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Nghien cuuduoc SThong tin thudc

JOURNAL OF PHARMACEUTICAL RESEARCH A N D DRUG INFORMATION

Nghien cuuduoc Thong tin thuoc

Bai ng

TRUNG TAM DI & ADR QUOC 6IA u «S Li TliiBh T6«9 - Hoan Kii'm • Ha Noi

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Bdo che he ty nhu hen chua silymnrin Nguyen Thach Tung1, Tran Cao Son2, Pham OUcTan3, Hoang Thi Trang1

'TrUpng Dai hoc Dupe Ha Ndi, 2Vien Kiem nghiem An toan Ve sinh Thuc pham Qudc Gia 'Cong ty Co phan Traphaco

Ddnh gid dnh huong cua thanh phdn cdng thuc vd qui trinh bde che Idp gidi phdng keo ddi tdi khd ndng gidi phdng amoxicilin tir vien nen 2 Idp

Le Oinh Quang, Nguyen Phuang Nhung, Nguyen Ngpc Chien TrUdng Dai hoc Dupe Ha Npi

Tdng hop vd thu hoqt tinh gay doc te bdo cua mot sd dan chat the N3-6-diethylamino-2-(2-trif luoromethoxy)phenylquinazolin-4-on

Van Thj My Hue1, Le Nguyen Thanh2

'TrUdng Dai hoc Dupe Ha Ndi 2Vien Hda sinh bien - Vien Han lam Khoa hoc vd Cong nghe Viet Nam

Xdy dung phuong phap dinh luong dong thdi paracetamol, loratadin, guaifenesin vd dextromethorphan trong che phdm da thdnh phdn bang HPLC-DAD

Ho Van Lcfi, Nguyen Thj Ngpc Van Khoa Dupe, TrUdng Dai hoc Y Dupe Can Thp

Thdm do khd ndng kich ung da vd ddnh gid tdc dung xua mudi Aedes aegypti cua tinh ddu Phong lu thdo (Pelargonium x horlorum L.H.Bailey)

Ta Le Mai Hau', Pham Van Minh2, LeTran Anh2, Ha Van Oanh3, Nguyen Hoang Tuan3, Bao Thj Thanh Hien3

'Benh vien Tarn than Trung UPng 1,2Hpc vien Quan Y, 3Trudng Dai hoc Dupe Ha Ndi,

Nghien cue bdo che he tieu phdn nano curcumin quy md 5 gam/me Duong Thj Hong Anh, Thai Thj Hong Anh, Nguyen Van Long, Nguyen Tran Linh

TrUdng Dai hoc Dupe Ha Npi

Bai Thong tin thubc

34 Qudn ly nhiem khuan tiet nieu: nhung dieu can luu y vdi duoc si Nguyen 06 Quang Trung, Hoang Ha Phuong

Nguon: Actualites pharmaceutiques so 536, thdng 5/2014

Bai Diem tin

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Le Ky niem 55 nam xdy dung vd phdt trien, 102 nam truyen thdng ddo tao duoc si

Cdng bd Quyet dinh bd nhiem vien ehuc qudn ly ede den vi

TONG BIEN TAP PGS.TS. Nguyen Dang Hoa

PH6TONG BIEN TAP 1

GS.TS. Nguyen Thanh Binh

BANTHLfKY ~ 1

PGS.TS. Nguyen Thi Kieu Anh ThS. Do Nggc Cuong

BAN BIEN TAP GS.TS. Nguyen Hai Nam GS.TS. Thai Nguyen Hung Thu PGS.TS. Nguyen Hoang Anh PGS.TS. Phiing Hoa Binh PGS.TS. Nguyen Ngpc Chien PGS.TS. Oinh Thi Thanh Hai PGS.TS. Vu Dang Hoang PGS.TS. Nguyen Thi Lien Huong PGS.TS. Tran Van On PGS.TS. Do Quyen PGS.TS. Nguyen Viet Than CN. Pham Van Tuoi

HOI DONG CO VAN GS.TS. Hoang Thi Kim Huyen GS.TS. Pham Thanh Ky GS.Oang Hanh Phufc TS.TrUOng Quoc CUdng ThS. Cao Hung Thai DS. Nguyen Thi Phuong Cham

