Y HQC VigT NAM THANG 2 - S6' 2/2013 Joseph Sim (1977), minor tooth In children,
Mosby edition 2 ed, pp 272-301.
Movers, R.E. et al (1980),"Differentiai Diagnosis of Class II Maiocclusions. "American Journal of Orthodontics. 78:477-494.
Bech R W (1978), Bioprogressive therapy, part V, Joumal of dinical Orthodontics, N" pp 48-92.
Kerosuo H {1990). Ocdusion In the pnmary and early mixed dendtkjns in in a group of Tanzanlan and Finnish chiidren.PS\yC J Dent Child; vol 57:293-8.
Kurol 2, Berglund L (1992). Longitudinal study and cost-ijenefit analysis of the effect of early treatment of postenor crosstJite in tte primary dendtfon.Eur J Orthod; vol 14:173-9.
DANH GIA HIEU QUA DIEU TRj VIEM KE DO VI KHU^N B A N G KHANG SINH
T 6 M TAT:
Mi^c tieu: danh gia hieu qua dieu tri viem ke do VI khuan bSng boi m3 Bactroban va uong Rovamycin.
Phu'cfng phap: tien cdu; thd nghiem lam sang, so sanh tri/dc, sau dieu tn gom 30 benh nhan du'dc chan doan xac dinh la viem ke do vi khuan tai Benh vien Da lieu Trung u'dng va Khoa Da lieu Benh vien Bach I^ai tu' thang 3 den thang 9 nam 2012. Ket qua: viem ke do vi khuan mu'c dp nhe va trung binh dieu tri bSng m8 Bactroban ddn tliuan sau 1 tuan ket qua khoi tot la 58,8%, trung binh la 41,2%, khong co ket qua kem, vi khuan am tinh hoan toan (100%). Sau 2 tuan dieu tri 100% tru'dng hdp dat ket qua rat tot va tot. Viem ke do vi khuan nang dung phoi hop boi md Bactroban va uong Rovamycin sau 2 tuan ket qua khoi rat tot la 30,8%, tot la 38,5% (cong ket qua tot va rat tot ia 69,3%), trung binh la 30,8%. Vi khuan am tfnh sau 1 tuan dieu tri dat 76,9%, sau 2 tuan mdi dat 100%.
Chu^ thay tac dung khong mong muon nao d tai cho cung nhu toan than do dung md Bactroban va Rovamycin. Ket lu?n: viem ke do vi triing nhe va trung binh dieu tri bang khang sinh tai cho dOn thuan rat hieu qua, tru'dng hdp nang can phoi hdp vdi khang sinh toan than, phoi hdp vdi Rovamicin hieu qua khong cao.
TO'khoa: viem ke, dieu tri viem ke, ham ke.
SUMMARY:
ASSESS EFFICACY OF ANTIBIOTICS IN THE TREATMENT OF BACTERIAL INTERTRIGO
Objective: to assess the efficacy of topical Bactroban and oral Rovamycin in the treatment of bacteria-induced-intertrigo. Method: A prospective, clincai trial comparing efficacy before and after treatments of 30 patients having bacterla-induced- intertrigo at National Hospital of Dermatology and Venereology and Dermatology Department of Bach Mai hospital from March to September 2012. Results: In ' B$nh vi$n BQch Mai. "B$nh vien Da li§u Tmng irang Phan bi?n khoa hpc: PGS.TS Nguyin Van Thu'dng
N g u y e n Thj M y H a * , T r a n V3n T i e n * *
the group of mild and moderate bacteria-induced- intertrigo, after a week treating solely with topical Bactroban, 58.8% of the patients recovered well, 41.2% of them recovered relatively and there was no unresponder; besides, 100% of these cases was negative with bacteria. After tvra weeks, 100% of this group recovered well and very well. Regarding to the group of severe bacteria-induced-intertrigo, after two- week-treatment with the combination of topical Bactroban to oral Rovamycin, 30.8% of the patients recovered very well, 38.5% of the patients recovered well (69.3% in total) and 30.8% of the patients recovered moderately. Relating to bacteria tests, 76.9% of the second group was negative after one week of treatment and this number reached to 100%
after two weeks. There was no local as well as systemic side-effecte seen on the treatment with topical Bactroban and oral Rovamycin. Condusions:mikJ and moderate bacteria-lnduced-interblgo responds well with topical antibiotics. Severer condltionsrequire a combination to systemic antibiotics, however, Rovamydn is not really efficacy.
