Kháng sinh - tác dụng phụ và vấn đề vi khuẩn kháng kháng sinh

TU'VAN

KHANG SINH - TAC DUNG PHU VA VAN DE

VI KHUAN KHANG KHANG SINH

Triin Nhan Th^ng *

Trong mpt hpi nghi ve chong nhiem khiicin tgi Chicago ndm 2004. cdc biio cdo deu cho rdng cdc hdng

dugc pham dang co xu hudng tir ho cam ket trien khai llnidc khdng sinh miri. Trong khi do, tmh hinh vi khudn

khdng khdng sinh ngdy cdng giu timg vd dung lu moi qiiun nggi cua todn cdu. Chu tich Hiep hpi Cdc benh nhiem

khudn My (Tien sy J.Ewards) cho rimg. cimg cupc nghien ciru chong vi khuan dang trin du xudng doc nghiem

trgng. Mat khiic, viec sir dung khimg sinh khong hgp ly dang Id vdn de co phgm vi anh htrdng rpng khdp a mgi

cdp dp cham sdc y te. Id nguyen nhdn tdm lung cite ADR vd la nguyen nhdn lam tdng ddng ke chi phi cho khdng

sinh. Hien trgng do dung lu tieng chuong canh bdo rimg. con ngudi se thua trong cupc chien chong vi khudn.

Khang sinh la nhtmg chat cd ngudn gde sinh

hpc, tdng hpp hoac ban tdng hpp ma ngay d ndng dp

thap da cd kha nang uc che (bacteriostatic) hoac tiSu

diet (bactericidal) vi sinh vat mdt each dac hieu. Viec

kham pha va phat trien cac khang sinh da tao ra cac the

he vu khi hiru hieu giitp con ngudi chdng lai vi khuan.

Tuy nhiSn, viec nghiSn ciru phat triSn khang sinh mdi

dang CO xu himg giam theo thdi gian: ttr nam 1936 bat

dau phat minh ra cac Sulfonamides, 1940 phat minh ra

|3-lactams, 1949 nghiSn ciru thanh cdng Tetracyclines va

Chloramphenicol, 1950 tim ra Aminoglycosides, 1952

la cac Macrolides, 1958 phat minh ra khang sinh nhdm

Glycopeptides, 1962 la nhdm Streptogramins va Qui￾nolones. Sau do, cdng cupc phat minh bj gian doan, cho

dSn nam 1999 mdi phat minh ra Oxazolidinones, va den

nam 2003 mdi phat minh thSm dugc cac Lipopeptides.

Trong khi do, tinh binh khang tbudc ngay cang gia tang

va trd thanh mdi quan ngai cita toan cau. Ty IS de khang

cao cita nhiSu vi khuan vdi Fluoroquinolone hay van dS

Phe cau da khang tbudc tai chau A hoac ty IS Pneumo￾cocci dS khang cao vdi khang sinh tai nhiSu vting trSn

the gidi... dang la tiSng chudng canh bao khan tbiSt ddi

voi nhan loai.

L Nguyen nhan gay ra Idiang sinh

Cd nhiSu ySu td gay nSn tinh trang vi khuan

khang khang sinh. Trong do, viec su dung khdng hpp

ly khang sinh la ySu td Idn nhat: each sir dung khdng

phti hpp (ditng khdng diing liSu lupng va khdng diing

khoang each giOa cac liSu); dting khang sinh khdng can

thiSt (khi nhiem siSu vi); chpn khang sinh khdng phit

hpp... la nhung ySu td tryc tiSp anh hudng den vdng

.\oan khang khang sinh: Nhiem trimg —+ Dieu tri

khdng thich hgp —> Khdng tiet trir duffc vi khudn -^

Chgn lgc cdc vi khudn de khdng —> Nhiem triing lan

trim —> Tiing khdng thuoc -^ Nhiem triing... Viec su

dung khang sinh khdng dat dugc thanh cdng vS mat vi

khuan se tao ra nguy co' that bai trSn lam sang (dap img

lam sang cham. xuat hien nhung biSn chimg...) va tao

ra sy dS khang khang sinh (ti'ong mdi trudng cd khang

sinh ma vi khuan van phat triSn), tao ra nbung chiing vi

khuan da khang tbudc sdng sdt, nban len va lan tran. Sir

dung khang sinh khdng hieu qua cdn tao ra sy de khang

cheo vdi nbung khang sinh cimg nhdm va khac nhdm.

Viec sir dung khang sinh khdng hpp ly dang la van

dS cd pham vi anh hudng rdng kbap d mpi cap dp cham

sdc y tS. khdng chi la nguySn nhan lam tang cac ADR

nghiem trpng ma cdn la nguySn nhan lam tang dang kS

chi phi cho ngudi benh. Kem tbeo viec su dung kbdng

ditng mdt each phd biSn dang la nguySn nhan bang dau

gay ra van dS vi khuan khang khang sinh. Td chuc Y te

ThS gidi da khuyen cao ve thyc trang kS don khang sinh

dang lo ngai trSn toan eau: vdi khoang 30-60%) benb

nban tai cac ca sd y tS dugc kS don khang sinh, WHO

cho rang ty IS nay cao gap ddi so vdi nbu cau lam sang;

WHO cting cho rang, khoang 20-90%) sd ca viSm dudng

hd hap tren do virus van dupe diSu trj bang khang sinh;

va 60-90%) benb nban dugc kS don khang sinh khdng

phit hpp. Ngay tai My va Trung Qudc, WHO van cho

rang cdn 60- 90%) sd ca viStn dudng bd bap trSn do vi￾rus dupe diSu trj bang khang sinh. Tai Thai Lan, van

cdn khoang 90%) benh nhan dugc kS don khang sinh

*Benh vien Bgch Mai

S6 47 (Thang 12/2009) Y HOC LAM SANG I 63