THIBT KE 1

Phong Che ban Cong ty CP In Cong Ooan Viet Nam

TOA SOAN 1

Phong Quan ly Khoa hoc 13-15 Le Thanh Tong - Ha Noi Oienthoai: 04.3.8245437 Fax: 04.3.9335642 Email: tapchincd-ttt@hup.edu.vn

ISSN 1859-364X Giay phep so: 70/GP-BTTTT

Ngay 30/3/2015 In t a i : Cong ty CP In Cong Doan Viet Nam

THONG TIN THUOC

Quan ly nhiem khuan tiel nieu: nhung dieu can luu y vai duoc si

Ngudi dich: Nguyen Do Quang Trung, Hoang Ha Phuang Nguon: Actuaiites pharmaceutiques so 536, thdng 5/2014

Viem bang quang cap t inh khong p h u t tap la mot nhiem khuan t iet nieu dudi , thu tmg gap d phu ni l , t hudng duoc dieu tri bang khang sinh. Vai t rd cua duoc si tai nha thuoc la nhac nhd benh nhan tuan thu mot so quy tac ve ve sinh de ngan ngda tai phat va bien chdng, co the ket hop t u v a n s d d u n g mot so thuoc co nguon gdc duoc lieu. Nguoc lai, v iem bang quang phu t tap lien quan den nhiem khuan tiet nieu tren lai la trUdng hop can dieu tr i khan cap.

Tai Phap, nhiem khuan dOdng tiet nieu la nguyen nhan cua hon 3 tr ieu loot kham benh moi nam. Mac du nam gidi cung cd the bj benh, t inh trang nay gap chu yeu d nCf gidi t i l 18 den 30 tuo i . Cac t rodng hop tai phat ngay cang pho bien va t inh t rang khang khang sinh cang ngay cang gia tang.

Phuong phap xet nghiem nhanh bang que giay cd the dap Ung du trong trUdng hap benh nhan co trieu chdng va dau hieu gdiy cho benh viem bang quang cap khdng phdc tap dphu nUkhdng trong thdi ky tien man kinh va khdng cd thai.

Giai thich ngan gon ve benh ly Node t ieu cd t inh chat vd khuan t rong dieu kien

sinh ly binh thodng . Nhiem khuan dudng t iet nieu duoc xac djnh bdi sUcd mat cua vi khuan t rong nude t ieu vdi ndng dp 100000 vi khuan/ml hoac cao hon, di kem vdi ket qua bat thudng ve so luong bach cau va hong cau t rong node t ieu.

- Vi khuan thudng gap nhat t rong nhiem khuan t iet nieu la Escherichia coli nhUng cung cd the xuat hien cac chung vi khuan khac cUt ru tai bang quang n h u Proteus, Klebsiella, t ham chi' la Staphylococcus saprophyticus. Can chan doan phan biet giUa v iem bang quang va nhiem t rung dudng t iet nieu dUdi.

- 3 the viem bang quang can duoc phan biet: + Viem bang quang cap khdng p h u t tap; + Viem bang quang tai phat (it nhat 4 do t /nam) ; + Viem bang quang p h u t tap bdi nh iem khuan

tiet nieu tren nhu viem be than cap tuong dng vdi su xam nhap cua tac nhan gay benh t rong nhu md than.

- Viem bang quang cap khdng phUc tap la mot nh iem khuan dudng t iet nieu dud i dac t rung bdi chufng t ieu rat (di t ieu nhieu Ian va t ieu rat it), t ieu khd (tieu buot), tr ieu chUng thudng bat dau dot ngpt ma khdng cd sot, khdng dau that lung, nhUng lai dau bung dudi . Nude t ieu cd the bj due, tham chi cd ca mau (tieu ra mau). Neu cd cac bieu hien sot, ret run, met mdi toan than va dau canh sUdn hoac gdc sUdn cot song, can nghi ngd v iem be than cap.

- 6 nam gidi , t ieu bud t cd the la dau hieu nghi ngd cac benh nh iem khuan lay t ruyen qua d u d n g t inh due. Trong trUdng hop cd sot hoac t ieu khd, nh iem khuan dudng t iet nieu cd the da cd bien chdng viem tuyen t ien Net.

-Viec chan doan dila tren ket qua xet nghiem vi sinh nUdc t ieu, bao g o m soi true t iep nUdc t ieu tren kinh hien vi va nudi cay de xac d jnh sUcd mat cua vi khuan (bang 1).