Key words: intertngo, antibiobcs treatment
I.
DAT VANoi:
Viem ke la tinh trang viem d vung nep gap da, ndi co hai be mat tiep xuc nhau. Chan doan viem ke tu'dng doi de, dda vao trieu chi^g lam sang, vj tri thu'dng ton. Co nhieu nguyen nhan gay viem ke nhutig viem ke do vi khuan la rat hay gap [1],[2],[4],[5]. Viec xac dinh viem ke do vi khuan va lira chpn phu'dng phap dieu tri phu hdp vcli mu'c dp benh la can thiet. Vi vay, chung toi tien hanh de tai danh gia hieu qua dieu tri viem ke do vi khuan bang boi m9 Bactroban va uong Rovamycin.
Y HOC VIET NAM THANG 2 - S6 2/2013 II. OOI Tl/ONG VA PHUONG PHAP NGHIEN COU:
2.1. Doi tiftfng nghiSn cihi: gom 30 benh nhan bi viem ke do vi khuan den kham tai Binh vien Da Lieu Trung u'dng va khoa Da lieu, B^nh vien Bach Mai^tuT thang 3 den thang 9 nam 20i2.
Tieu chuan chpn: benh nhan bj viem ke, xet nghiem vi khuan du'dng tfnh, nam am tfnh, loai triy viem ke do benh da khac va nhij'ng tru'dng hdp khong dong y tham gia nghien cuXi.
2.2. Phi/tfng phap nghien cuTu: tien ciru, thir nghiem lam sang so sanh tru'dc- sau dieu tri, mau thuan tien gom cac benh nhan viem ke du'dc xac dinh la do vi khuan, chia lam hai nhom:
- Nhom I: gom 17 benh nhan viem ke do vi khuan miTc dp nhe va trung binh, du'dc boi m3 Bactroban ngay 2 IBn sang va toi, trong 10 ngay.
- Nhom II: gom 13 benh nhan viem ke do vi khuan miTc dp nang, boi m3 Bactroban ngay 2
III. K I T Q U A N G H I E N ClJfU:3.1. Ket qua deu trj blng boi md Bactroban ddn thuan (nhom I )
lan sang va toi, ket hpp uong Rovamycin lieu ngu'di Idn ngay 2 vien 3MIU, uong chia 2 lan sang va toi, trong 10 ngay; tre em > 20 kg: diing 200.000 lU/kg/ngay, udng chia 2 lan, trong 10 ngay; nhu nhi va tre em dung dang gdi 200.000 lU/kg/ngay, uong chia 2 lan, trong 10 ngay.
- Danh gia ket qua dieu tn sau 1 tuan va 2 tuan bang each tfnh t^ le phan tram tong diem cac trieu chirng lam sang giam, tinh theo cong thirc:
(Tong diem budc PT- Tong diem sau PT) Tdng diem tru'dc dieu tri ^
- Ket qua rat tot:giam 90-100%; tot: 70-<90%; trung binh: 50-<70%; kem <50%. Xet nghiem khong con vi khuan: ket qua tot, cdn vi khuan ket qua kem.
- Xir ly bang chu'dng trinh SPSS 18.0 vdi dp tin cay 95%.
Bang 3,1; Ket qua sau moi tuan dieu tr
^ ^ f f i gian Kit qua ^ ^ ^ ^ ^ ^ R^ttot
Tot Trunq binh
Kimcua niiom I (n=17) Sau 1 tu^n n
0 10 7 0
% 0 58,8 41,2 0
Sau 2 tuln n 6 11
0 0
35,3 %
64,7 0 0 Nhan xet: sau 1 tuan dieu tri nhdm I dat ket qua tot chiem ty le 58,8%, ket qua trung binh chiem ty le 41,2%. Sau 2 tuan dieu trj 100% dat ket qua rat tot va tot, khong tru'dng hdp nao la khong dap utig dieu trj.
