Lao kháng thuốc rất nguy hiểm

Lao hhi

rat nquu hiem

DC

-e-BS. QUYNH VIEN

Lao khdng thudc la khi vi

trimg lao trong ed the chdng

lai vdi mdt hay nhieu loai

thulc lao. Cd 2 nhdm thud'c tri benh

lao, thudng gpi la "thud'c khang lao

hdng 1" va "thud'c khdng lao hang

2": Khang lao hfing 1 la cac thuoe

dugc lua chon dau tien dl dieu tri

cho b&nh nhan lao, gom cd 5 thuoe:

rifampicin (vie't tat la RIF hay R),

isoniazid (USTH hay H), pyrazinamid

(PZA hay Z), ethambutol (EMB hay

E), vd streptomycin (SM hay S).

Khdng lao hang 2 gim: kanamycin,

capreomycin, amikacin, ethionamid,

PAS, cycloserin, elofazimin,

ciprofloxacin, ofloxacin, levofloxacin...

Id ede thud'c dugc dCing khi bdnh

nhan bi khang vdi thudc lao hang 1,

thudng cd nhilu tac dung phu hon

vd vi^c SLf dung thud'c cdng phdc tap

hdn thudc khang lao hang 1.

B^nh lao khdng thuoc dUpc

phan log,i nhi£ sau:

- Khdng thud'c tien phdt: la sii

khdng thudc xay ra d benh nhan

chua dugc dung thud'c khang lao

Ian ndo. Nguyen nhan la do vi

khuan lao khang thud'c Ian truyen

td benh nhan khac sang,

- Khang thud'c mac phai hay

cdn gpi Id khang thud'c thd phat Id

sU khang thudc sau khi dung cdc

thud'c chd'ng lao it nhat mot thang.

Nguyen nhan do dung thud'c khong

dung lilu lugng va phdi hgp thudc

khdng dung gay ra cac chung vi

khuan khang thud'c.

Ngodi ra, cdn cii vdo miic do

nguy hiem, cd 2 loai:

• Khdng da thudc (Multi drug

Resistant TB): La khdng thud'c d

ngudi b^nh cd vi khuan lao khdng

vdi ca 2 loai INH va rifampicin.

• Sieu khdng thudc (Extensively

drug Resistant TB): Ld nhiTng

trUdng hgp lao khdng da thudc cd

Vl khuan lao qua kinh hien vi

khang them vdi bait cu" thud'c nao

trong nhdm quinolon vd khdng

vdi it nhat mpt Ipai thud'c khdng

lao hdng 2 dang tiem (amikacin,

capreomycin hpfic kanamycin).

Co ba nguyen nhdn ddn den lao

khdng da thuoc la bdnh nhan,

thay thud'c va dot biln vi trung lao.

> Do benh nh^n khdng tuan

thu dieu tri: ud'ng thudc khdng

diing chi ddn, dilu tri khdng du

thdi gian quy dinh.

> Do thay thuoe dung thud'c

chd'ng lao khdng tuan thu theo

phac do: Khdng phoi hgp cac

thud'c dieu tri lao, lilu lugng thudc

khdng du,..

> Do vi khuan lao dpt biln gen

cd kha nang de khdng lai vdi thud'c

khdng lao, ldm vi khuan khdng

bi chit trong mdi trudng cd thud'c

khdng lao. Khi benh lao dugc phdt

hien mudn, SP lugng vi khuan lao

sinh san den mpt so' lugng nhd't

dinh se ed mdt so vi khuan dpt

bien khang lai thud'c chd'ng lap, vi

du tai p tin thUdng lap d phoi khi

sd' lugng vi khuan lap din 10 trieu

eon vi khuan se cd 1 cpn khdng

Ngudi benh lao dang dieu In lai phong

cap cuu benh vien Pham Ngoc Thach

lai thud'c rifampicin, 100.000 con

vi khuan se cd mdt con vi khuan

ddt bien khdng lai streptpmyein

vd isoniazid.

Phdt hifn lao khdng thu&c: Khi

benh nhan dang dieu tri lao nhuiig

cdc tri^u chufng sd't, ho, khac ddm

khdng thuydn giam hofic thuyen

giam mpt thdi gian roi lai xudt hidn

trd lai nfing hon thi cdn ngM den

lao khdng thud'c, ngUdi b^nh cdn

bdo cho thdy thudc bilt dl ldm cdc

x^t nghiem can lam sdng: X quang

phoi cd hinh dnh ton thuong tren

phim khdng thay doi hofic xuat hien

thdm ton thUdng mdi. Xdt nghi?m

ddm thay AFB dUdng tinh lien tuc

hoac dm tinh mpt thdi gian r6i

duong tinh trd lai hofic dm tinh -

dUdng tinh xen ke. Cdn chdn dodn

xac dinh b^nh lao khdng thuSc bdng

each nudi cay tim vi khufo lao,

khdng sinh do vdi cdc thulc chong

lao hdng 1 vd hdng 2.

PhUdng phdp sinh hoc phdn td:

Cd the chan dodn nhanh bdng cdch

xdc dinh cdc doan gen khdng thudc.

Hg.u qua cua b^nh lao khdng

thuoc: B0nh nhdn dilu tri khdng

THUOC & S0C KHOE sd 497 (1.4.2014)