Ngoai ra, con cd the dua vao ket qua khang sinh do.

- Benh nhan cd the sd dung ngay tai nha cac bang giay t h d nUdc t ieu de xac d jnh sU cd mat cua bach cau hoac ni tr i t . Neu ket qua duong t i nh , can nghi td i nh iem khuan t iet nieu va d jnh hudng di kham bac si. Sir dung bang giay t h d n u d c t ieu cd the dap i lng yeu cau t rong t rUdng hop cd cac t r ieu ch i lng va dau hieu goi y v iem bang quang cap khdng phu t tap d phu nU khdng t rong thdi ky t ien

34 I Nghien cufu dUdc Thdng tin thuoc I S66/2016

THONG TIN THUOC

Bang 1. Xet nghiem vi sinh nUdc tieu dp dung trong thuc hdnh

man kinh va khong co thai. Trong giai doan tai phat, ket qua bang giay t h d cho phep phat hien sdm t inh trang nhiem khuan, trudc khi co cac trieu c h l n g dien hinh hoac t ranh t inh t rang co nh iem khuan ma khong co dau hieu tren lam sang. Ngoai ra, co the s i dung bang giay 6 giai doan sau dieu trj de kiem tra xem vi khuan co con ton lUu hay khong. Mat khac, bang giay t h i con phat hien dupe s i co mat cua nitrit t rong nUdc t ieu, day la dau hieu cho thay s l e d mat cua vi khuan (true khuan coli) chuyen hoa nitrat thanh nitrit.

Cdc yeu Id nguy cv - Phu nu" de bj nhiem khuan dUbng tiet nieu hon

nam gidi bdi nieu dao ngan hon va nam gan hau mdn hon. Nhu vay, vi khuan t i l hau mdn va t r i e trang cd the de dang xam nhap nieu dao va gay nhiem khuan.

- Quan he t inh due cd the gay ra nh iem khuan dudng t iet nieu d phu ni l .

- Ldi song: mac quan ao chat, si l dung chat diet t inh t rung hoac sd dung mang ngan t inh t rung, cac roi loan t ieu t ien (nhjn t ieu, t ieu it, t ieu khdng het) cung la cac yeu to lam benh nang them.

- Phu n i l cd thai de bj nh iem khuan dudng t iet nieu do thai gay chen ep len nieu dao.

- Phu nU bj khd am dao sau thd i ky man kinh cung de bj nhiem khuan.

-Tao bdn gay i l phan, lam tang nguy co nhiem benh do E. coli.

- CS nam gidi , phi dai tuyen t ien Met lanh t inh lam tang 1 nUdc t ieu.

- Cac bat t hudng tren dudng t iet nieu la cac yeu td lam benh nang len: sdi (sdi than), hep nieu dao, u xo tuyen t ien Met, ung t h u bang quang, khdi u,...

- Cuoi cung, viec dat sonde nieu dao tren nen cac benh ly toan than (dai thao dudng , suy g iam mien djch) cd the gay nhiem khuan.

Nhac Iqi cdc quy tdc ve sinh thiet yeu Tat ca nhiem khuan dudng t iet nieu tren deu can

duoc dieu trj khan cap. Tuy nhien, vdi nhiem khuan dudng nieu dudi khdng phi lc tap va khdng tai phat, duoc si cd the t u van:

- Uong nhieu nUdc (1,5-2 M't/ngay) de lam loang mat do vi khuan va nla sach bang quang, do do lam giam sU phat tr ien cua vi khuan;

- Di tieu thudng xuyen (moi 2-3 gid) va phai di het nude tieu, tap thdi quen di tieu sau khi quan he tinh due;

- Dieu trj nhiem t rung sinh due kem theo; -Ve sinh vung hau mdn, sinh due dung each; - Sau moi Ian di ve sinh, lau khd vung hau mdn,

sinh due theo hudng t i l phia trudc ra phia sau; - Dieu chinh loi song, t ranh tao bdn; -Tranh mac quan qua chat va quan lot t i l soi tong

hop (Uu t ien chat lieu bang cotton); - Han che s i dung r i o u sam-panh va r i o u vang

trang vi cac loai do uong nay lam thay doi pH nUdc tieu; -Thuc hien ve sinh am ho d pH thich hop; -Theo ddi tuyen t ien Net d nam gidi t ! 5 0 tuo i .