Bang 3,2; Ket qua so
^^^^^^Tho-i gian K M q u a ^ ^ ^ ^ - ^ VK duonq tinh VK am tinh
tim vi i<huan sau 1 tuan dieu tri cua nhom I (n=17) Tru'O'c didu tri
n 17 0
100,0 %
Sau Ituan n 0 17
%
100,0 Nhan xit: sau 1 tuan dieu trj, hau het benh nhan nhdm I xet nghiem tim vi khuan am tinh.
3.2. Ket qua diSu trj bang boi Bactroban ket hdp uong Rovamicin (nhom I I ) Bang3,3;j6nq diem trieu chutig tru'cfc va sau dieu tri cua nhom II {n=13;
—^^r6ng diem IWiJC do b^nK^^^^
Nanq Trunq binh Nhe
Tru'd'c diiu trj 147
0 0
Sau diiu trj 23
0 0
IHieu qud diiu trj (%) 84.4
NhSn xet: sau 2 tuan dieu trj tong diem cac trieu chiJng lam sang giam du'dc 84,'!
Y HQC VI$T NAM THANG 2 . s 6 2/2013 Bang 3.4: Ket qua sau cac tuan dieu tri ciia nhdm II(n=13)
^ ^-.^^ThM gian Kit q u 4 ^ — - - ^ Rit tit
Tit Trunq binh K6m
Sau 1 tulin n
0 5 7 1
%
38,5 53,8 7,7
Sau 2 tuin n
4 5 4 0
30,8 %
38,5 30,8 Nh^n xit: sau 1 tuan dieu trj nhdm II dat ket qua tot chiem ty 1^ 38,5%, ket qua trung binh la 53,8%, ket qua kem 7,7%. Sau 2 tu3n ket qua rat tot va tot la 69,3%, ket qua trung binh la 30,8%, khong cd tru'dng hdp nao dat ket qua kem.
fli/jg J.5; Ket qua sol tim vi khuan sau cac tuan dieu trjciia nhdm II (n=13) Kit qui
VK du-onq tinh VK am tinh
Tru'd'c diiu trj n 13 0
100,0 % -
Sau 1tuin n 3 10
23,1 %
76,9
Sau 2 tuin n 0 13
%
100,0
Nhin xit: sau 1 tuan dieu tn ty le benh nhan d nhdm II xet nghiem vi khuan con du'dng tfnh la23,1%, sau 2 tuan mdi am tfnh hoan toan.
IV. BAN LUAN:
Dung md Bactroban ddn thuan dieu trj viem ke do vi khuan mire dp nhe va trung binh, ket qua ve lam sang tai bang 3.1 thay sau 1 tuan dieu trj da cd 58,8% benh nhan dat ket qua tot, tu'c la tong diem cac trieu chu'ng lam sang giam du'dc tir 70- <90%; ty le dat ket qua trung binh la 41,2%, tire la tong diem cac trieu chu'ng lam sang giam du'dc 50-<70%; khong cd tru'dng hdp nao cd ket qua kem. Sau 2 tuan dieu trj, cac trieu chutig lam sang hau nhu" du'dc cai thien hoan toan d tat ca cac benh nhan. Chi cdn mpt so it tru'dng hdp da ke cdn dd nhe. Pat ket qua rat tot va tot sau 2 tuan dieu trj la 100% tru'dng hdp.
Ket qua xet nghiem vi khuan tai bang 3.2 thay sau 1 tuan dieu trj, hau het cac benh nhan (100%) dUdc xet nghiem tim cac loai vi khuan deu am tfnh. Nhu' vay, tir ket qua lam sang va ket qua xet nghiem vi khuan, chiing tdi nhan thay doi vdi nhij'ng benh nhan bj viem ke d mdc dp nhe va trung binh chf can dieu trj bang bdi md Bactroban thi da dii de khdi benh hoan toan.
