{"id":32882,"date":"2023-05-10T20:12:24","date_gmt":"2023-05-10T13:12:24","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=32882"},"modified":"2023-05-10T20:12:24","modified_gmt":"2023-05-10T13:12:24","slug":"tieu-chay-lien-quan-den-khang-sinh-dieu-tri-va-du-phong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/10\/tieu-chay-lien-quan-den-khang-sinh-dieu-tri-va-du-phong\/","title":{"rendered":"Ti\u00eau ch\u1ea3y li\u00ean quan \u0111\u1ebfn kh\u00e1ng sinh: \u0110i\u1ec1u tr\u1ecb v\u00e0 D\u1ef1 ph\u00f2ng"},"content":{"rendered":"

Ti\u00eau ch\u1ea3y l\u00e0 m\u1ed9t t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n m\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 g\u1eb7p ph\u1ea3i khi s\u1eed d\u1ee5ng kh\u00e1ng sinh trong \u0111i\u1ec1u tr\u1ecb, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng. Ti\u00eau ch\u1ea3y li\u00ean quan \u0111\u1ebfn s\u1eed d\u1ee5ng kh\u00e1ng sinh c\u00f3 h\u00ecnh th\u00e1i r\u1ea5t \u0111a d\u1ea1ng, c\u00f3 th\u1ec3 ch\u1ec9 l\u00e0 \u0111\u1ee3t ti\u00eau ch\u1ea3y \u0111\u01a1n thu\u1ea7n, kh\u00f4ng \u1ea3nh h\u01b0\u1edfng t\u1ed5n tr\u1ea1ng ho\u1eb7c b\u1ec7nh c\u1ea3nh vi\u00eam \u0111\u1ea1i tr\u00e0ng gi\u1ea3 m\u1ea1c nguy hi\u1ec3m, th\u1eadm ch\u00ed c\u00f3 th\u1ec3 g\u1eb7p m\u1ed9t s\u1ed1 bi\u1ebfn ch\u1ee9ng n\u1eb7ng n\u1ec1. Ti\u00eau ch\u1ea3y li\u00ean quan \u0111\u1ebfn kh\u00e1ng sinh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng b\u1eb1ng nhi\u1ec1u bi\u1ec7n ph\u00e1p kh\u00e1c nhau.<\/strong><\/p>\n

1. Nguy\u00ean nh\u00e2n g\u00e2y ti\u00eau ch\u1ea3y li\u00ean quan kh\u00e1ng sinh<\/h2>\n

Ti\u00eau ch\u1ea3y l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p, kh\u00f4ng ch\u1ec9 \u1edf nh\u1eefng r\u1ed1i lo\u1ea1n c\u1ee7a c\u00e1c c\u01a1 qua ti\u00eau h\u00f3a m\u00e0 c\u00f2n c\u1ea3 c\u00e1c c\u01a1 quan ngo\u00e0i ti\u00eau h\u00f3a. \u0110\u1ecbnh ngh\u0129a ti\u00eau ch\u1ea3y \u0111\u01b0\u1ee3c ch\u1ea5p thu\u1eadn v\u00e0 s\u1eed d\u1ee5ng ph\u1ed5 bi\u1ebfn nh\u1ea5t l\u00e0 \u0111\u1ecbnh ngh\u0129a ti\u00eau ch\u1ea3y c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf gi\u1edbi (WHO): Ti\u00eau ch\u1ea3y (diarrhea) l\u00e0 khi \u0111i ti\u00eau t\u1eeb ba l\u1ea7n tr\u1edf l\u00ean ho\u1eb7c l\u00e0 ph\u00e2n tr\u1edf n\u00ean l\u1ecfng h\u01a1n ho\u1eb7c l\u00e0 \u0111i ph\u00e2n v\u1edbi l\u01b0\u1ee3ng nhi\u1ec1u h\u01a1n so v\u1edbi b\u00ecnh th\u01b0\u1eddng.<\/p>\n

Ti\u00eau ch\u1ea3y c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n m\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 g\u1eb7p ph\u1ea3i khi s\u1eed d\u1ee5ng kh\u00e1ng sinh v\u00e0 c\u00f3 th\u1ec3 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a nhi\u1ec1u c\u01a1 ch\u1ebf kh\u00e1c nhau. D\u1ea1ng th\u01b0\u1eddng g\u1eb7p nh\u1ea5t c\u1ee7a c\u00e1c h\u00ecnh th\u00e1i ti\u00eau ch\u1ea3y sau s\u1eed d\u1ee5ng kh\u00e1ng sinh \u0111\u01b0\u1ee3c g\u1ecdi l\u00e0 Ti\u00eau ch\u1ea3y li\u00ean quan \u0111\u1ebfn kh\u00e1ng sinh (antibiotic-associated diarrhea – AAD).<\/p>\n