Nguyen tac dieu tri Viem bang quang cap khdng p h l c tap cd the

duoc dieu trj bang cac loai khang sinh (bang 2). Muc dich s i dung khang sinh la diet vi khuan, ngan n g l a tai phat va ngan n g l a nguy co vi khuan khang thudc. Phan Idn cac khang sinh de dieu trj nhiem khuan t iet nieu dUOc s i dung don trj lieu va t rong thd i gian ngan. Benh nhan can tuan thu dung lieu lUOng va thd i gian dieu trj.

- Cac qu ino lon the he mot ( f lumequin , acid pipemidic, acid nalidixic) cd pho tac dung hep chu yeu tren Escherichia coli hoac Proteus mirabilis. Do duoc thai trU chu yeu qua than, thudc dat nong dp cao t rong nude t ieu va dupe chi d jnh chu yeu t rong dieu trj nhiem khuan dudng t iet nieu do cac chung vi khuan nhay cam. Tuy nhien, m l c dp khang thuoc ngay cang gia tang do t inh t rang lam dung khang sinh nhdm qu ino lon . Cac tac dung khdng m o n g mudn t hudng gap bao g o m dau t h u p n g vj, buon

- Ooi vdi ngUdi trUdng thanh: + Rtia tay can than; + Ve sinh 16 nieu dao bang dung dich sat khuan

Dakin; + Logi bo phdn nude tieu ddu; + ifu tien lay nude tieu vao buoi sang hogc nUdc tieu

da luu Igi trong bang quang it nhat 3 gid. -Doi vdi tre so sinh: + SC( dung tui dinh de thu nUdc tieu (Urinicol), dgt

vao trong ta lot; + Phdi dam bao mdu nude tieu dugc lay trong vdng

30 phut sau khi tre di tieu. Mdu nUdc tieu can dUdc van chuyen tdi phdng xet

nghiem cdng nhanh cdng tot va xet nghiem nen dUdc lam ngay trong vdng 3 gid sau do.

Neu khdng dam bao dieu kien nay can phdi bdo qudn mdu nude tieu d nhiet do tdi da +4"C trong thdi gian tdi da 12 gid.

- Ket qua: + Gid tri ngudng so luang vi sinh vgt > 10s don vi

khudn Igc/ml. + Gid tri ngUdng bgch cdu >10t tebdo/ml.

S66/20161 Nghien cull duttcThong tin thuoc I 35

Bang 2. Donhgycam cua vikhudn vdi khdng sinh

ndn, ndn, tieu chay, tang nhay cam anh sang va phan i lng di i lng tren da.

- Cac qu ino lon the he hai hay con goi la cac f luoroquino lon (pefloxacin, ofloxacin, ciprofloxacin, norfloxacin, enoxacin) co hoat t inh in vitro manh hon 100 Ian so vdi cac qu ino lon the he mot . Cac f luoroqu ino lon cd hoat phd t uong ddi rpng so vdi cac thuoc the he cu tac dung tren vi khuan Gram am n h u Salmonella, E. coli, Shigella, lau cau, Proteus, Enterobacter, Helicobacter, vi khuan Gram duong n h u tu cau, lien cau,... Mot Uu d iem khac cua cac f luoroquinolon la sinh kha dung tot , kha nang phan bd to t vao md va npi bao. Thudc dope thai trU chu yeu qua than nen dupe Uu t ien chi d jnh t rong dieu trj nh iem khuan t iet nieu. Theo nguyen tac chung, phac do dieu trj keo dai t rong 3 ngay. Cac tac dung khdng mong mudn bao g d m rdi loan t ieu hda, dj i lng tren da, tang nhay cam vdi anh sang, dau CO khdp, viem gan va dac biet la d i l t gan.

- Fosfomycin (fosfomycin t rometamol) la mot khang sinh diet khuan nhdm phosphonic.Thudc dupe sCf dung mot lieu duy nhat va nen udng luc doi hoac 2-3 g id trudc hoac sau bUa an. Viec dung mot lieu duy nhat fosfomycin khdng thich hop vdi cac nhiem khuan tiet nieu tai phat khi cd bieu hien trieu chi lng keo dai tren 5 ngay, nhiem khuan tiet nieu d phu n i l mang thai hoac cho con bu, hoac d phu nU bj benh tieu dudng hoac suy giam mien djch. Hiem gap cac tac dung khdng mong mudn khi sddung thudc.