Benh d mire dp cang nhe thi bdi md Bactroban cang nhanh khdi. Cd the nhuhg tru'dng hdp viem ke do vi khuan d mii'c dp nhe thi thu'dng ton cd tinh chat tai cho, khu tru, thu'dng ton ndng, it anh hu'dng den toan than nen chi can diing thudc dieu trj tai cho da cd hieu qua tot. So vdi ket qua nghien ciru ciia Vdiger J.W va cdng su"
[6], bdi md Bactroban 3 lan/ngay trong 10 ngay thi cd 83% khdi benh va cd 23% benh nhan chi du'dc cai thien. Trong nghien cii'u ciia tac gia 90
nay, ddi tu'dng benh nhan gom tat ca nhii'ng tru'dng hdp bj nhiem trung da d cac mii'c dp n^ng khac nhau. Nghien cu'u cua chung toi, ddi tudng benh nhan la nhutig tru'dng hdp viem ke d miTc dp benh nhe va trung binh. Vi vay, ty I^ khoi benh trong nghien cii'u cue chung toi cao hdn so vdi ciia tac gia tren mSc du so lan boi thuoc trong ngay cho moi benh nhan ciia chung toi it hdn (2 lan/ngay).
Diing md Bactroban phoi hdp uong Rovamycin de dieu trj nhChig tru'dng hdp viem ke do vi khuan mu'c dp nSng, ket qua ve lam sang{bang 3.3) thay sau 1 tuan dieu tri, ty le benh nhan du'dc cai thien dat mu'c dp tot chiem 38,5%; mCrc dp trung binh la 53,8%; kem la 7,7%. Sau 2 tuan dieu trj thay dat rat tot la 30,8%; ket qua tot la 38,5%; trung binh la 30,8%; khong cd tru'dng hdp nao ket qua kem va
"khdng dap uTig vdi dieu tri. Tong ty le benh nhan
dat ket qua tot va rat tot la 69,3%. Ket quaxet
nghiem vi khuan d nhdm nghien cuti nay tai
bang 3.4 cho thay ty le vi khuan am tfnh chi dat
76,9% tru'dng hdp, van cdn 23,1% trudng hdp vi
khuan du'dng tfnh. Phai sau 2 tuan dieu tri (bang
3.5) thi toan bp benh nhan bj viem ke d miit do
nang dutic dieu trj bang m3 Bactroban phoi hdp
uong Rovamycin xet nghiem vi khuan mdi am
tfnh hoan toan (100%), Nhu" vay, nhutig b$nh
nhan bj viem ke nang mac dii diioc dieu trj phoi
hdp khang sinh tai cho (boi md Bactroban) va
ktiang sinh toan than (uong Rovamycin) nhutig
mire dp cai thien ve lam sang va xet nghiem vi
Y HOC VigT NAM T H A N G 2 - S6 2/2013 khuan deu cham hdn so vdi nhdm benh nhan bj
viem ke mu'c dp nhe va trung binh chi dieu trj bang khang sinh tai cho (bdi md Bactroban) ddn thuan. Glal thich ket qua nay, chung to! cho rang cd the la nhutig tru'dng hdp viem ke nang thu'dng ton sau va lan rpng hdn, md da va du'di da bj ton thu'dng nang hdn nen kha nang hdi phue se lau hdn. Ngoai thu'dng ton tai cho thi nhOtig tru'dng hdp viem ke nang cd the bj anh hu'dng den toan than, dieu dd eung cd the gdp phan lam cho kha nang hoi phue ciia thu'dng ton cham. Mpt van de dat ra la lieu uong Rovamycin cd phai la s i / lu'a clipn phu hdp, hieu qua cho nhQ'ng tru'dng hdp viem ke nang trong nghien eiru ciia chiing toi hay khdng. Hien nay xuat hien ngay cang nhieu cac chiing vi khuan khang vdi khang sinh thupe nhom macrolid. Cho nen, trong nghien ciru ciia chung toi Idii sir dung plioi hdp uong Rovamicin de dieu trj viem ke thi ed the nhu'ng tru'dng hdp vi khuan khang thuoc thi se khdng ed tac dung, ma tac dung dieu trj chinh se la do vai trd ciia md Bactroban. Trong pham vi de tai nay chung tdi chu^ ed dieu kien de nghien ciru danh gia hieu qua dieu trj viem ke bang each bdi md Bactroban phdi hdp vdi eac loai khang sinh toan than khac. Cho nen, ehiing tdi chu'a dii cd sd de xac dinh mdt each chinh xac tae dung, hipu quji chong nhiem trung ciia Rovamicin trong viem ke.