Nguy\u00ean nh\u00e2n c\u1ee7a ADD \u0111\u01b0\u1ee3c cho l\u00e0 kh\u00f4ng ph\u1ea3i do m\u1ed9t nhi\u1ec5m tr\u00f9ng th\u1ef1c s\u1ef1, m\u00e0 thay v\u00e0o \u0111\u00f3 l\u00e0 do s\u1ef1 r\u1ed1i lo\u1ea1n h\u1ec7 vi sinh v\u1eadt \u0111\u01b0\u1eddng ru\u1ed9t. S\u1ef1 r\u1ed1i lo\u1ea1n n\u00e0y g\u00e2y ra nhi\u1ec1u thay \u0111\u1ed5i li\u00ean quan \u0111\u1ebfn chuy\u1ec3n h\u00f3a v\u00e0 nhu \u0111\u1ed9ng c\u1ee7a ru\u1ed9t. S\u1ef1 r\u1ed1i lo\u1ea1n h\u1ec7 vi sinh v\u1eadt c\u00f3 th\u1ec3 thay \u0111\u1ed5i s\u1ef1 ti\u00eau h\u00f3a c\u1ee7a c\u00e1c carbohydrate, c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m qu\u00e1 tr\u00ecnh gi\u1ea3i li\u00ean h\u1ee3p h\u00f3a (deconjugation) c\u1ee7a mu\u1ed1i m\u1eadt, g\u00e2y t\u0103ng t\u00ednh th\u1ea5m c\u1ee7a th\u00e0nh ru\u1ed9t, l\u00e0m cho bi\u1ec3u m\u00f4 \u0111\u1ea1i tr\u00e0ng t\u0103ng b\u00e0i ti\u1ebft d\u1ecbch v\u00e0o b\u00ean trong l\u00f2ng ru\u1ed9t.<\/p>\n

AAD c\u00f2n c\u00f3 th\u1ec3 l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1\u00a0 ph\u00e1t tri\u1ec3n b\u1ea5t th\u01b0\u1eddng c\u1ee7a c\u00e1c vi khu\u1ea9n thu\u1ed9c h\u1ec7 vi sinh v\u1eadt \u0111\u01b0\u1eddng ru\u1ed9t k\u00e8m theo s\u1ef1 bi\u1ec3u hi\u1ec7n c\u1ee7a c\u00e1c \u0111\u1ed9c t\u1ed1 ru\u1ed9t g\u00e2y ti\u00eau ch\u1ea3y. M\u1ed9t s\u1ed1 vi khu\u1ea9n th\u01b0\u1eddng \u0111\u01b0\u1ee3c ph\u00e2n l\u1eadp \u1edf b\u1ec7nh nh\u00e2n AAD g\u1ed3m Clostridium perfringens<\/em> lo\u1ea1i A, Klebsiella oxytoca\u00a0<\/em>v\u00e0 \u0111\u00f4i khi Staphylococcus aureus.\u00a0\u00a0<\/em><\/p>\n

AAD\u00a0 x\u1ea3y ra trong kho\u1ea3ng t\u1eeb\u00a0 2% \u0111\u1ebfn 25% c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh, ph\u1ed5 bi\u1ebfn h\u01a1n trong qu\u00e1 tr\u00ecnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ampicilin, amoxicilin-clavulanate ho\u1eb7c cefixim.<\/p>\n

\u0110\u1ecbnh ngh\u0129a v\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a ADD, c\u00f9ng v\u1edbi c\u00e1c h\u00ecnh th\u00e1i ti\u00eau ch\u1ea3y n\u1eb7ng khi c\u00f3 s\u1eed d\u1ee5ng kh\u00e1ng sinh (vi\u00eam \u0111\u1ea1i tr\u00e0ng gi\u1ea3 m\u1ea1c) \u0111\u01b0\u1ee3c gi\u1edbi thi\u1ec7u v\u00e0 b\u00e0n lu\u1eadn ri\u00eang \u1edf c\u00e1c b\u00e0i vi\u1ebft tr\u00ean chuy\u00ean trang VinmecDr<\/a>.<\/p>\n

2. \u0110i\u1ec1u tr\u1ecb v\u00e0 d\u1ef1 ph\u00f2ng ti\u00eau ch\u1ea3y li\u00ean quan kh\u00e1ng sinh<\/strong><\/h2>\n
\"Minh-hoa-tieu-chay-do-khang-sinh\"
Kh\u00e1ng sinh c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ti\u00eau ch\u1ea3y<\/figcaption><\/figure>\n

