u00e1n th\u1ea3i l\u00e0 2h, \u1edf tr\u1ebb s\u01a1 sinh th\u1eddi gian n\u00e0y l\u00e0 4-5h. \u1ede b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, th\u1eddi gian b\u00e1n th\u1ea3i l\u00e0 13,5h.
    \nThu\u1ed1c th\u1ea3i tr\u1eeb qua n\u01b0\u1edbc ti\u1ec3u (85% \u1edf d\u1ea1ng thu\u1ed1c kh\u00f4ng bi\u1ebfn \u0111\u1ed5i).<\/p>\n

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

    VNTMNK do tr\u1ef1c khu\u1ea9n Gram \u00e2m: 2g c\u00e1ch 8h truy\u1ec1n t\u0129nh m\u1ea1ch trong 30 ph\u00fat, k\u1ebft h\u1ee3p v\u1edbi tobramycin. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb \u00edt nh\u1ea5t 6 tu\u1ea7n. \u0110i\u1ec1u ch\u1ec9nh li\u1ec1u khi suy th\u1eadn:<\/p>\n

      \n
    • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn > 60 mL\/ph\u00fat: kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u.<\/li>\n
    • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn 30-60 mL\/ph\u00fat: gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u m\u1ed7i 12h.<\/li>\n
    • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn 11-29 mL\/ph\u00fat: gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u m\u1ed7i 24h.<\/li>\n
    • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn <11 mL\/ph\u00fat: gi\u1ea3m li\u1ec1u m\u1ed7i l\u1ea7n xu\u1ed1ng 1g v\u00e0 gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u m\u1ed7i 24h.<\/li>\n<\/ul>\n

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

      C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 th\u01b0\u1eddng g\u1eb7p gi\u1ed1ng nh\u01b0 c\u00e1c kh\u00e1ng sinh beta-lactam kh\u00e1c nh\u01b0 ph\u00e1t ban, ti\u00eau ch\u1ea3y, \u0111au \u0111\u1ea7u, bu\u1ed3n n\u00f4n\/n\u00f4n, gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh,t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan, gi\u1ea3m ti\u1ec3u c\u1ea7u, t\u0103ng men gan\u2026
      \n\u0110\u00e3 c\u00f3 b\u00e1o c\u00e1o h\u1ed9i ch\u1ee9ng ng\u01b0\u1eddi \u0111\u1ecf khi d\u00f9ng cefepime.
      \nFDA c\u1ea3nh b\u00e1o nguy c\u01a1 tr\u1ea1ng th\u00e1i \u0111\u1ed9ng kinh kh\u00f4ng c\u00f3 c\u01a1n gi\u1eadt (non-convulsive status epilepticus) khi d\u00f9ng cefepime. Suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1.
      \nC\u01a1 ch\u1ebf l\u00e0 do thu\u1ed1c \u1ee9c ch\u1ebf c\u1ea1nh tranh h\u1ec7 d\u1eabn truy\u1ec1n GABA. Bi\u1ec3u hi\u1ec7n bao g\u1ed3m l\u00fa l\u1eabn, m\u1ea5t t\u1eadp trung, r\u1ed1i lo\u1ea1n \u0111\u1ecbnh h\u01b0\u1edbng, b\u1ea5t th\u01b0\u1eddng h\u00e0nh vi, k\u00edch \u0111\u1ed9ng, \u1ea3o gi\u00e1c,
      \nrung gi\u1eadt c\u01a1, th\u1ea5t ng\u00f4n, suy gi\u1ea3m \u00fd th\u1ee9c v\u00e0 h\u00f4n m\u00ea. Ch\u1ea9n \u0111o\u00e1n t\u00ecnh tr\u1ea1ng n\u00e0y d\u1ef1a v\u00e0o thay \u0111\u1ed5i tr\u00ean \u0111i\u1ec7n n\u00e3o \u0111\u1ed3.<\/p>\n

