{"id":26576,"date":"2023-04-22T13:04:10","date_gmt":"2023-04-22T06:04:10","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26576"},"modified":"2023-04-22T13:04:10","modified_gmt":"2023-04-22T06:04:10","slug":"tobramycin-va-rifampicin-trong-viem-noi-tam-mac-nhiem-khuan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/22\/tobramycin-va-rifampicin-trong-viem-noi-tam-mac-nhiem-khuan\/","title":{"rendered":"Tobramycin v\u00e0 rifampicin trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n."},"content":{"rendered":"

Tobramycin v\u00e0 rifampicin l\u00e0 2 lo\u1ea1i kh\u00e1ng sinh th\u01b0\u1eddng d\u00f9ng trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/a>. B\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y h\u1ec7 th\u1ed1ng t\u1eeb d\u01b0\u1ee3c l\u1ef1c h\u1ecdc \u0111\u1ebfn li\u1ec1u s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng c\u1ee7a 2 lo\u1ea1i kh\u00e1ng sinh n\u00e0y.<\/strong><\/p>\n

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

Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n tr\u00ean si\u00eau \u00e2m<\/strong><\/p>\n

1.Tobramycin<\/h2>\n

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

Tobramycin l\u00e0 kh\u00e1ng sinh aminoglycosid b\u1eaft ngu\u1ed3n t\u1eeb n\u1ea5m Streptomyces tenebrarius. Thu\u1ed1c \u0111\u01b0\u1ee3c \u0111\u0103ng k\u00fd b\u1eb1ng s\u00e1ng ch\u1ebf n\u0103m 1965 v\u00e0 \u0111\u01b0a v\u00e0o s\u1eed d\u1ee5ng trong l\u0129nh v\u1ef1c y n\u0103m 1974.
\nSo v\u1edbi gentamicin, tobramycin c\u00f3 ho\u1ea1t t\u00ednh kh\u00e1ng tr\u1ef1c khu\u1ea9n m\u1ee7 xanh Pseudomonas aeruginosa m\u1ea1nh h\u01a1n, t\u00e1c d\u1ee5ng tr\u00ean nh\u1eefng ch\u1ee7ng P. aeruginosa v\u00e0 Acinetobacter baumannii kh\u00e1ng gentamicin v\u00e0 \u00edt \u0111\u1ed9c t\u00ednh h\u01a1n.<\/p>\n