H\u1ea7u h\u1ebft c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u1ee7a AAD \u0111\u1ec1u nh\u1eb9 v\u00e0 t\u1ef1 gi\u1edbi h\u1ea1n, kh\u00f4ng k\u00e8m theo s\u1ed1t, kh\u00f4ng c\u00f3 d\u1ea5u hi\u1ec7u c\u1ee7a vi\u00eam \u0111\u1ea1i tr\u00e0ng gi\u1ea3 m\u1ea1c v\u00e0 nh\u1eefng bi\u1ebfn ch\u1ee9ng n\u1eb7ng. Qu\u1ea3n l\u00fd c\u1ee7a AAD bao g\u1ed3m ng\u1eebng s\u1eed d\u1ee5ng kh\u00e1ng sinh g\u00e2y ra b\u1ec7nh n\u1ebfu c\u00f3 th\u1ec3. N\u1ebfu ti\u00eau ch\u1ea3y c\u00f3 m\u1ee9c \u0111\u1ed9 trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng, c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf nhu \u0111\u1ed9ng ru\u1ed9t (v\u00ed d\u1ee5 nh\u01b0 loperamid) ho\u1eb7c bismuth subsalicylate c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng.<\/p>\n

B\u1edfi v\u00ec AAD \u0111\u01b0\u1ee3c cho l\u00e0 k\u1ebft qu\u1ea3 c\u1ee7a s\u1ef1 thay \u0111\u1ed5i c\u1ee7a vi sinh v\u1eadt \u0111\u01b0\u1eddng ru\u1ed9t b\u00ecnh th\u01b0\u1eddng, nhi\u1ec1u lo\u1ea1i probiotic \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o nghi\u00ean c\u1ee9u trong \u0111i\u1ec1u tr\u1ecb v\u00e0 ph\u00f2ng ng\u1eeba c\u00e1c h\u00ecnh th\u00e1i ti\u00eau ch\u1ea3y c\u00f3 s\u1eed d\u1ee5ng kh\u00e1ng sinh. Probiotics \u0111\u01b0\u1ee3c hi\u1ec3u l\u00e0 nh\u1eefng vi sinh v\u1eadt c\u00f3 nh\u1eefng \u0111\u1eb7c t\u00ednh c\u00f3 l\u1ee3i cho k\u00fd ch\u1ee7. Probiotics t\u01b0\u01a1ng t\u00e1c v\u1edbi h\u1ec7 vi sinh v\u1eadt c\u1ee7a k\u00ed ch\u1ee7 v\u00e0 mang t\u1edbi nh\u1eefng t\u00e1c \u0111\u1ed9ng c\u00f3 l\u1ee3i v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh r\u00f5 r\u00e0ng. Nh\u00ecn chung, probiotics c\u00f3 th\u1ec3 gi\u00fap: \u1ee8c ch\u1ebf s\u1ef1 ph\u00e1t tri\u1ec3n\u00a0 c\u1ee7a c\u00e1c vi khu\u1ea9n g\u00e2y b\u1ec7nh, C\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng c\u1ee7a bi\u1ec3u m\u00f4 ru\u1ed9t, \u0110i\u1ec1u ch\u1ec9nh h\u1ec7 th\u1ed1ng mi\u1ec5n d\u1ecbch, \u0110i\u1ec1u ch\u1ec9nh qu\u00e1 tr\u00ecnh nh\u1eadn c\u1ea3m v\u00e0 nhu \u0111\u1ed9ng c\u1ee7a ru\u1ed9t.<\/p>\n

Trong m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng, vi\u00ean nang \u0111\u01b0\u1eddng u\u1ed1ng ch\u1ee9a Saccharomyces boulardii<\/em> s\u1ed1ng, m\u1ed9t lo\u1ea1i n\u1ea5m men kh\u00f4ng g\u00e2y b\u1ec7nh, \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi kh\u00e1ng sinh. Li\u1ec1u k\u1ebft h\u1ee3p n\u00e0y \u0111\u00e3 gi\u1ea3m t\u1ea7n su\u1ea5t AAD \u1edf b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n t\u1eeb 22% trong nh\u00f3m \u0111\u1ed1i ch\u1ee9ng gi\u1ea3 d\u01b0\u1ee3c xu\u1ed1ng c\u00f2n 9,5% trong nh\u00f3m s\u1eed d\u1ee5ng S. boulardii.<\/em> Tuy nhi\u00ean, m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean, ki\u1ec3m so\u00e1t gi\u1ea3 d\u01b0\u1ee3c kh\u00e1c l\u1ea1i kh\u00f4ng ch\u1ee9ng minh \u0111\u01b0\u1ee3c t\u00e1c d\u1ee5ng c\u00f3 l\u1ee3i c\u1ee7a S. boulardii<\/em> \u0111\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u1edbn tu\u1ed5i c\u00f3 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh.<\/p>\n

