{"id":134207,"date":"2025-08-22T13:32:23","date_gmt":"2025-08-22T06:32:23","guid":{"rendered":"https:\/\/vnras.com\/drug\/?p=134207"},"modified":"2025-08-22T13:44:06","modified_gmt":"2025-08-22T06:44:06","slug":"viem-hong-cap-nguyen-nhan-phan-loai-cach-dieu-tri","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/viem-hong-cap-nguyen-nhan-phan-loai-cach-dieu-tri\/","title":{"rendered":"Vi\u00eam h\u1ecdng c\u1ea5p: Nguy\u00ean nh\u00e2n, ph\u00e2n lo\u1ea1i, c\u00e1ch \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"<p style=\"text-align: right;\"><em>L\u01b0\u1ee3t d\u1ecbch: NT HN <\/em><\/p>\n<h2>T\u00d3M T\u1eaeT<\/h2>\n<p>Vi\u00eam h\u1ecdng \u0111\u1eb7c tr\u01b0ng v\u1edbi kh\u1edfi ph\u1ea3i \u0111\u1ed9t ng\u1ed9t c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111au h\u1ecdng: kh\u00f4ng ho, ngh\u1eb9t m\u0169i ho\u1eb7c ch\u1ea3y m\u0169i g\u1ee3i \u00fd nguy\u00ean nh\u00e2n do vi khu\u1ea9n,<\/p>\n<p>Ch\u1ea9n \u0111o\u00e1n b\u1eaft \u0111\u1ea7u b\u1eb1ng khai th\u00e1c b\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng, \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng x\u00e9t nghi\u1ec7m nhanh ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean (trong tr\u01b0\u1eddng h\u1ee3p vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u nh\u00f3m A \u2014GAS), c\u1ea5y d\u1ecbch h\u1ecdng ho\u1eb7c x\u00e9t nghi\u1ec7m PCR khi c\u1ea7n.<\/p>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng r\u00f5 r\u00e0ng c\u1ee7a nhi\u1ec5m virus th\u00ec kh\u00f4ng c\u1ea3n x\u00e9t nghi\u1ec7m GAS.<\/p>\n<p>M\u1ee5c ti\u00eau c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m GAS l\u00e0 ph\u00f2ng ng\u1eeba th\u1ea5p tim c\u1ea5p, gi\u1ea3m m\u1ee9c \u0111\u1ed9 n\u1eb7ng v\u1ea3 th\u1eddi gian c\u1ee7a tri\u1ec7u ch\u1ee9ng c\u0169ng nh\u01b0 ng\u0103n ng\u1eeba l\u00e2y nhi\u1ec5m.<\/p>\n<p>Vi\u00eam h\u1ecdng c\u1ea5p nh\u00ecn chung l\u00e0 m\u1ed9t b\u1ec7nh t\u1ef1 gi\u1edbi h\u1ea1n, th\u01b0\u1eddng t\u1ef1 kh\u1ecfi trong v\u00f2ng 2 tu\u1ea7n. Ng\u01b0\u1eddi b\u1ecb nhi\u1ec5m kh\u00f4ng c\u00f3 mi\u1ec5n d\u1ecbch ho\u00e0n to\u00e0n, do \u0111\u00f3 v\u1eabn c\u00f3 th\u1ec3 t\u00e1i nhi\u1ec5m v\u1edbi h\u1ea7u h\u1ebft c\u00e1c t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh.<\/p>\n<p>Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb bao g\u1ed3m: \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 (v\u00ed d\u1ee5: thu\u1ed1c gi\u1ea3m \u0111au). \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n (v\u00ed d\u1ee5: kh\u00e1ng sinh trong tr\u01b0\u1eddng h\u1ee3p GAS).<\/p>\n<p>Ch\u1ec9 \u0111\u1ecbnh d\u00f9ng kh\u00e1ng sinh d\u1ef1 ph\u00f2ng ch\u1ec9 \u00e1p d\u1ee5ng cho nh\u1eefng ng\u01b0\u1eddi c\u00f3 ti\u1ec1n s\u1eed b\u1ecb th\u1ea5p tim.