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

C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a tobramycin l\u00e0 g\u1eafn v\u00e0o ribosome 30S v\u00e0 50S c\u1ee7a vi khu\u1ea9n, ng\u0103n ng\u1eeba h\u00ecnh th\u00e0nh ph\u1ee9c 70S khi\u1ebfn mARN kh\u00f4ng th\u1ec3 d\u1ecbch m\u00e3 th\u00e0nh protein v\u00e0 g\u00e2y ch\u1ebft t\u1ebf b\u00e0o. Ph\u1ed5 kh\u00e1ng khu\u1ea9n c\u1ee7a tobramycin ch\u1ee7 y\u1ebfu l\u00e0 c\u00e1c tr\u1ef1c khu\u1ea9n Gram \u00e2m hi\u1ebfu kh\u00ed, trong \u0111\u00f3 c\u00f3 tr\u1ef1c khu\u1ea9n m\u1ee7 xanh. 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 sau ti\u00eam b\u1eafp l\u00e0 30-60 ph\u00fat, sau truy\u1ec1n t\u0129nh m\u1ea1ch l\u00e0 30 ph\u00fat.
\nThu\u1ed1c ph\u00e2n b\u1ed1 v\u00e0o d\u1ecbch ngo\u1ea1i b\u00e0o, bao g\u1ed3m huy\u1ebft thanh, d\u1ecbch \u00e1p xe, d\u1ecbch c\u1ed5 tr\u01b0\u1edbng, d\u1ecbch m\u00e0ng ngo\u00e0i tim, d\u1ecbch m\u00e0ng ph\u1ed5i, d\u1ecbch kh\u1edbp, b\u1ea1ch huy\u1ebft v\u00e0 d\u1ecbch m\u00e0ng b\u1ee5ng. Ng\u1ea5m k\u00e9m v\u00e0o d\u1ecbch n\u00e3o t\u1ee7y, m\u1eaft, x\u01b0\u01a1ng, tuy\u1ebfn ti\u1ec1n li\u1ec7t. T\u1ef7 l\u1ec7 g\u1eafn protein d\u01b0\u1edbi 30%.
\nTh\u1eddi gian b\u00e1n th\u1ea3i ph\u1ee5 thu\u1ed9c tr\u1ef1c ti\u1ebfp m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn. Th\u00f4ng th\u01b0\u1eddng l\u00e0 2-3h nh\u01b0ng khi suy th\u1eadn k\u00e9o d\u00e0i t\u1edbi 5-70 gi\u1edd. \u1ede tr\u1ebb s\u01a1 sinh th\u1eddi gian b\u00e1n th\u1ea3i 2-9h, c\u00f2n \u1edf tr\u1ebb nh\u1ecf th\u1eddi gian n\u00e0y l\u00e0 1-5h. Thu\u1ed1c th\u1ea3i tr\u1eeb qua n\u01b0\u1edbc ti\u1ec3u (90-95%). \u0110\u1ed9 thanh th\u1ea3i gi\u1ea3m khi suy th\u1eadn.<\/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: Li\u1ec1u t\u1ea3i \u0111\u1ea7u ti\u00ean 5-7 mg\/kg truy\u1ec1n t\u0129nh m\u1ea1ch (60 ph\u00fat), sau \u0111\u00f3 1,5-2 mg\/kg truy\u1ec1n t\u0129nh m\u1ea1ch (20-60 ph\u00fat) c\u00e1ch 8h, ph\u1ed1i h\u1ee3p v\u1edbi m\u1ed9t beta-lactam nh\u01b0 cefepim, meropenem ho\u1eb7c piperacillin\/tazobactam. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb \u00edt nh\u1ea5t 6 tu\u1ea7n.
\nN\u1ebfu theo d\u00f5i \u0111\u01b0\u1ee3c n\u1ed3ng \u0111\u1ed9 tobramycin huy\u1ebft thanh th\u00ec \u0111i\u1ec1u ch\u1ec9nh \u0111\u1ec3 n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh 4-10 \u03bcg\/mL, n\u1ed3ng \u0111\u1ed9 \u0111\u00e1y 1-2 \u03bcg\/mL.
\n\u0110i\u1ec1u ch\u1ec9nh li\u1ec1u d\u00f9ng 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 40-60 mL\/ph\u00fat: gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u m\u1ed7i 12h.<\/li>\n
  • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn 20-39 mL\/ph\u00fat: gi\u00e3n kho\u1ea3ng c\u00e1ch li\u1ec1u m\u1ed7i 24h.<\/li>\n
  • M\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn < 20 mL\/ph\u00fat: cho li\u1ec1u t\u1ea3i, sau \u0111\u00f3 theo d\u00f5i n\u1ed3ng \u0111\u1ed9 huy\u1ebft thanh \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u ti\u1ebfp theo.<\/li>\n<\/ul>\n