Ngoai ra vdi ed mau nghien ciTu ciia chiing tdi cQng chula du Idn nen eung anh hu'dng den ket qua nghien ciiU.
Tac dung khdng mong mudn cua thudc: hau het cac b^nh nhan trong nghien ciru ciia chiing toi dUdc dieu trj bang md Bactroban ddn thuan hay phdi hdp vdi udng Rovamycin d ea hai nhdm deu chu^ thav xuat hien trieu chutig khong rnong muon tai eho nao nhir: tang ngira, tang j J d da, cam giac ndng rat tai cho hoac nhu'ng bieu hien toan than nhu' buon ndn, ehdng mat nhirc dau hay nhu'ng bieu hien khac. Tuy nhien, vdi so ludng benh nhan nghien eiru ehu^ nhieu nen cung khdng the danh gia du'dc mdt each day du tac dung khdng mong mudn ciia thuoc du'dc. Ket qua nghien ciTu eua chiing tdi ve tac dung khong mong mudn ciia m d Bactroban cung phii hpp vdi nhan xet Mistiaen Patriek va cdng su" [3] khi nghien cu'u dieu trj eac nhiem trung_ dathi thay tac dung khdng mong mudn eua md Bactroban cung chi ddn thuan la phan irng nhe d tai vung thu'dng ton va rat it gap.
V. KET LUAN:
Dieu trj viem ke do vi khuan mire dp nhe va trung binh bang md Bactroban diJng ddn thuan, sau 1 tuan t / le dat ket qua tdt la 58,8%, ket qua trung binh la 41,2%, khdng cd trUdng hdp nao cd ket qua kem, vi khuan am tinh hoan toan (100%). Sau 2 tuan dieu trj 100% tru'dng hpp dat ket qua rat tot va tot.
Pieu trj phdi hdp bdi md Bactroban va uong Rovamycin cho nhiitig tru'dng hdp viem ke nang, sau 2 tuan ty le khdi rat tot la 30,8%, tdt la 38,5%
(ket qua tdt va rat tdt la 69,3%), trung binh la 30,8%. VI khuan am tinh sau 1 tuan dieu trj dat 76,9%, sau 2 tuan mdi am toan bp (100%).
Viem ke nang dung phdi hdp bdi md Bactroban va udng Rovamycin nhu'ng mu'c dp eai thien ve lam sang va xet nghiem vi khuan deu Cham hdn so vdi nhdm viem ke nhe va trung binh chi dung md Bactroban ddn thuan.
NhiJng tru'dng hdp viem ke do vi triing nhe va trung binh dieu trj bang khang sinh tai cho ddn thuan rat hieu qua, tru'dng hdp nang can phoi hdp vdi khang sinh toan than, nhu'ng Rovamicin hieu qua khdng cao.
Chu'a thay tac dung khdng mong muon tai cho cung nhu' toan than nao ciia md Bactroban va Rovamycin.
T A I L I E U THAM KHAO:
l.Aste N; Atzori L; Zucca M; e l al.(2001), "Gram- negative bacterial toe web infection: a survey of 123 cases from the district of Cagiiari, Italy", J Am Acad Dermatol, 45, pp. 537-541.
2. Honig PJ; Frieden U ; Kim HJ; Yan AC. (2003),
"Streptococcal intertrigo: an underrecognized condition in children". Pediatrics, 112(6 Pt 1), pp.
1427-1429.
3. Mistiaen Patriek; van Halm-Walter Meike.
(2010), 'Prevention and treatment of intertrigo in large skin folds of adults: a systematic review ", pp. 1- 9, 4 Roberts S; Chambers S.(2005), "Diagnosis and
management of Staphyloroccus aureus infections of the skin and soft tissue",35, pp. 97-105.
5. Smith, Water Worth. (1962), The bacteriology of some cases ofintertrigo •;: 74, pp. 323-325.
6. Vdiger Jwr, WD; Robertson K; Kanji M;
AhChan J;et al.(1986), "Comparison ofthe new topical antibiotic mupirocin (Bactroban)with oral antibiotics in the treatment ofskin infections in general practice", pp. 340 - 342.
