{"id":29509,"date":"2023-04-29T19:21:21","date_gmt":"2023-04-29T12:21:21","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29509"},"modified":"2023-04-29T19:24:17","modified_gmt":"2023-04-29T12:24:17","slug":"nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/","title":{"rendered":"N\u1ea5m ph\u1ed5i: c\u00e1c nh\u00f3m thu\u1ed1c v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a B\u1ed9 Y t\u1ebf"},"content":{"rendered":"<p><strong>B\u1ec7nh n\u1ea5m ph\u1ed5i th\u01b0\u1eddng l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a m\u1ed9t t\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch: HIV, s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch nh\u01b0 h\u00f3a ch\u1ea5t \u0111i\u1ec1u tr\u1ecb ung th\u01b0, <\/strong><strong>corticoid k\u00e9o d\u00e0i, thu\u1ed1c ch\u1ed1ng th\u1ea3i gh\u00e9p, b\u1ec7nh h\u1ec7 th\u1ed1ng ho\u1eb7c n\u1ea5m ph\u00e1t tri\u1ec3n tr\u00ean n\u1ec1n c\u1ee7a m\u1ed9t t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i c\u00f3 tr\u01b0\u1edbc nh\u01b0 hang lao, gi\u00e3n ph\u1ebf qu\u1ea3n. Hi\u1ec7n nay \u0111i\u1ec1u tr\u1ecb n\u1ea5m ph\u1ed5i d\u1ef1a v\u00e0o c\u00e1c nh\u00f3m thu\u1ed1c ch\u00ednh \u0111\u00f3 l\u00e0 Polyens (amphotericin B), triazole ph\u1ed5 r\u1ed9ng v\u00e0 e<span class=\"fontstyle0\">chinocandins.<\/span><\/strong><\/p>\n<h2>1. C\u00e1c nh\u00f3m thu\u1ed1c ch\u00ednh \u0111i\u1ec1u tr\u1ecb n\u1ea5m ph\u1ed5i.<\/h2>\n<h3>1.1. Polyens<\/h3>\n<p><span class=\"fontstyle0\">Amphotericin B l\u00e0 thu\u1ed1c \u0111\u1ea7u ti\u00ean thu\u1ed9c nh\u00f3m polyens, v\u1eabn l\u00e0 thu\u1ed1c n\u1ec1n t\u1ea3ng cho l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m n\u1ea5m n\u1eb7ng nh\u01b0 aspergillosis, cryptococcosis, candidiasis h\u1ec7 th\u1ed1ng, histoplasmosis n\u1eb7ng, blastomycosis, coccidioidomycosis, v\u00e0 zygomycosis. Amphotericin B d\u00f9ng \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch v\u00e0 c\u00f3 nhi\u1ec1u t\u00e1c d\u1ee5ng ph\u1ee5, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ed9c th\u1eadn. Do \u0111\u00f3 c\u1ea7n theo d\u00f5i \u0111\u1ecbnh k\u1ef3 h\u00f3a sinh m\u00e1u, c\u00f4ng th\u1ee9c m\u00e1u.<\/span><\/p>\n<p>Polyens ho\u1ea1t \u0111\u1ed9ng b\u1eb1ng c\u00e1ch g\u1eafn v\u00e0o sterols c\u1ee7a m\u00e0ng t\u1ebf b\u00e0o n\u1ea5m, t\u1ea1o k\u00eanh xuy\u00ean m\u00e0ng g\u00e2y th\u1ee7ng t\u1ebf b\u00e0o v\u00e0 ch\u1ebft.<\/p>\n<h3>1.2. Triazoles.<\/h3>\n<p>C\u00f3 c\u1ea5u tr\u00fac v\u00f2ng azole g\u1ed3m 3 nguy\u00ean t\u1eed N. C\u00e1c triazole \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng tr\u00ean l\u00e2m s\u00e0ng g\u1ed3m: <span class=\"fontstyle0\">ketoconazole,<br \/>\nitraconazole, fluconazole, voriconazole, and posaconazole.