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

    Nguy c\u01a1 \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn, \u1ed1c tai v\u00e0 c\u01a1 quan ti\u1ec1n \u0111\u00ecnh nh\u01b0 \u0111\u1ed1i v\u1edbi c\u00e1c aminoglycosid. Hi\u1ec7n t\u1ea1i ch\u01b0a c\u00f3 bi\u1ec7n ph\u00e1p n\u00e0o gi\u00fap lo\u1ea1i b\u1ecf nguy c\u01a1 \u0111\u1ed9c v\u1edbi th\u1eadn v\u00e0 tai c\u1ee7a aminoglycosid. Ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb \u0111\u00fang \u0111\u1eafn, t\u00ednh to\u00e1n li\u1ec1u d\u00f9ng nghi\u00eam t\u00fac v\u00e0 theo d\u00f5i ch\u1ee9c n\u0103ng th\u1eadn trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb gi\u00fap gi\u1ea3m \u0111\u01b0\u1ee3c nguy c\u01a1 n\u00e0y. N\u1ebfu c\u00f3 \u0111i\u1ec1u ki\u1ec7n th\u00ec theo d\u00f5i n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong huy\u1ebft thanh gi\u00fap \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u s\u00e1t h\u1ee3p h\u01a1n.
    \nNguy c\u01a1 \u0111\u1ed9c v\u1edbi th\u1eadn t\u0103ng l\u00ean khi d\u00f9ng c\u00f9ng c\u00e1c thu\u1ed1c: amphotericin B, cisplatinum, cyclosporin, thu\u1ed1c ch\u1ed1ng vi\u00eam kh\u00f4ng steroid, thu\u1ed1c c\u1ea3n quang, vancomycin. Nguy c\u01a1 \u0111\u1ed9c v\u1edbi tai t\u0103ng l\u00ean khi d\u00f9ng c\u00f9ng: cis-platinum, l\u1ee3i ti\u1ec3u quai.<\/p>\n

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

    M\u1eb7c d\u00f9 ti\u1ec1m \u1ea9n nguy c\u01a1 \u0111\u1ed9c t\u00ednh th\u1eadn, tai v\u00e0 ti\u1ec1n \u0111\u00ecnh, tobramycin v\u1eabn c\u00f2n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng b\u1edfi t\u00ednh hi\u1ec7u qu\u1ea3 c\u1ee7a n\u00f3.<\/p>\n

    2. Rifampicin<\/h2>\n

    2.1. L\u1ecbch s\u1eed<\/h3>\n

    Rifampicin l\u00e0 kh\u00e1ng sinh \u0111\u01b0\u1ee3c nh\u00f3m nghi\u00ean c\u1ee9u c\u1ee7a Piero Sensi v\u00e0 Maria Teresa Timbal ph\u00e2n l\u1eadp t\u1eeb vi khu\u1ea9n Amycolatopsis (tr\u01b0\u1edbc kia g\u1ecdi l\u00e0 Streptomyces v\u00e0 Nocardia) mediterranei v\u00e0o n\u0103m 1957. Do Sensi, Timbal v\u00e0 c\u00e1c nh\u00e0 nghi\u00ean c\u1ee9u trong nh\u00f3m \u0111\u1ec1u r\u1ea5t th\u00edch b\u1ed9 phim h\u00ecnh s\u1ef1 c\u1ee7a Ph\u00e1p. H\u1ecd quy\u1ebft \u0111\u1ecbnh \u0111\u1eb7t t\u00ean cho h\u1ee3p ch\u1ea5t m\u1edbi ph\u00e2n l\u1eadp l\u00e0 \u201crifamycin\u201d. Sau \u0111\u00f3 v\u00e0o n\u0103m 1965 khi c\u00f3 \u0111\u01b0\u1ee3c s\u1ea3n ph\u1ea9m b\u00e1n t\u1ed5ng h\u1ee3p \u1ed5n \u0111\u1ecbnh h\u01a1n v\u1edbi hi\u1ec7u qu\u1ea3 cao v\u00e0 kh\u1ea3 n\u0103ng dung
    \nn\u1ea1p t\u1ed1t, h\u1ee3p ch\u1ea5t m\u1edbi \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 \u201crifampicin\u201d t\u1ed3n t\u1ea1i cho \u0111\u1ebfn ng\u00e0y nay. Rifampicin \u0111\u01b0\u1ee3c b\u00e1n tr\u00ean th\u1ecb tr\u01b0\u1eddng t\u1eeb n\u0103m 1968 v\u00e0 \u0111\u01b0\u1ee3c FDA c\u00f4ng nh\u1eadn t\u1eeb n\u0103m 1971.<\/p>\n