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

      M\u1eb7c d\u00f9 c\u00f3 hi\u1ec7u l\u1ef1c m\u1ea1nh tr\u00ean vi khu\u1ea9n Gram \u00e2m nh\u01b0ng cefepime kh\u00f4ng ph\u1ea3i l\u00e0 l\u1ef1a ch\u1ecdn cho vi khu\u1ea9n Gram \u00e2m sinh ESBL. \u0110i\u1ec1u n\u00e0y khi\u1ebfn cho vai tr\u00f2 c\u1ee7a cefepime trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng b\u1ecb thu h\u1eb9p l\u1ea1i nhi\u1ec1u.<\/p>\n

      3. Meropenem<\/h2>\n

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

      Meropenem l\u00e0 kh\u00e1ng sinh nh\u00f3m carbapenem \u0111\u01b0\u1ee3c \u0111\u0103ng k\u00fd b\u1eb1ng s\u00e1ng ch\u1ebf n\u0103m 1983 v\u00e0 c\u00f4ng nh\u1eadn s\u1eed d\u1ee5ng trong l\u0129nh v\u1ef1c y t\u1eeb n\u0103m 1996.
      \nV\u1edbi hi\u1ec7u qu\u1ea3 v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi c\u00e1c kh\u00e1ng sinh kh\u00e1c v\u1ec1 ho\u1ea1t ph\u1ed5 di\u1ec7t khu\u1ea9n, meropenem \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ng\u00e0y c\u00e0ng r\u1ed9ng r\u00e3i, nh\u1ea5t l\u00e0 trong l\u0129nh v\u1ef1c h\u1ed3i s\u1ee9c.<\/p>\n

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

      Meropenem l\u00e0 kh\u00e1ng sinh di\u1ec7t khu\u1ea9n nhanh v\u00e0 m\u1ea1nh. So v\u1edbi imipenem l\u00e0 kh\u00e1ng sinh c\u00f9ng nh\u00f3m carbapenem, meropenem c\u00f3 t\u00e1c d\u1ee5ng m\u1ea1nh h\u01a1n \u0111\u1ed1i v\u1edbi tr\u1ef1c
      \nkhu\u1ea9n Gram \u00e2m nh\u01b0ng l\u1ea1i k\u00e9m h\u01a1n v\u1ec1 c\u1ea7u khu\u1ea9n Gram d\u01b0\u01a1ng. Ho\u1ea1t ph\u1ed5 c\u1ee7a meropenem bao g\u1ed3m tr\u1ef1c khu\u1ea9n Gram \u00e2m c\u1ea3 hi\u1ebfu kh\u00ed v\u00e0 k\u1ef5 kh\u00ed, trong \u0111\u00f3 c\u00f3 tr\u1ef1c khu\u1ea9n Gram \u00e2m hi\u1ebfu kh\u00ed sinh beta-lactamase ph\u1ed5 r\u1ed9ng (ESBL). C\u0169ng nh\u01b0 c\u00e1c kh\u00e1ng sinh beta-lactam kh\u00e1c, c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a meropenem l\u00e0 g\u1eafn v\u1edbi protein, g\u1eafn penicillin g\u00e2y \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p v\u00e1ch vi khu\u1ea9n d\u1eabn \u0111\u1ebfn vi khu\u1ea9n b\u1ecb ly gi\u1ea3i.
      \nThu\u1ed1c ph\u00e2n b\u1ed1 t\u1ed1t \u0111\u1ebfn ph\u1ea7n l\u1edbn c\u00e1c m\u00f4 v\u00e0 d\u1ecbch c\u01a1 th\u1ec3 bao g\u1ed3m \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u, d\u1ecbch m\u00e0ng b\u1ee5ng, x\u01b0\u01a1ng, d\u1ecbch m\u1eadt, ph\u1ed5i, ni\u00eam m\u1ea1c ph\u1ebf qu\u1ea3n, m\u00f4 c\u01a1, van tim v\u00e0 d\u1ecbch n\u00e3o t\u1ee7y. Ngo\u1ea1i tr\u1eeb \u1edf d\u1ecbch m\u1eadt, ph\u1ed5i v\u00e0 c\u01a1, thu\u1ed1c \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh t\u1ea1i m\u00f4 kho\u1ea3ng 1h sau khi truy\u1ec1n t\u0129nh m\u1ea1ch. Trong tr\u01b0\u1eddng h\u1ee3p m\u00e0ng n\u00e3o vi\u00eam, thu\u1ed1c \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh trong d\u1ecbch n\u00e3o t\u1ee7y 2-3 gi\u1edd sau truy\u1ec1n.
      \nThu\u1ed1c r\u1ea5t \u00edt g\u1eafn protein (2%). Chuy\u1ec3n h\u00f3a t\u1ea1i gan th\u1ee7y ph\u00e2n m\u1edf v\u00f2ng betalactam \u0111\u1ec3 thu\u1ed1c chuy\u1ec3n th\u00e0nh d\u1ea1ng kh\u00f4ng c\u00f2n ho\u1ea1t t\u00ednh.
      \nTh\u1eddi gian b\u00e1n th\u1ea3i l\u00e0 1h. \u1ede tr\u1ebb 3 th\u00e1ng-2 tu\u1ed5i th\u1eddi gian n\u00e0y l\u00e0 1,5h. \u1ede tr\u1ebb s\u01a1 sinh v\u00e0 tr\u1ebb \u2264 3 th\u00e1ng tu\u1ed5i, th\u1eddi gian b\u00e1n th\u1ea3i l\u00e0 2,7h.
      \nThu\u1ed1c th\u1ea3i tr\u1eeb qua n\u01b0\u1edbc ti\u1ec3u (70% d\u01b0\u1edbi d\u1ea1ng thu\u1ed1c kh\u00f4ng bi\u1ebfn \u0111\u1ed5i, 28% d\u01b0\u1edbi d\u1ea1ng ch\u1ea5t chuy\u1ec3n h\u00f3a kh\u00f4ng c\u00f2n ho\u1ea1t t\u00ednh) v\u00e0 ph\u00e2n (2%). \u0110\u1ed9 thanh th\u1ea3i thu\u1ed1c gi\u1ea3m t\u1ef7 l\u1ec7 v\u1edbi m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn \u1edf b\u1ec7nh nh\u00e2n suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n