\u00a0<\/span><\/p>\n<p>C\u01a1 ch\u1ebf: t\u00e1c \u0111\u1ed9ng l\u00ean <span class=\"fontstyle0\">14-<\/span><span class=\"fontstyle2\">a<\/span><span class=\"fontstyle0\">-demethylase enzyme, v\u00e0 l\u00ean qu\u00e1 tr\u00ecnh chuy\u1ec3n lanosterol th\u00e0nh ergosterol.<\/span><\/p>\n<h3><span class=\"fontstyle0\">1.3. Echinocandins<\/span><\/h3>\n<p><span class=\"fontstyle0\">L\u00e0 nh\u00f3m thu\u1ed1c kh\u00e1ng n\u1ea5m m\u1edbi, ph\u00e1 h\u1ee7y m\u00e0ng t\u1ebf b\u00e0o n\u1ea5m th\u00f4ng qua \u1ee9c ch\u1ebf ph\u1ee9c h\u1ee3p <span class=\"fontstyle1\">1,3-<\/span><span class=\"fontstyle3\">b<\/span><span class=\"fontstyle1\">-glucan synthase. Hi\u1ec7n nay c\u00f3 3 thu\u1ed1c c\u00f3 s\u1eb5n tr\u00ean th\u1ecb tr\u01b0\u1eddng l\u00e0 caspofungin, micafungin, v\u00e0 anidulafungin.<\/span><\/span><\/p>\n<h2>2. \u0110i\u1ec1u tr\u1ecb n\u1ea5m ph\u1ed5i do Aspergillus.<\/h2>\n<h3>2.1. U n\u1ea5m Aspergilloma<\/h3>\n<p>\u2014 Ch\u1ee7 y\u1ebfu \u0111i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt c\u1eaft b\u1ecf th\u00f9y ph\u1ed5i ho\u1eb7c m\u1ed9t ph\u1ed5i.<br \/>\n\u2014 Thu\u1ed1c kh\u00e1ng n\u1ea5m \u00edt c\u00f3 t\u00e1c d\u1ee5ng \u0111\u1ed1i v\u1edbi u n\u1ea5m.<\/p>\n<p>\u2014 Trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u0111\u1ed1i v\u1edbi \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i khoa v\u00e0 c\u00f3 ho m\u00e1u n\u1eb7ng th\u00ec g\u00e2y t\u1eafc \u0111\u1ed9ng m\u1ea1ch ph\u1ebf qu\u1ea3n.<\/p>\n<h3>2.2. \u0110i\u1ec1u tr\u1ecb n\u1ea5m Aspergillus ph\u1ebf qu\u1ea3n ph\u1ed5i d\u1ecb \u1ee9ng<\/h3>\n<p>\u0110i\u1ec1u tr\u1ecb c\u01a1 b\u1ea3n l\u00e0 corticoid \u0111\u01b0\u1eddng u\u1ed1ng nh\u1eb1m l\u00e0m gi\u1ea3m ph\u1ea3n \u1ee9ng vi\u00eam &#8211; qu\u00e1 m\u1eabn v\u1edbi Aspergillus: hai tu\u1ea7n \u0111\u1ea7u d\u00f9ng prednisolon 0,5 mg\/kg\/ng\u00e0y, sau \u0111\u00f3<br \/>\ngi\u1ea3m d\u1ea7n c\u00f3 th\u1ec3 d\u00f9ng ph\u1ed1i h\u1ee3p itraconazole.<\/p>\n<h3>2.3. \u0110i\u1ec1u tr\u1ecb n\u1ea5m Aspergillus x\u00e2m nh\u1eadp<\/h3>\n<p>Thu\u1ed1c kh\u00e1ng n\u1ea5m: T\u00f9y theo \u0111i\u1ec1u ki\u1ec7n s\u1eb5n c\u00f3 v\u00e0 t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3<br \/>\nl\u1ef1a ch\u1ecdn m\u1ed9t trong 2 thu\u1ed1c sau:<\/p>\n<ul>\n<li><strong>Amphoricin B-Dexoxycholat:<\/strong> Pha truy\u1ec1n t\u0129nh m\u1ea1ch li\u1ec1u t\u0103ng d\u1ea7n (theo<br \/>\nquy tr\u00ecnh truy\u1ec1n amphotericin B).<\/li>\n<li>\u0110\u1ed9c t\u00ednh v\u00e0 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c: \u0111\u1ed9c v\u1edbi th\u1eadn c\u00f3 th\u1ec3 g\u00e2y co th\u1eaft ph\u1ebf qu\u1ea3n v\u00e0 h\u1ea1 huy\u1ebft \u00e1p, h\u1ea1 kali m\u00e1u, \u1ee9c ch\u1ebf t\u1ee7y g\u00e2y gi\u1ea3m ba d\u00f2ng. Nguy c\u01a1 \u0111\u1ed9c t\u00ednh t\u0103ng<br \/>\nkhi k\u1ebft h\u1ee3p v\u1edbi cyclosporin, aminoglycosid, tacrolimus, cisplatin, acetazolamid. D\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi zidovudin l\u00e0m t\u0103ng nguy c\u01a1 g\u00e2y \u0111\u1ed9c cho th\u1eadn v\u00e0 h\u1ec7 t\u1ea1o m\u00e1u. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: qu\u00e1 m\u1eabn v\u1edbi thu\u1ed1c. Th\u1eadn tr\u1ecdng: ph\u1ee5 n\u1eef mang thai, suy gan, suy th\u1eadn, r\u1ed1i lo\u1ea1n sinh t\u1ee7y.<\/li>\n<\/ul>\n<p><strong>* Quy tr\u00ecnh truy\u1ec1n amthotericin B t\u0129nh m\u1ea1ch:<\/strong><\/p>\n<ul>\n<li>Tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c: Ki\u1ec3m tra c\u00f4ng th\u1ee9c m\u00e1u, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, ch\u1ee9c n\u0103ng gan, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3, b\u00f9 kali n\u1ebfu thi\u1ebfu.<\/li>\n<li>Ng\u00e0y \u0111\u1ea7u ti\u00ean:<\/li>\n<\/ul>\n<p>\u2014 Pha 10 mL dung d\u1ecbch Glucose 5% + 50 mg amphotericin B (01 l\u1ecd).<\/p>\n<p>\u2014 L\u1ea5y 10mL thu\u1ed1c \u0111\u00e3 pha cho v\u00e0o 500 mL Glucose 5%.<\/p>\n<p>\u2014 Truy\u1ec1n TM qua m\u00e1y truy\u1ec1n d\u1ecbch 10ml trong 30 ph\u00fat, theo d\u00f5i s\u00e1t BN.<br \/>\n\u2014 N\u1ebfu an to\u00e0n, ti\u1ebfp t\u1ee5c truy\u1ec1n v\u1edbi t\u1ed1c \u0111\u1ed9 50 ml\/h.<\/p>\n<p>Nh\u1eefng ng\u00e0y sau: kh\u00f4ng ph\u1ea3i th\u1eed test, truy\u1ec1n t\u1ed1c \u0111\u1ed9 50 mL\/h.<\/p>\n<ul>\n<li>Li\u1ec1u thu\u1ed1c: 0,1-0,3 mg\/kg\/ng\u00e0y, t\u0103ng li\u1ec1u 5-10 mg\/ng\u00e0y cho t\u1edbi li\u1ec1u 0,5-1 mg\/kg\/ng\u00e0y. V\u00ed d\u1ee5: b\u1ec7nh nh\u00e2n n\u1eb7ng 60 kg 1 li\u1ec1u ng\u00e0y \u0111\u1ea7u 1\/3 l\u1ecd, li\u1ec1u ng\u00e0y th\u1ee9 2, th\u1ee9 3 l\u00e0 1\/2 l\u1ecd, li\u1ec1u ng\u00e0y 4, 5, 6 l\u00e0 2\/3 l\u1ecd, c\u00e1c ng\u00e0y sau 1 l\u1ecd\/ng\u00e0y. T\u1ed5ng li\u1ec1u: kh\u00f4ng qu\u00e1 2 g trong m\u1ed9t \u0111\u1ee3t \u0111i\u1ec1u tr\u1ecb.<\/li>\n<li>L\u01b0u \u00fd:<\/li>\n<\/ul>\n<p>\u2014 Tr\u01b0\u1edbc truy\u1ec1n 60 ph\u00fat cho BN u\u1ed1ng 2 vi\u00ean paracetamol 0,5 g, sau 30 ph\u00fat ti\u00eam b\u1eafp 01 \u1ed1ng dimedrol 10 mg.<\/p>\n<p>\u2014 Trong qu\u00e1 tr\u00ecnh truy\u1ec1n: 30 ph\u00fat l\u1eafc chai 1 l\u1ea7n.<\/p>\n<p>\u2014 Chu\u1ea9n b\u1ecb s\u1eb5n methylpredisolon 40 mg, n\u1ebfu c\u00f3 bi\u1ec3u hi\u1ec7n s\u1ed1c th\u00ec ti\u00eam t\u0129nh m\u1ea1ch 1 l\u1ecd.<\/p>\n<p>\u2014 Th\u01b0\u1eddng xuy\u00ean cho th\u00eam kali 2-4 g\/ng\u00e0y, u\u1ed1ng trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb n\u1ebfu kh\u00f4ng c\u00f3 t\u0103ng kali m\u00e1u. Theo d\u00f5i: ch\u1ee9c n\u0103ng gan, th\u1eadn, c\u00f4ng th\u1ee9c m\u00e1u,<br \/>\n\u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 m\u1ed9t tu\u1ea7n\/m\u1ed9t l\u1ea7n.