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

    Rifampicin th\u01b0\u1eddng d\u00f9ng tr\u00ean l\u00e2m s\u00e0ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb lao v\u00e0 c\u00e1c vi khu\u1ea9n Mycobacterium. Ngo\u00e0i ra rifampicin c\u00f2n d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u1ee5 c\u1ea7u, n\u00e3o m\u00f4 c\u1ea7u Neisseria sp., Legionella sp. v\u00e0 m\u1ed9t s\u1ed1 vi khu\u1ea9n kh\u00e1c. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c l\u00e0 g\u1eafn v\u00e0o ti\u1ec3u \u0111\u01a1n v\u1ecb beta c\u1ee7a ARN polymerase ph\u1ee5 thu\u1ed9c ADN, ng\u0103n c\u1ea3n qu\u00e1 tr\u00ecnh sao ch\u00e9p ARN v\u00e0 \u1ee9c ch\u1ebf t\u1ed5ng h\u1ee3p ARN c\u1ee7a vi khu\u1ea9n. Tuy nhi\u00ean, vi khu\u1ea9n r\u1ea5t d\u1ec5 kh\u00e1ng thu\u1ed1c do ch\u1ec9 c\u1ea7n \u0111\u1ed9t bi\u1ebfn \u0111\u01a1n \u1edf gen rpoB c\u1ee7a ARN polymerase.
    \nThu\u1ed1c h\u1ea5p thu t\u1ed1t qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a. Sau u\u1ed1ng thu\u1ed1c 2-4h \u0111\u1ea1t \u0111\u01b0\u1ee3c n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh huy\u1ebft thanh. Th\u1ee9c \u0103n l\u00e0m ch\u1eadm th\u1eddi gian \u0111\u1ea1t \u0111\u01b0\u1ee3c ho\u1eb7c gi\u1ea3m nh\u1eb9 n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh.
    \nThu\u1ed1c ph\u00e2n b\u1ed1 r\u1ea5t \u01b0a lipid, d\u1ec5 d\u00e0ng qua \u0111\u01b0\u1ee3c h\u00e0ng r\u00e0o m\u00e1u n\u00e3o. T\u1ec9 s\u1ed1 n\u1ed3ng \u0111\u1ed9 thu\u1ed1c trong d\u1ecbch n\u00e3o t\u1ee7y : trong m\u00e1u khi m\u00e0ng n\u00e3o vi\u00eam l\u00e0 25%. Thu\u1ed1c g\u1eafn protein t\u1edbi 80%. Chuy\u1ec3n h\u00f3a thu\u1ed1c \u1edf gan v\u00e0 thu\u1ed1c tham gia v\u00e0o chu tr\u00ecnh gan ru\u1ed9t.
    \nTh\u1eddi gian b\u00e1n th\u1ea3i l\u00e0 3-4h, k\u00e9o d\u00e0i h\u01a1n khi c\u00f3 suy ch\u1ee9c n\u0103ng gan. \u1ede b\u1ec7nh nh\u00e2n b\u1ec7nh th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i, th\u1eddi gian n\u00e0y l\u00e0 1,8-11h.
    \nThu\u1ed1c th\u1ea3i tr\u1eeb qua ph\u00e2n (60-65%) v\u00e0 n\u01b0\u1edbc ti\u1ec3u (~30%) d\u01b0\u1edbi d\u1ea1ng thu\u1ed1c kh\u00f4ng bi\u1ebfn \u0111\u1ed5i.<\/p>\n

