Tgp chi Tai MQi Hpng Vi^t Nam - Volume (57-7). N°1 - March. 2012 4. Dc The et al (1975). "Oncogenesis
and herpesviruses II", International agency for research on cancer Lyon.
5. R. Dardari, W. Hindcrcr, D. Lang, et al (2001). "Antibody responses to recombinant Epstein-barr virus antigens in NPC patients; complemcnttary test of zebra protein and early aniigent p.54 and
p. 138", Institut Pasteur du Maroc, center de Oncoligie.
6. R. Glascr, EC Strain, KL Tarr et al (1985). "Changes in Epstain-Barr virus antibody titers associated with aging".
Proceedings of the society for experimental biology and medicine, vol 179. 352-355. Coppyright.
S. PNEUMONIAE KHANG PENICILLIN VA NHUNG THACH THUC TRONG filEU TRI BENH
NHIEM TRUNG TAI MUI HONG
Viing tai mui hpng thupc ve ca quan cua dudng lieu hda vd hd hap tren.
Id cira ngd ciia dudng dn vd dudng Ihd, khi bi nhiem khuan thi mui vd hpng thudng bi trudc rdi lir do lan xuong dudng hd hdp dudi. Viem mui, viem mui hpng, viem hpng, viem VA, viem Amidan, viem thanh quan deu thupc nhiem khudn dudng hd hap tren. Theo Bs Norio Ohmagari trudng dan vi bpnh iruyen nhiem (Benh vien trung tam ung thu Shizuaka- Nhdt Bdn) cho biet, hdng ndm, chi tinh rieng cac bpnh nhiem khudn trong dd nhiem khuan tai mui hpng chiem chu yeu, vdi khodng 2 tripu trudng hgp va ngudi ta phdi tieu tdn khodng 4.5 ty dd ta cho chdm sdc y te'".
Nhirng tdc nhdn gdy nen bpnh nhiem khudn tai mui hgng chii yeu Id cdc loai virus sau dd mdi la cac nguyen nhan vi khuan. Trong nguyen nhdn vi khudn thi nhiJng chiing vi khudn nhu S.pneumoniae, H influenzae, M catarrhalis Id nhirng nguyen nhan phd bien nhdt. Theo Wikipedia thi S.pneumoniae Id tdc nhan vi khuan thudng gdp thir 2 irong cac tdc nhan vi khudn gdy viem amidan cap. Tuong l^r,
* B$nh vi$n TMH trung u o n g
" BO mon TMH DHY Hd N0i Nh$n bat 25/1/2012 Duy$t in 30/1/2012
BS. Lc Minh Ky*. BS. Do Ba Hang**
theo nghien ciru ciia Mary Talley Dom vd Norman R. Friedman, cd khoang 5- 30% viem amidan cap Id do nhiem khudn. vi khuan thudng gdp nhat trong nhirng viem nhicm amidan man tinh, viem amidan tdi phdt Id do S.pneumoniae, Hinfluenzae. Mcatarrhalis. Trong mpl nghien cuu ciia Kevin Katzenmeyer va Ronald W. Deskin tai khoa tai mui hpng cua bpnh vipn thugc trudng dai hgc Texas nguyen nhan gay viem tai giiia do vi khuan gdm: S.pneumoniae chiem 30- 35%, Hinfluenzae chilm 20-25%, M.catarrhalis ch'i^m 10-15%'^'
Van dl khang khdng sinh (KKS) hipn nay Id mgt thdch thirc toan cdu, to chuc y tl the gidi (WHO) da dinh nghia KKS Id khd ndng mdt loai vi sinh vat v6 hipu hda tdc dung cua mpt loai thudc khdng sinh dugc sir dung de chdng lai n6.
Cdc vi sinh v^t cd khd ndng khdng ihudc ndy bao gdm \irus, vi khudn vd mgt so lo^i ky sinh triing. Trong tnrdng hgp co bieu hipn khdng thudc, cac lieu phdp diiu tri chuan khdng cdn hieu qua, nhiem khudn van tdn tai, phat trien vd co thi lay Ian sang cho nhimg ngudi khac.
KKS Id hau qud cua nhilu yeu to, nhung nguyen nhdn chii yeu Id do viec
Tap chi Tai MOi Hpng Vi0t Nam-Volume (57-7). N°1 -March. 2012 su dung khdng sinh khdng hgp ly vd
khdng dung each. Diiu ndy xdy ra lai mpt mdi trudng chdm sdc sue khde noi ma cdc bdc sT vd nhdn vien y te ke diing khdng sinh cho ngudi benh qua lilu. sai lieu hoac thieu lieu. KKS cung xdy ra khi ngudi benh tu dieu tn, mua va dimg thudc khdng cdn kc don.