<\/p>\n<ul>\n<li><strong>\u00a0Itraconazol:<\/strong><\/li>\n<\/ul>\n<p>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh: BN c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn &lt; 30 ml\/ph\u00fat, ph\u1ee5 n\u1eef \u0111ang cho con b\u00fa, c\u00f3 ti\u1ec1n s\u1eed qu\u00e1 m\u1eabn v\u1edbi thu\u1ed1c ho\u1eb7c th\u00e0nh ph\u1ea7n c\u1ee7a thu\u1ed1c. Th\u1eadn tr\u1ecdng:<br \/>\nph\u1ee5 n\u1eef mang thai, suy gan.<\/p>\n<p>\u2014 D\u00f9ng t\u1ea5n c\u00f4ng trong 2 ng\u00e0y \u0111\u1ea7u: truy\u1ec1n 200 mg trong 1 gi\u1edd x 2 l\u1ea7n\/ng\u00e0y.<br \/>\n\u2014 T\u1eeb ng\u00e0y th\u1ee9 3 tr\u1edf \u0111i: truy\u1ec1n 200 mg trong 1 gi\u1edd x 1 l\u1ea7n\/ng\u00e0y x 12 ng\u00e0y.<\/p>\n<p>* Quy tr\u00ecnh truy\u1ec1n itraconazol (Sporanox) t\u0129nh m\u1ea1ch.<\/p>\n<p>\u2014 Tr\u01b0\u1edbc khi d\u00f9ng thu\u1ed1c: Ki\u1ec3m tra c\u00f4ng th\u1ee9c m\u00e1u, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3, ch\u1ee9c n\u0103ng gan th\u1eadn, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3.<\/p>\n<p>\u2014 M\u1ed9t li\u1ec1u c\u00f3 200 mg itraconazol t\u01b0\u01a1ng \u1ee9ng v\u1edbi 60 mL dung d\u1ecbch \u0111\u01b0\u1ee3c pha truy\u1ec1n.<\/p>\n<p>C\u00e1ch pha d\u1ecbch truy\u1ec1n:<br \/>\n\u2014 R\u00fat thu\u1ed1c itraconazol \u1edf l\u1ecd th\u1ee7y t\u1ec9nh (250 mg trong 25 m).<\/p>\n<p>\u2014 B\u01a1m to\u00e0n b\u1ed9 thu\u1ed1c v\u00e0o t\u00fai dung m\u00f4i \u0111\u00f3ng s\u1eb5n (50 ml) natri chlorid 0,9% t\u1ea1o ra 75 mL dung d\u1ecbch truy\u1ec1n. L\u1eafc nh\u1eb9 nh\u00e0ng dung d\u1ecbch sau khi pha.<\/p>\n<p>\u2014 Truy\u1ec1n t\u0129nh m\u1ea1ch qua b\u1ea7u \u0111\u1ebfm gi\u1ecdt ngay sau khi pha thu\u1ed1c tr\u00e1nh ti\u1ebfp x\u00fac tr\u1ef1c ti\u1ebfp v\u1edbi \u00e1nh s\u00e1ng m\u1eb7t tr\u1eddi (c\u00f3 th\u1ec3 \u0111\u1ec3 \u00e1nh s\u00e1ng ph\u00f2ng).<\/p>\n<p>\u2014 Truy\u1ec1n t\u0129nh m\u1ea1ch qua b\u1ea7u \u0111\u1ebfm gi\u1ecdt (ho\u1eb7c m\u00e1y truy\u1ec1n d\u1ecbch) t\u1ed1c \u0111\u1ed9 1ml\/ph\u00fat (60 mL\/h).<\/p>\n<p>\u2014 Truy\u1ec1n \u0111\u01b0\u1ee3c 60 mL th\u00ec d\u1eebng truy\u1ec1n (t\u01b0\u01a1ng \u1ee9ng \u0111\u00e3 truy\u1ec1n \u0111\u01b0\u1ee3c 200 mg Sporanox), b\u1ecf 15 ml c\u00f2n l\u1ea1i. Tr\u00e1ng d\u00e2y truy\u1ec1n d\u1ecbch b\u1eb1ng 20 mL natri chloride 0,9%.<\/p>\n<p>&#8211; R\u00fat b\u1ecf d\u00e2y truy\u1ec1n d\u1ecbch, d\u00e2y n\u1ed1i kh\u00f3a van (kh\u00f4ng s\u1eed d\u1ee5ng \u0111\u01b0\u1eddng truy\u1ec1n n\u00e0y \u0111\u1ec3 truy\u1ec1n c\u00e1c thu\u1ed1c ti\u1ebfp theo).<\/p>\n<p>\u2014 Theo d\u00f5i: ch\u1ee9c n\u0103ng gan, th\u1eadn, c\u00f4ng th\u1ee9c m\u00e1u, \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 m\u1ed9t tu\u1ea7n\/m\u1ed9t l\u1ea7n.<\/p>\n<p>\u2014 Sau \u0111\u00f3 chuy\u1ec3n \u0111i\u1ec1u tr\u1ecb duy tr\u00ec thu\u1ed1c \u0111\u01b0\u1eddng u\u1ed1ng v\u1edbi li\u1ec1u 200 mg\/ng\u00e0y x3 th\u00e1ng.