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

    Th\u00f4ng th\u01b0\u1eddng rifampicin \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u01b0\u1eddng u\u1ed1ng. N\u00ean u\u1ed1ng thu\u1ed1c l\u00fac \u0111\u00f3i \u0111\u1ec3 tr\u00e1nh th\u1ee9c \u0103n \u1ea3nh h\u01b0\u1edfng h\u1ea5p thu thu\u1ed1c.
    \nRifampicin hi\u1ebfm khi \u0111i\u1ec1u tr\u1ecb \u0111\u01a1n \u0111\u1ed9c m\u00e0 th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 c\u1ed9ng g\u1ed9p ho\u1eb7c hi\u1ec7p \u0111\u1ed3ng v\u00e0 gi\u1ea3m nguy c\u01a1 ph\u00e1t sinh \u0111\u1ec1 kh\u00e1ng. VNTMNK do t\u1ee5 c\u1ea7u tr\u00ean van nh\u00e2n t\u1ea1o: 300 mg m\u1ed7i 8h trong \u00edt nh\u1ea5t 6 tu\u1ea7n. Trong tr\u01b0\u1eddng h\u1ee3p VNTMNK do MRSA, c\u1ea7n k\u1ebft h\u1ee3p rifampicin v\u1edbi vancomycin trong su\u1ed1t li\u1ec7u tr\u00ecnh v\u00e0 v\u1edbi gentamicin trong 2 tu\u1ea7n \u0111\u1ea7u. Trong tr\u01b0\u1eddng h\u1ee3p VNTMNK do MSSA, c\u1ea7n k\u1ebft h\u1ee3p rifampicin v\u1edbi nafcillin ho\u1eb7c oxacillin trong su\u1ed1t li\u1ec7u tr\u00ecnh v\u00e0 v\u1edbi gentamicin trong 2 tu\u1ea7n \u0111\u1ea7u.
    \n\u0110i\u1ec1u tr\u1ecb theo kinh nghi\u1ec7m VNTMNK tr\u00ean van nh\u00e2n t\u1ea1o: Rifampicin 300 mg m\u1ed7i 8h k\u1ebft h\u1ee3p v\u1edbi vancomycin v\u00e0 gentamicin. Kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u khi suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn.<\/p>\n

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

    Rifampicin c\u00f3 nguy c\u01a1 g\u00e2y ng\u1ed9 \u0111\u1ed9c gan, th\u01b0\u1eddng bi\u1ec3u hi\u1ec7n tr\u00ean l\u00e2m s\u00e0ng l\u00e0 vi\u00eam gan \u1ee9 m\u1eadt. Th\u1eadn tr\u1ecdng khi d\u00f9ng thu\u1ed1c cho b\u1ec7nh nh\u00e2n suy gi\u1ea3m ch\u1ee9c n\u0103ng gan ho\u1eb7c \u0111\u00e3 c\u00f3 ti\u1ec1n s\u1eed hay hi\u1ec7n t\u1ea1i \u0111ang l\u1ea1m d\u1ee5ng r\u01b0\u1ee3u. N\u1ebfu t\u0103ng bilirubin v\u00e0\/ho\u1eb7c t\u0103ng \u0111\u00e1ng k\u1ec3 men gan th\u00ec ng\u1eebng \u0111i\u1ec1u tr\u1ecb rifampicin. Rifampicin t\u01b0\u01a1ng t\u00e1c v\u1edbi r\u1ea5t nhi\u1ec1u c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c nhau. Tr\u01b0\u1edbc khi \u0111i\u1ec1u tr\u1ecb rifampicin cho b\u1ec7nh nh\u00e2n ho\u1eb7c tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c cho b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb rifampicin c\u1ea7n th\u1eadn tr\u1ecdng tra c\u1ee9u c\u00e1c t\u01b0\u01a1ng t\u00e1c thu\u1ed1c c\u00f3 th\u1ec3 c\u00f3 \u0111\u1ec3 ph\u00f2ng tr\u00e1nh. Khi \u0111i\u1ec1u tr\u1ecb rifampicin n\u01b0\u1edbc ti\u1ec3u, ph\u00e2n, n\u01b0\u1edbc b\u1ecdt, m\u1ed3 h\u00f4i, n\u01b0\u1edbc m\u1eaft v\u00e0 d\u1ecbch n\u00e3o t\u1ee7y chuy\u1ec3n sang m\u00e0u \u0111\u1ecf cam. N\u01b0\u1edbc m\u1eaft m\u00e0u \u0111\u1ecf cam c\u00f3 th\u1ec3 l\u00e0m k\u00ednh \u00e1p tr\u00f2ng b\u1ecb b\u1eaft m\u00e0u v\u0129nh vi\u1ec5n. Khi \u0111i\u1ec1u tr\u1ecb gi\u00e1n \u0111o\u1ea1n, cho d\u00f9 l\u00e0 gi\u00e1n \u0111o\u1ea1n c\u00f3 ch\u1ee7 \u0111\u00edch hay k\u00e9m tu\u00e2n th\u1ee7 th\u00ec c\u0169ng d\u1ec5 g\u1eb7p h\u1ed9i ch\u1ee9ng gi\u1ed1ng c\u00fam.
    \nC\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n gi\u1ea3m ti\u1ec3u c\u1ea7u mi\u1ec5n d\u1ecbch do thu\u1ed1c, vi\u00eam m\u1ea1ch, vi\u00eam th\u1eadn k\u1ebd.<\/p>\n