Nhieu chuyen gia chong nhiem khudn canh bdo, Vipt Nam dugc Td chirc Y te the gidi ddnh gia la mpt trong nhimg nude cd ty Ip vi khudn KKS cao nhat trong khu vuc. Cdc khdng sinh the he mdi dang dugc sir dung rpng rai cdng Idm tdng them tinh khdng thuoc ciia nhieu loai vi khuan - trd Ihdnh mpt trong nhiing nguyen nhdn chinh gdy nhiem khuan benh vien.
Trong sd cac yeu td Idm tdng \i khudn khdng ihudc. nhiim khuan benh vien id yeu td quan trpng lien quan den tinh KKS ciia vi khuan. Them vao dd, viec sir dung khang sinh rgng rdi trong cdng ddng, thdy thudc ke dan lam dung khdng sinh, ngudi dan cd thdi quen tu y mua thudc khang sinh khi bi cdc benh nhiem triing thdng thudng khdng theo chi dinh eiia thay thudc. Penicillin, tetracyclin, streptomycin.
Theo nghien curu ciia Jae-Hong Song vd cdng su nghien cuu ve ty le KKS ciia S.pneumoniae a 11 qudc gia chau A tir thdng 1 ndm 2000 den thdng 6 ndm 2001, 685 mau S.pneumoniae phdn lap tren benh nhan chi ra rdng:
483(52,4%) khdng nhay cam vdi Penicillin, trong do d Viet Nam ty le khang Penicillin Id cao nhat (71,4%) sau do Id nhirng nude Han Qudc, Hdng Kong vd Dai Loan. Ty le khdng Erythromycin ciing rat cao d Viet Nam (92,1%), Dai Loan (86%), Han Qudc (80,6%) Hdng Kong(76,8%)"*. Du lieu tir nghien ciru gidm sdt da qudc gia Id tdi
lieu rd rang ve su gia tang khac biet vl tdn sudt vd muc dp KKS eiia S.pneumoniae dugc phan lap d nhilu nude chau A la mot trong noi cao nhdt tren Ihe gidi cdng bd cho den nay*".
Trong hai iha]i ky qua, ty le khdng penicillin, beta - lactam khac vd cdc nhdm khan^ sinh khac tdng len nhanh chdng d nhieu nai tren Ihl gidi. Ddc biet, du iicu v l ly Ip khang phi cdu khudn tir cdc nude chau A vao cudi nhiing ndm 1990 Id ddng bao dpng. Nghien ciru qudc t l gidm sdt tiln hdnh ndm 1996-1997 vd 1998-1999 d l i qudc gia chdu A do mang ludi chau A gidm sal cac tdc nhdn gdy bpnh khang(ANSORP) cho thay tan sual rat cao khdng Penicilhn vd Erythromycin ciia S.pneunJoniae phan lap d dich mui d cdc nude Hdn Qudc.
Nhdt Ban. Viet Nam, Thdi Lan, Dai Loan va Sri Lanka' '.
Amoxicillin/clavulanat la mpl thudc khdng khuan phd rdng da dugc sir dung rgng rai cho Idm sang han 30 nam va hien van dang dugc sir dung chii yeu trong viec dieu tri ciia nhiem khuan cdng dong dudng hd hap. Amoxicillin/
clavulanate cd boat tinh khdng khuan manh, bao gdm cd cdc tdc nhdn gdy benh cd men khdng p-lactamase va dugc ddng hpc thuan Igi. Day la yeu td giup chdng lai sir gia tang cua su KKS ngdy cdng gia tdng ciia ede vi khuan khdng p-lactamase nhu H influenzae vd M.catarrhalis ddi vdi Penicillin, Macrolid va Spneumoniae ddi vdi Quinolon. su kel hgp Amoxicillin/clavulanat lieu thdp cung cd hieu qua tuy nhien thdi gian su dung thudc keo ddi vd them nu:a Id su xudt hien ciia cdc chiing S.pneumoniae vdi MIC Penicillin cao da dugc quan sal thdy d nhilu nude tren the gidi trong do cd cac nude d khu vuc chdu A dac biet la tai Viet Nam. Dl ddp ung nhu cdu dieu
Tap chi Tai Mui Hpng Vi0t Nam - Volume (57-7). N°1 - March. 2012 tri thudc khang S pneumoniae thi sir
dgng lilu cao Amoxicillin/clavulanat (2000/125mg) hai lan tren ngdy dd ihrac phdi trien''". Tai My sir dyng thuoc vdi cdng tliirc tren dd dugc nghien cOru vd sir dyng Irong nhicm triing dudng hd hap cho ngudi Idn do cac mam bpnh khdng thudc chdng h^m uhu Spneumoniae gidm tinh nh^iy cdm vdi penicillin, cung nhu nhiing mam bpnh san xuat p-laclamasc ciia H.in/liienzae v;'i .\lcatarrhali.s' '.