C\u00e1c lo\u00e0i Lactobacillus<\/em>, \u0111\u1eb7c bi\u1ec7t l\u00e0 Lactobacillus rhamnosus<\/em> GG, c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u1ec1 AAD. Trong m\u1ed9t nghi\u00ean c\u1ee9u v\u1ec1 tr\u1ebb em \u0111ang \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p b\u1eb1ng kh\u00e1ng sinh, Lactobacillus<\/em> GG \u0111\u00e3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c gi\u1ea3m t\u1ea7n su\u1ea5t AAD xu\u1ed1ng c\u00f2n 5% so v\u1edbi 16% trong nh\u00f3m \u0111\u1ed1i ch\u1ee9ng gi\u1ea3 d\u01b0\u1ee3c; c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng kh\u00e1c v\u1ec1 Lactobacillus<\/em> GG \u0111\u00e3 cho k\u1ebft qu\u1ea3 t\u00edch c\u1ef1c trong c\u1ea3i thi\u1ec7n t\u1ea7n su\u1ea5t AAD. T\u00e1m nghi\u00ean c\u1ee9u kh\u00e1c nhau \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o ph\u00e2n t\u00edch, trong \u0111\u00f3 c\u00f3 4 nghi\u00ean c\u1ee9u s\u1eed d\u1ee5ng S. boulardii<\/em> v\u00e0 4 nghi\u00ean c\u1ee9u s\u1eed d\u1ee5ng Lactobacillus<\/em> GG. T\u1ec9 s\u1ed1 odds (OD) cho AAD trong c\u00e1c nh\u00f3m \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb probiotics l\u00e0 0,37 so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c (kho\u1ea3ng tin c\u1eady 95% [CI]: 0,26-0,53; P <0,001). \u0110\u1ed1i v\u1edbi S. boulardii<\/em>, OR \u1ee7ng h\u1ed9 \u0111i\u1ec1u tr\u1ecb h\u01a1n gi\u1ea3 d\u01b0\u1ee3c l\u00e0 0,39 v\u00e0 \u0111\u1ed1i v\u1edbi Lactobac<\/em>illi, OR l\u00e0 0,34.<\/p>\n

M\u1ed9t ph\u00e2n t\u00edch to\u00e0n di\u1ec7n v\u00e0 t\u1ed5ng h\u1ee3p g\u1ea7n \u0111\u00e2y c\u0169ng \u0111\u00e3 xem x\u00e9t hi\u1ec7u qu\u1ea3 v\u00e0 kh\u1ea3 n\u0103ng dung n\u1ea1p c\u1ee7a c\u00e1c probiotics cho AAD. C\u00e1c t\u00e1c gi\u1ea3 \u0111\u00e3 t\u00ecm th\u1ea5y r\u1eb1ng L. rhamnosus<\/em> GG (LGG) c\u00f3 kh\u1ea3 n\u0103ng x\u1ebfp h\u1ea1ng t\u1ed1t nh\u1ea5t c\u1ea3 v\u1ec1 hi\u1ec7u qu\u1ea3 v\u00e0 \u0111\u1ed9 ch\u1ecbu \u0111\u1ef1ng trong d\u1ef1 ph\u00f2ng AAD.<\/p>\n

T\u00f3m l\u1ea1i, c\u00e1c b\u1eb1ng ch\u1ee9ng \u0111\u00e3 c\u00f4ng b\u1ed1 cho th\u1ea5y r\u1eb1ng c\u00e1c probiotics nh\u01b0 LGG v\u00e0 S. boulardii<\/em>, khi \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ph\u00f2ng ng\u1eeba k\u1ebft h\u1ee3p v\u1edbi kh\u00e1ng sinh, gi\u1ea3m nguy c\u01a1 m\u1eafc AAD. \u0110i\u1ec1u tr\u1ecb n\u00e0y c\u00f3 th\u1ec3 \u0111\u1eb7c bi\u1ec7t c\u00f3 l\u1ee3i cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 ti\u1ec1n s\u1eed d\u1ec5 b\u1ecb AAD.<\/p>\n","protected":false},"excerpt":{"rendered":"

Ti\u00eau ch\u1ea3y l\u00e0 m\u1ed9t t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n m\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 g\u1eb7p ph\u1ea3i khi s\u1eed d\u1ee5ng kh\u00e1ng sinh trong \u0111i\u1ec1u tr\u1ecb, \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c kh\u00e1ng sinh ph\u1ed5 r\u1ed9ng. 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