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

    Nh\u01b0\u1ee3c \u0111i\u1ec3m c\u1ee7a rifampicin kh\u00e1 nhi\u1ec1u: T\u1eeb ho\u1ea1t t\u00ednh in vitro hay thay \u0111\u1ed5i, d\u1ec5 ph\u00e1t sinh \u0111\u1ec1 kh\u00e1ng cho \u0111\u1ebfn nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5, \u0111\u1eb7c bi\u1ec7t l\u00e0 t\u01b0\u01a1ng t\u00e1c v\u1edbi nhi\u1ec1u lo\u1ea1i thu\u1ed1c. Do \u0111\u00f3, vai tr\u00f2 c\u1ee7a rifampicin \u0111\u00e3 \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf trong \u0111i\u1ec1u tr\u1ecb VNTMNK tr\u00ean van t\u1ef1 nhi\u00ean.
    \nTuy nhi\u00ean \u0111\u1ed1i v\u1edbi VNTMNK tr\u00ean van nh\u00e2n t\u1ea1o, m\u00f4 h\u00ecnh th\u1ef1c nghi\u1ec7m cho th\u1ea5y ph\u1ed1i h\u1ee3p rifampicin v\u1edbi vancomycin v\u00e0 gentamicin \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 cao nh\u1ea5t.
    \n\u0110\u00e2y l\u00e0 c\u0103n c\u1ee9 \u0111\u1ec3 c\u00e1c H\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb VNTMNK T\u00e2y \u00c2u c\u0169ng nh\u01b0 B\u1eafc M\u1ef9 khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng ph\u00e1c \u0111\u1ed3 c\u00f3 rifampicin. Tr\u00ean l\u00e2m s\u00e0ng, rifampicin th\u01b0\u1eddng \u0111\u01b0\u1ee3c b\u1ed5 sung sau khi \u0111\u00e3 c\u00f3 k\u1ebft qu\u1ea3 ph\u00e2n l\u1eadp vi khu\u1ea9n \u0111\u1ec3 gi\u1ea3m h\u01a1n n\u1eefa nguy c\u01a1 kh\u00e1ng thu\u1ed1c v\u00e0 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c.<\/p>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    Tobramycin v\u00e0 rifampicin l\u00e0 2 lo\u1ea1i kh\u00e1ng sinh th\u01b0\u1eddng d\u00f9ng trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n. B\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y h\u1ec7 th\u1ed1ng t\u1eeb d\u01b0\u1ee3c l\u1ef1c h\u1ecdc \u0111\u1ebfn li\u1ec1u s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng c\u1ee7a 2 lo\u1ea1i kh\u00e1ng sinh n\u00e0y. Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n tr\u00ean si\u00eau \u00e2m 1.Tobramycin 1.1. L\u1ecbch s\u1eed Tobramycin l\u00e0 […]<\/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":"\nTobramycin v\u00e0 rifampicin trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n<\/title>\n<meta name=\"description\" content=\"Tobramycin v\u00e0 rifampicin trong vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n l\u00e0 v\u1ea5n \u0111\u1ec1 quan t\u00e2m. 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