Amoxicillin/clavulanat 90/6,4mg/kg/
ngay chia hai lan vdi Ire em dd dugc diing de dieu trj nhung Irudng hgp bpnh dai ddng hodc \icm tai giiia cap ho^c
\ iciii lai giO'a man tinh nai cd nguy ca cd su tham gia ciia cdc chiing \ i khudn sdn xudt p-lactamase hodc' S.pneiimonuie giam linh nha> cdm vdi Penicillin. Ngoai linh hieu qua cao Amoxicillin/clavulanat cdn rdi an loan cho ngudi sir dung qua vice nghien cuu 819 trieu bpnh nhan sir dung nd*^*. Amoxicillin/clavulanat dd dugc hudng dan va khuyen cdo dc dieu tri viem xoang do vi khuan. viem tai guia cap linh, viem phdi cgng ddng, dgt kich phdt ciia viem phe qudn man tinh vd dugc coi la mdt tdc nhan quan trpng dc dieu tri nhiing benh ly nhicm triing dudng hd hap ca trong hien tai vd trong tuang lai'^*-
TAI LIEU THAM KHAO
I. .hic-IIoon Song, Sook-In J u n g , Kwan Sdo Ko, Na Young Kim, J u n Seong Son, I l y u n - l l a Chang, Ilyun Kyun Ki, Won Sup Oh, Ji Votun Suh, Kyong Ran Peck,Nam Vong Lee, Vonghong Vang, Quan Lu, Anan Chongthalcong, Chcng-Hsun Chiu, M.
K. Lalitha, Jennifer Pcrera, Ti Tcow Vee, Gantini K u m a r a s i n g h c , Farida J a m a l , Adccba K a m a r u l z a m a n , Navaratnam Parasakthi, Pham Hung Van, Cclia Carlo.s, Thomas So, T a k
Keung Ng, and Atef ShibI . High Prevalence of Antimicrobial Resistance among Clinical streptococcus pneumoniae Isolates in Asia (an ANSORP Study.) ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, .lune 2004. p 2101-210? Vol 4H. No 6 2. Brian Wynne. Augmentin (amoxicillin/clavulanate) in the treatment of community-acquired respiratory tract infection: a review of the continuing development of an innovative antimicrobial agent. Journal of Antimicrobial Chemotherapy (2004) 53. SuppI. Sl, i3-i20
3. Kevin Kat/.cnmcyer, Ronald W.
Deskin. Otitis media. IJTMB-Galvcston.
(1999) 17(2).
4 Michael S Bcnninger Amoxicillin/clavulanate potassium extended release tablets: a new antimicrobial for the treatment of acute bacterial sinusitis and community- acquired pneumonia. Drug evaluation Expert Opin. Pharmacother. (2003) 4(10): 1839-IH46
5. Patrick Petitprctz, Christian Chidiac, Francisco Soriano ^ a i e r G a r a u , K a t h a r i n e Stecnson , Elisabeth Rouffiac, T h e 556 Clinical Study G r o u p . The etTicncy and safety of oral pharmacokinelicaM;' enhanced amoxycillin /cia ulanate 2000/125 mg.
twice daily, versus oral amoxycillin /claulanate 1000/125 mg. three times daily, for the treatment of bacterial community-acquired pneumonia in adulls. International Journal of Antimicrobial Agents 20 (2002) 119/129 6. T. M. File J r . , H. Lode, H. Kurz, R.