<\/p>\n<p>\u2014 \u0110\u1ed9c t\u00ednh v\u00e0 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c: C\u00e1c thu\u1ed1c kh\u00e1ng acid, ch\u1eb9n k\u00eanh caleium (amlodipin, nifedipin); h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft khi cho \u0111\u1ed3ng th\u1eddi sulfonylureas; t\u0103ng<br \/>\nn\u1ed3ng \u0111\u1ed9 tacrolimus v\u00e0 cyclosporin trong huy\u1ebft t\u01b0\u01a1ng khi s\u1eed d\u1ee5ng li\u1ec1u cao. Hi\u1ec7n t\u01b0\u1ee3ng ti\u00eau c\u01a1 v\u00e2n khi cho v\u1edbi c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf enzym HMG-CoA reductase<br \/>\n(atorvastatin, simvastatin). Khi cho c\u00f9ng cisaprid c\u00f3 th\u1ec3 g\u00e2y b\u1ea5t th\u01b0\u1eddng nh\u1ecbp tim v\u00e0 th\u1eadm ch\u00ed t\u1eed vong; t\u0103ng n\u1ed3ng \u0111\u1ed9 digoxin trong m\u00e1u; t\u0103ng n\u1ed3ng \u0111\u1ed9 midazolam, triazolam trong huy\u1ebft t\u01b0\u01a1ng; c\u00f3 th\u1ec3 gi\u1ea3m t\u00e1c d\u1ee5ng c\u1ee7a phenytoin v\u00e0 rifampicin.<\/p>\n<h2>3. \u0110i\u1ec1u tr\u1ecb n\u1ea5m ph\u1ed5i do Candida<\/h2>\n<p>D\u00f9ng thu\u1ed1c kh\u00e1ng n\u1ea5m:<\/p>\n<p>\u2014 Amphotericin B (lo\u1ea1i tan trong n\u01b0\u1edbc) li\u00eau 0,5 &#8211; 1 mg\/kg\/ng\u00e0y. Th\u1eddi gian t\u1eeb 4-6 tu\u1ea7n, ph\u1ed1i h\u1ee3p v\u1edbi flucytosin cytosin 100-200 mg\/kg\/ng\u00e0y.<\/p>\n<p>&#8211; D\u00f9ng Amphotericin B th\u00f4ng th\u01b0\u1eddng hay \u0111\u1ed9c v\u1edbi gan n\u00ean ng\u01b0\u1eddi ta khuy\u00ean d\u00f9ng liposomal amphotericin B li\u1ec1u 3-5 mg\/kg\/ng\u00e0y truy\u1ec1n t\u0129nh m\u1ea1ch.<br \/>\nTh\u1eddi gian c\u0169ng ph\u1ea3i b\u1ea3o \u0111\u1ea3m 4 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>&#8211; L\u01b0u \u00fd: c\u1ea7n b\u1ed5 sung kali v\u00e0 theo d\u00f5i s\u00e1t \u0111i\u1ec7n gi\u1ea3i \u0111\u1ed3 c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3<br \/>\nb\u00f9 kali k\u1ecbp th\u1eddi.<\/p>\n<p>Khi c\u00f3 n\u1ea5m th\u1ef1c qu\u1ea3n do Candida k\u00e8m theo:<\/p>\n<p>+ Ketoconazol 200-400 mg\/ng\u00e0y, th\u1eddi gian 1-2 tu\u1ea7n<\/p>\n<p>+ Fluconazol 100-200 mg\/ng\u00e0y, th\u1eddi gian 1-2 tu\u1ea7n<\/p>\n<p>+ Ho\u1eb7c itraconazol 200-400 mg\/ng\u00e0y k\u00e9o d\u00e0i 2 tu\u1ea7n.<\/p>\n<h2>4. \u0110i\u1ec1u tr\u1ecb n\u1ea5m ph\u1ed5i do Cryptococus<\/h2>\n<p>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n nhi\u1ec5m n\u1ea5m ph\u1ed5i cryptococcus n\u1eb7ng, kh\u00f4ng ph\u1ea3i nhi\u1ec5m HIV, n\u00ean t\u1ea5n c\u00f4ng b\u1eb1ng amphotericin B (lo\u1ea1i tan trong n\u01b0\u1edbc) li\u1ec1u 0,7 &#8211; 1 mg\/kg\/ng\u00e0y, th\u1eddi gian t\u1eeb 4 tu\u1ea7n ph\u1ed1i h\u1ee3p v\u1edbi flucytosin 100 mg\/ng\u00e0y u\u1ed1ng chia l\u00e0m 4 l\u1ea7n trong 4 tu\u1ea7n r\u1ed3i \u0111i\u1ec1u tr\u1ecb c\u1ee7ng c\u1ed1 b\u1eb1ng fluconazol 400 mg\/ng\u00e0y th\u1eddi gian 8 tu\u1ea7n. U c\u00f3 nhi\u1ec1u \u0111\u1ed9c t\u00ednh v\u1edbi amphotericin B lo\u1ea1i tan trong n\u01b0\u1edbc th\u00ec d\u00f9ng liposomal amphotericin B. \u0110i\u1ec1u tr\u1ecb duy tr\u00ec fluconazol 200 mg\/ng\u00e0y th\u1eddi gian 6 th\u00e1ng.