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

      VNTMNK do tr\u1ef1c khu\u1ea9n Gram \u00e2m: 1g c\u00e1ch 8h truy\u1ec1n t\u0129nh m\u1ea1ch trong 30 ph\u00fat, k\u1ebft h\u1ee3p v\u1edbi tobramycin. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb \u00edt nh\u1ea5t 6 tu\u1ea7n.
      \n\u0110i\u1ec1u ch\u1ec9nh li\u1ec1u d\u00f9ng khi suy th\u1eadn:<\/p>\n

        \n
      • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn > 50 mL\/ph\u00fat: kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u.<\/li>\n
      • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn 26-50 mL\/ph\u00fat: gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u m\u1ed7i 12h.<\/li>\n
      • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn 10-25 mL\/ph\u00fat: gi\u1ea3m n\u1eeda li\u1ec1u v\u00e0 gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u m\u1ed7i 12h.<\/li>\n
      • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 10 ml\/ph\u00fat: gi\u1ea3m n\u1eeda li\u1ec1u v\u00e0 gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u m\u1ed7i 24h.<\/li>\n<\/ul>\n

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

        Nguy c\u01a1 co gi\u1eadt th\u1ea5p h\u01a1n imipenem. Khi d\u00f9ng c\u00f9ng thu\u1ed1c ch\u1ed1ng co gi\u1eadt, acid valproic, meropenem l\u00e0m gi\u1ea3m n\u1ed3ng \u0111\u1ed9 c\u1ee7a acid valproic n\u00ean tr\u00e1nh d\u00f9ng \u0111\u1ed3ng th\u1eddi hai thu\u1ed1c n\u00e0y.
        \nC\u0169ng nh\u01b0 nhi\u1ec1u thu\u1ed1c kh\u00e1c thu\u1ed9c nh\u00f3m beta-lactam, meropenem c\u00f3 nguy c\u01a1 d\u1ecb \u1ee9ng ch\u00e9o v\u1edbi penicillin.
        \nC\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 hay g\u1eb7p bao g\u1ed3m ti\u00eau ch\u1ea3y, bu\u1ed3n n\u00f4n\/n\u00f4n, t\u0103ng men gan, \u0111au \u0111\u1ea7u, ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn, gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh, t\u0103ng b\u1ea1ch c\u1ea7u \u00e1i toan, gi\u1ea3m ti\u1ec3u c\u1ea7u.<\/p>\n