Kozak, H. Xic and E. Bcrkowitz Double-Blind, Randomized Study ofthe EtTicacy and Safety of Oral Pharmacokinetically Enhanced
T9P chi Tai IVIui Hpng Viet Nam - V o l u m e (57-7). N°1 - IVIarch. 2012
Amoxicillin-Clavulanate (2,000/125 Adults Aniimicroh. Af-enls (•henwiher Milligrams) versus Those of 2004, 48(9):332S
Amoxicillin-Clavulanate (875/125 7 ohn.aRari Norio et . 1 , Inlbct.on Milligrams), Both Given Twice Daily
for 7 Days, in Treatment of Baclerial
prevention strategy for antimicrobial resistant organisms. Ptibget. 39 (2) 162-4 Community-Acquired Pneumonia in (2012)
DI^M BAO
M A C n i l DA D i r O C CHAN DOAN UNC; Till)", NIIIKU BKNH NHAN VAN T I E P T V C HUT T H U O C LA
(Many people continue to smoke after being diagnosed with cancer-- Cancer • • Tobacco & Marijuana • Jan 22, 2012)
BS. Nguyen Xuan Quang, PGS. TS. Nguyen Dinh Phuc Mpt nghien cim mdi day cho thay cd mgt so lugng ldn benh nhan ung thu phdi vd ung thu true trdng van tiep luc hut thudc sau khi duac chan dodn xdc dinh. Dugc cdng bo tren tap chi Cancer, mpt tap chi dugc kiem duyet cd uy lin ciia Hipp hdi ung thu Hoa Ky.
nghien cuu ndy dd cung cap nhihig thdng tin cd gid tri ve nhung benh nhan ung thu cdn dugc trg giiip bd thudc Id. Khi mpl benh nhan dugc chan dodn ung thu, dieu dau lien mpi ngudi thudng nghi tdi Id \iec chira benh. Nhung vice cai thudc la cung vd ciing quan trpng VI tiep tuc hut thudc cd the dnh hudng lieu cue hieu qua dieu tri, ldm tang nguy ca ung thu khac sau dd. vd cdn cd kha nang dnh hudng Idi su sdng con ciia hp. Tien sy Elyse R.Park Idm viec tai Benh vien da khoa Massachusetts va Trudng Y khoa Havard d Boston, dimg dau mgt nhdm cdc nhd khoa hgc tien hdnh mgt nghien cuu tim hieu ty le benh nhdn bd thudc Id quanh thdi diem dugc chdn doan ung thu, vd nhirng ngudi nghien thudc ndo cd kha nang bd thudc cao nhat. Cdc nhd khoa hgc da xdc dinh dugc ty le hiit thudc quanh thdi diem chan doan va 5 thang sau dd d 5338 benh nhan ung thu phdi va ung Ihu true trang. 6 thdi diem dugc chan doan cd 39% benh nhan ung thu phdi va 14% benh nhan ung thu true trdng van tiep tuc hut thudc. Ket qua nay cho thdy cd mgt sd lupng khdng nhd benh nhan ung thu van tiep tuc hut thudc sau khi dugc chan doan. Benh nhan ung Ihu phdi cd ly le hut thudc cao hem trong vd sau khi dugc chan doan, cdn benh nhan ung thu true trang cd xu hudng bd Ihudc it ban sau khi dugc chan dodn. Co nhunng yeu td vd dac diem khdc nhau tiiy thupc loai ung thu giiip lien lugng bpnh nhan co liep tuc hiit thudc hay khdng. Nhiing benh nhdn ung thu phdi tiep tuc hut thudc thudng Id nhimg ngudi co dich vu cham sdc y t^ hodc cd mpt loai bdo hi^m y te nao dd, cd chi so khdi co the thap, khdng cd hd trg tdt v^ mat tinh thdn, khdng dugc dieu trj hda chdt cung nhu phau thudt, cd ti^n su bpnh tim mach, vd da timg hut thudc rdt nhieu. Bpnh nhan ung thu true trang ti^p tuc hiit thudc thudng Id nam gidi, khong hpc qua cao, khdng cd bao hiem, khdng duac phdu thual, va cung da tung htit thudc rdt nhieu."Nhij'ng k^t qua nay cd Ih^ giup cac nhd ung thu hpc xac dinh nhirng bpnh nhdn ung thu ed khd ndng cao se tiep luc hiil thudc vd CO phucmg hudng de hd trg hp bd thudc Id," Bac sy Park ndi.
Bac sy Carolyn Dressier, Idm vipc tai bd phan cham sdc sire khde Arkansas d Liule Rock, ngudi ddng biSn tap cdng trinh nghien curu nhdn manh rang nghien cuu nay ciia Bdc sy Park da ldm ndi bat vai trd vd cii'iig quan trpng ciia cac bac sy cung nhu cac nhan