<\/p>\n<p>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n nhi\u1ec5m n\u1ea5m ph\u1ed5i Cryptococcus nh\u1eb9 c\u00f3 th\u1ec3 d\u00f9ng fluconazol 400 mg\/ng\u00e0y th\u1eddi gian 6- 12 th\u00e1ng.<\/p>\n<p>&nbsp;<\/p>\n<p>Ngu\u1ed3n: B\u1ed9 Y t\u1ebf 2012, H\u01b0\u1edbng d\u1eabn ch\u1ea9n \u0111o\u00e1n b\u1ec7nh l\u00fd h\u00f4 h\u1ea5p.<\/p>\n<p>Limper AH, Knox KS, Sarosi GA, Ampel NM, Bennett JE, Catanzaro A, Davies SF, Dismukes WE, Hage CA, Marr KA, Mody CH, Perfect JR, Stevens DA; American Thoracic Society Fungal Working Group. An official American Thoracic Society statement: Treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med. 2011 Jan 1;183(1):96-128.<\/p>\n<p><a href=\"https:\/\/vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/chan-doan-va-dieu-tri-nam-phoi\/\">Ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ea5m ph\u1ed5i<\/a><\/p>\n<div class=\"share\"><\/div>\n","protected":false},"excerpt":{"rendered":"<p>B\u1ec7nh n\u1ea5m ph\u1ed5i th\u01b0\u1eddng l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a m\u1ed9t t\u00ecnh tr\u1ea1ng suy gi\u1ea3m mi\u1ec5n d\u1ecbch: HIV, s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf mi\u1ec5n d\u1ecbch nh\u01b0 h\u00f3a ch\u1ea5t \u0111i\u1ec1u tr\u1ecb ung th\u01b0, corticoid k\u00e9o d\u00e0i, thu\u1ed1c ch\u1ed1ng th\u1ea3i gh\u00e9p, b\u1ec7nh h\u1ec7 th\u1ed1ng ho\u1eb7c n\u1ea5m ph\u00e1t tri\u1ec3n tr\u00ean n\u1ec1n c\u1ee7a m\u1ed9t t\u1ed5n th\u01b0\u01a1ng ph\u1ed5i c\u00f3 tr\u01b0\u1edbc nh\u01b0 [&hellip;]<\/p>\n","protected":false},"author":69,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[20,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>N\u1ea5m ph\u1ed5i: c\u00e1c nh\u00f3m thu\u1ed1c v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a B\u1ed9 Y t\u1ebf - Vinmec<\/title>\n<meta name=\"description\" content=\"N\u1ea5m ph\u1ed5i g\u1ed3m th\u1ec3 c\u1ed5 \u0111i\u1ec3n v\u00e0 c\u01a1 h\u1ed9i, v\u1edbi 3 t\u00e1c nh\u00e2n: Aspergillus, Candida, Cryptococcus. \u0110i\u1ec1u tr\u1ecb g\u1ed3m polyens, triazole ph\u1ed5 r\u1ed9ng, echinocandin\" \/>\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=\"N\u1ea5m ph\u1ed5i: c\u00e1c nh\u00f3m thu\u1ed1c v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a B\u1ed9 Y t\u1ebf - Vinmec\" \/>\n<meta property=\"og:description\" content=\"N\u1ea5m ph\u1ed5i g\u1ed3m th\u1ec3 c\u1ed5 \u0111i\u1ec3n v\u00e0 c\u01a1 h\u1ed9i, v\u1edbi 3 t\u00e1c nh\u00e2n: Aspergillus, Candida, Cryptococcus. \u0110i\u1ec1u tr\u1ecb g\u1ed3m polyens, triazole ph\u1ed5 r\u1ed9ng, echinocandin\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-29T12:21:21+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-04-29T12:24:17+00:00\" \/>\n<meta