- Trong so cac sulfamid dieu trj t iet nieu, sulfamethizol la khang sinh kirn khuan cd ngudn gdc t i l sul fani lamid. Thudc dope chi djnh t rong nhiem khuan tiet nieu dudi khdng phu t tap do cac chung vi khuan nhay cam.Tren ly thuyet, phd khang khuan cua thudc rpng, nhUng tren t h g t te', khang thudc mac phai da t rd nen phd bien. Hon nUa, cac phan i lng dj i lng (ndi me day, ban do,...) tang nhay cam anh sang va tao

t inh the trong nUdc tieu gay sdi than gap kha phd bien. Do do, khi sd dung thudc, phai cd bien phap tang bai nieu va kiem hda nude tieu (udng 2 lit nUdc khoang moi 24 gid). Phdi hop sulfamethoxazol va tr imethoprim (Bactrim) cd tac dung lie che tdng hop acid folic va cd tac dung hiep dong tang cUdng diet khuan. Cac chat nay chu yeu dope thai t r d qua nUdc tieu d dang con hoat t inh nen dope sil dung de dieu trj nhiem khuan tiet nieu.Thudc cung cd nhieu tac dung phu nhophan i lng dj i lng, rdi loan huyet hoc va t ieu hda, t inh the nieu, tang nhay cam anh sang.

- Cac dan chat n i t rofuran dung t rong dieu trj dodng t iet nieu nh i i ni t rofurantoin la khang sinh kirn khuan. Thudc dope dung nap tot , thai t r i l qua than d i ld i dang con hoat t inh vdi hoat Ipc khang khuan tdi i lu t rong mdi t r i l dng acid. Cac rdi loan t ieu hda (budn ndn, ndn) xuat hien th i l dng xuyen, do do nen udng vao cudi bila an va tranh sddung dong thdi vdi do udng cd con. Acid hda ni ldc t ieu lam tang hoat Ipc khang khuan.

- Cac thudc giam dau cd the chi d jnh t rong t n l dng hop dau nang.

Nhung fruong hap can dinh hvong di kham bdc si

Sp keo dai dai dang cua cac trieu chi lng tdi ngay t h i l bay cd the la dau hieu dieu trj that bai hoac can xem lai chan doan viem bang quang khdng phu t tap. Tuy theo yeu td nguy co, mile dp nghiem trpng va cac bien chi lng, can xem xet di kham bac si.Thpc te, viem bang quang cap philc tap cd the can tham kham lam sang chuyen khoa ve tiet nieu sinh due, cung nh i l cac xet nghiem vi sinh, chup X-quang di ldng nieu. Phac do khang sinh cd the can keo dai hon.

Nhiem khudn tiet nieu - nhufng cdu hdi tgi nhd thuoc:

- Day la Ian mac benh dau tien, dieu tri chua thanh cdng hay tai phat ?

- Benh nhan cd cdc trieu chUng nao cho thay tinh trgng nhiem khudn ngng (sot > 38°C, dau vung that lung,...) ?

- Benh nhdn cd xuat hien cdc dau hieu cua bien chUng nhu tieu mdu, rdi logn tiet nieu, tien sCrcdc benh tiet nieu, ddt sonde nieu dgo ?

- Benh nhan dang mac benh ddi thdo dudng hay co suy giam mien dich? Benh nhdn cd dang mang thai khdng?

- Benh nhdn da thuc hien xet nghiem te bdo, vi j khudn hoc nude tieu hogc xet nghiem que thCmudc tieu i chua ?

- Benh nhdn cd udng du nUdc trong ngdy khdng ?

- Escherichia coli: ty le khdng khdng sinh nhdm aminopenicilin (ampicilin va amoxicilin) Id tren 40%, amoxicilin/acid clavulanic la 35%, quinolon the he cu va cdc fluoroquinolon Idn lUdt Id 10% va 7%. Ty le khdng vdi fosfomycin dmUc do thdp hdn.

- Proteus mirabilis va Klebsiella: de khdng tunhien nitrofurantoin. Ty le khdng vdi cdc aminopenicilin vd cotrimoxazol khoang 15-20%.

- Staphylococcus saprophyticus: de khdng fosfomycin, tan sudt khdng thudc <5% vdi cdc logi khdng sinh khde.

36 I Nghien cufu diraccThdng tin thudc I S66/2016