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

        V\u1edbi ho\u1ea1t ph\u1ed5 r\u1ea5t r\u1ed9ng v\u00e0 c\u00e1ch d\u00f9ng kh\u00f4ng qu\u00e1 ph\u1ee9c t\u1ea1p, meropenem \u0111ang \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng h\u1ebft s\u1ee9c r\u1ed9ng r\u00e3i tr\u00ean l\u00e2m s\u00e0ng, nh\u1ea5t l\u00e0 \u1edf c\u00e1c \u0111\u01a1n v\u1ecb h\u1ed3i s\u1ee9c. Tuy nhi\u00ean \u1edf b\u1ec7nh nh\u00e2n nhi\u1ec5m khu\u1ea9n n\u1eb7ng, th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 th\u01b0\u1eddng t\u0103ng cao d\u1eabn \u0111\u1ebfn nguy c\u01a1 n\u1ed3ng \u0111\u1ed9 thu\u1ed1c gi\u1ea3m h\u01a1n so v\u1edbi \u0111\u1ed1i t\u01b0\u1ee3ng ng\u01b0\u1eddi t\u00ecnh nguy\u1ec7n kh\u1ecfe m\u1ea1nh.
        \nC\u1ea7n s\u1eed d\u1ee5ng h\u1ee3p l\u00fd meropenem \u0111\u1ec3 h\u1ea1n ch\u1ebf nguy c\u01a1 \u0111\u1ec1 kh\u00e1ng thu\u1ed1c, gi\u00fap b\u1ea3o t\u1ed3n t\u00ednh hi\u1ec7u qu\u1ea3 c\u1ee7a thu\u1ed1c trong t\u01b0\u01a1ng lai. B\u00ean c\u1ea1nh vi\u1ec7c ch\u1ec9 \u0111\u1ecbnh h\u1ee3p l\u00fd, c\u1ea7n l\u01b0u \u00fd t\u1ed1i \u01b0u h\u00f3a li\u1ec1u d\u00f9ng v\u00e0 c\u00e1ch d\u00f9ng (v\u00ed d\u1ee5 nh\u01b0 truy\u1ec1n t\u0129nh m\u1ea1ch li\u00ean t\u1ee5c) nh\u1eb1m \u0111\u1ea3m b\u1ea3o duy tr\u00ec th\u1eddi gian n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong huy\u1ebft t\u01b0\u01a1ng tr\u00ean n\u1ed3ng \u0111\u1ed9 \u1ee9c ch\u1ebf t\u1ed1i thi\u1ec3u (t > MIC).<\/p>\n","protected":false},"excerpt":{"rendered":"

        Piperacillin\/tazobactam l\u00e0 k\u1ebft h\u1ee3p gi\u1eefa beta-lactam v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf betalactamase v\u1edbi t\u1ef7 l\u1ec7 8:1. K\u1ebft h\u1ee3p n\u00e0y l\u1ea7n \u0111\u1ea7u ti\u00ean \u0111\u01b0\u1ee3c \u0111\u0103ng k\u00fd v\u00e0o n\u0103m 1993, cefepime \u0111\u01b0\u1ee3c \u0111\u0103ng k\u00fd b\u1eb1ng s\u00e1ng ch\u1ebf n\u0103m 1982 v\u00e0 \u0111\u01b0\u1ee3c c\u00f4ng nh\u1eadn d\u00f9ng trong l\u0129nh v\u1ef1c y h\u1ecdc t\u1eeb n\u0103m 1994. V\u1ecb tr\u00ed vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c […]<\/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":"\nPiperacillin\/tazobactam v\u00e0 c\u00e1c kh\u00e1ng sinh trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c<\/title>\n<meta name=\"description\" content=\"Piperacillin\/tazobactam v\u00e0 c\u00e1c kh\u00e1ng sinh trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c l\u00e0 nh\u1eefng \u0111i\u1ec1u quan t\u00e2m. 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