name=\"author\" content=\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/\",\"name\":\"N\u1ea5m ph\u1ed5i: c\u00e1c nh\u00f3m thu\u1ed1c v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a B\u1ed9 Y t\u1ebf - Vinmec\",\"isPartOf\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\"},\"datePublished\":\"2023-04-29T12:21:21+00:00\",\"dateModified\":\"2023-04-29T12:24:17+00:00\",\"author\":{\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e\"},\"description\":\"N\u1ea5m ph\u1ed5i g\u1ed3m th\u1ec3 c\u1ed5 \u0111i\u1ec3n v\u00e0 c\u01a1 h\u1ed9i, v\u1edbi 3 t\u00e1c nh\u00e2n: Aspergillus, Candida, Cryptococcus. \u0110i\u1ec1u tr\u1ecb g\u1ed3m polyens, triazole ph\u1ed5 r\u1ed9ng, echinocandin\",\"breadcrumb\":{\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/noithathoaphat.in\/ctv\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"N\u1ea5m ph\u1ed5i: c\u00e1c nh\u00f3m thu\u1ed1c v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a B\u1ed9 Y t\u1ebf\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#website\",\"url\":\"https:\/\/noithathoaphat.in\/ctv\/\",\"name\":\"Vinmec\",\"description\":\"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e\",\"name\":\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/\",\"url\":\"http:\/\/1.gravatar.com\/avatar\/d8b9ad8e288884ecf4bc8ee441f3596b?s=96&d=mm&r=g\",\"contentUrl\":\"http:\/\/1.gravatar.com\/avatar\/d8b9ad8e288884ecf4bc8ee441f3596b?s=96&d=mm&r=g\",\"caption\":\"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n\"},\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/meogods1234gmail-com\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"N\u1ea5m ph\u1ed5i: c\u00e1c nh\u00f3m thu\u1ed1c v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a B\u1ed9 Y t\u1ebf - Vinmec","description":"N\u1ea5m ph\u1ed5i g\u1ed3m th\u1ec3 c\u1ed5 \u0111i\u1ec3n v\u00e0 c\u01a1 h\u1ed9i, v\u1edbi 3 t\u00e1c nh\u00e2n: Aspergillus, Candida, Cryptococcus. \u0110i\u1ec1u tr\u1ecb g\u1ed3m polyens, triazole ph\u1ed5 r\u1ed9ng, echinocandin","robots":{"index":"noindex","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"og_locale":"en_US","og_type":"article","og_title":"N\u1ea5m ph\u1ed5i: c\u00e1c nh\u00f3m thu\u1ed1c v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a B\u1ed9 Y t\u1ebf - Vinmec","og_description":"N\u1ea5m ph\u1ed5i g\u1ed3m th\u1ec3 c\u1ed5 \u0111i\u1ec3n v\u00e0 c\u01a1 h\u1ed9i, v\u1edbi 3 t\u00e1c nh\u00e2n: Aspergillus, Candida, Cryptococcus. \u0110i\u1ec1u tr\u1ecb g\u1ed3m polyens, triazole ph\u1ed5 r\u1ed9ng, echinocandin","og_url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/","og_site_name":"Vinmec","article_published_time":"2023-04-29T12:21:21+00:00","article_modified_time":"2023-04-29T12:24:17+00:00","author":"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n","Est. reading time":"7 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/","url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/","name":"N\u1ea5m ph\u1ed5i: c\u00e1c nh\u00f3m thu\u1ed1c v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a B\u1ed9 Y t\u1ebf - Vinmec","isPartOf":{"@id":"https:\/\/noithathoaphat.in\/ctv\/#website"},"datePublished":"2023-04-29T12:21:21+00:00","dateModified":"2023-04-29T12:24:17+00:00","author":{"@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e"},"description":"N\u1ea5m ph\u1ed5i g\u1ed3m th\u1ec3 c\u1ed5 \u0111i\u1ec3n v\u00e0 c\u01a1 h\u1ed9i, v\u1edbi 3 t\u00e1c nh\u00e2n: Aspergillus, Candida, Cryptococcus. \u0110i\u1ec1u tr\u1ecb g\u1ed3m polyens, triazole ph\u1ed5 r\u1ed9ng, echinocandin","breadcrumb":{"@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/"]}]},{"@type":"BreadcrumbList","@id":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/29\/nam-phoi-cac-nhom-thuoc-va-phac-do-dieu-tri-cua-bo-y-te\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/noithathoaphat.in\/ctv\/"},{"@type":"ListItem","position":2,"name":"N\u1ea5m ph\u1ed5i: c\u00e1c nh\u00f3m thu\u1ed1c v\u00e0 ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u1ee7a B\u1ed9 Y t\u1ebf"}]},{"@type":"WebSite","@id":"https:\/\/noithathoaphat.in\/ctv\/#website","url":"https:\/\/noithathoaphat.in\/ctv\/","name":"Vinmec","description":"H\u1ec7 th\u1ed1ng Y t\u1ebf Vinmec","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/noithathoaphat.in\/ctv\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/b812b6273d037966dff4008e0eed896e","name":"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/noithathoaphat.in\/ctv\/#\/schema\/person\/image\/","url":"http:\/\/1.gravatar.com\/avatar\/d8b9ad8e288884ecf4bc8ee441f3596b?s=96&d=mm&r=g","contentUrl":"http:\/\/1.gravatar.com\/avatar\/d8b9ad8e288884ecf4bc8ee441f3596b?s=96&d=mm&r=g","caption":"Nguy\u1ec5n Ch\u00ed Nguy\u1ec7n"},"url":"http:\/\/noithathoaphat.in\/ctv\/index.php\/author\/meogods1234gmail-com\/"}]}},"_links":{"self":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/29509"}],"collection":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/users\/69"}],"replies":[{"embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/comments?post=29509"}],"version-history":[{"count":2,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/29509\/revisions"}],"predecessor-version":[{"id":29526,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/posts\/29509\/revisions\/29526"}],"wp:attachment":[{"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/media?parent=29509"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/categories?post=29509"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/noithathoaphat.in\/ctv\/index.php\/wp-json\/wp\/v2\/tags?post=29509"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}