<\/p>\n<h2>\u0110\u1ecaNH NGH\u0128A<\/h2>\n<p>Vi\u00eam h\u1ecdng c\u1ea5p \u0111\u1eb7c tr\u01b0ng v\u1edbi kh\u1edfi ph\u00e1t nhanh c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111au h\u1ecdng v\u00e0 vi\u00eam h\u1ecdng (c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 gi\u1ea3 m\u1ea1c). B\u1ec7nh c\u00f3 th\u1ec3 do nhi\u1ec1u t\u00e1c nh\u00e2n g\u00e2y ra. bao g\u1ed3m virus, vi khu\u1ea9n (trong \u0111\u00f3 c\u00f3 li\u00ean c\u1ea7u nh\u00f3m A \u2014 GAS), c\u0169ng nh\u01b0 n\u1eafm (v\u00ed d\u1ee5: Candida albicans). Vi\u1ec7c kh\u00f4ng c\u00f3 ho, ngh\u1eb9t m\u0169i v\u00e0 ch\u1ea3y m\u0169i g\u1ee3i \u00fd nguy\u00ean nh\u00e2n do v\u1ecb khu\u1ea9n h\u01a1n l\u00e0 do virus, \u1ede v\u00f9ng kh\u00ed h\u1eadu \u00f4n \u0111\u1edbi, vi\u00eam h\u1ecdng do vi khu\u1ea9n th\u01b0\u1eddng g\u1eb7p h\u01a1n v\u00e0o m\u00f9a \u0111\u00f4ng ho\u1eb7c \u0111\u1ea7u m\u00f9a xu\u00e2n, trong khi nhi\u1ec5m enterovirus th\u01b0\u1eddng g\u1eb7p h\u01a1n v\u00e0o m\u00f9a h\u00e8 v\u00e0 m\u00f9a thu. Vi\u00eam h\u1ecdng c\u1ea5p th\u01b0\u1eddng l\u00e0 m\u1ed9t b\u1ec7nh t\u1ef1 gi\u1edbi h\u1ea1n, v\u1edbi tri\u1ec7u ch\u1ee9ng thuy\u00ean gi\u1ea3m trong v\u00f2ng 2 tu\u1ea7n.<\/p>\n<h2>D\u1ecaCH T\u1ec4 H\u1eccC<\/h2>\n<p>Vi\u00eam h\u1ecdng do vi khu\u1ea9n \u1edf c\u00e1c v\u00f9ng kh\u00ed h\u1eadu \u00f4n \u0111\u1edbi, th\u01b0\u1eddng g\u1eb7p h\u01a1n v\u00e0o m\u00f9a \u0111\u00f4ng ho\u1eb7c \u0111\u1ea7u m\u00f9a xu\u00e2n, trong khi nhi\u1ec5m enterovirus l\u1ea1i th\u01b0\u1eddng g\u1eb7p h\u01a1n v\u00e0o m\u00f9a h\u00e8 v\u00e0 m\u00f9a thu.<\/p>\n<p>Vi\u00eam h\u1ecdng g\u1eb7p nhi\u1ec1u nh\u1ea5t \u1edf tr\u1ebb em tu\u1ed5i \u0111i h\u1ecdc trong nh\u1eefng th\u00e1ng m\u00f9a \u0111\u00f4ng. Vi\u00eam h\u1ecdng c\u1ea5p chi\u1ebfm kho\u1ea3ng 2% \u0111\u1ebfn 5% s\u1ed1 l\u01b0\u1ee3t kh\u00e1m b\u1ec7nh nhi t\u1ea1i b\u1ec7nh vi\u1ec7n.<\/p>\n<p>T\u1ef7 l\u1ec7 tr\u1ebb em b\u1ecb li\u00ean c\u1ea7u nh\u00f3m A theo m\u00f9a \u0111\u1ea1t \u0111\u1ec9nh trong th\u1eddi gian n\u00e0y l\u00ean t\u1edbi 20%. M\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y 48% tr\u1ebb em t\u1eeb 3 \u0111\u1ebfn 12 tu\u1ed5i \u0111\u00e3 t\u1eebng b\u1ecb GAS t\u1ea1i m\u1ed9t th\u1eddi \u0111i\u1ec3m n\u00e0o \u0111\u00f3 trong v\u00f2ng 2\u00a0 n\u0103m nghi\u00ean c\u1ee9u. T\u1ea1i Hoa K\u1ef3, vi\u00eam h\u1ecdng \u0111o GAS th\u01b0\u1eddng g\u1eb7p nh\u1ea5t v\u00e0o m\u00f9a \u0111\u00f4ng v\u00e0 m\u00f9a xu\u00e2n.<br \/>\nVi\u00eam h\u1ecdng do GAS l\u00e0 tr\u1ecdng t\u00e2m trong l\u00e2m s\u00e0ng c\u1ee7a vi\u00eam h\u1ecdng, v\u00ec m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb ch\u00ednh l\u00e0 ph\u00f2ng ng\u1eeba b\u1ec7nh th\u1ea5p tim li\u00ean quan \u0111\u1ebfn vi khu\u1ea9n n\u00e0y. GAS l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y ra 20% \u0111\u1ebfn 30% c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111au h\u1ecdng \u1edf tr\u1ebb em v\u00e0 5% \u0111\u1ebfn 15% \u1edf ng\u01b0\u1eddi l\u1edbn.<\/p>\n<h2>C\u0102N NGUY\u00caN<\/h2>\n<p>\u0110au h\u1ecdng c\u1ea5p th\u01b0\u1eddng do virus ho\u1eb7c li\u00ean c\u1ea7u khu\u1ea9n nh\u00f3m A g\u00e2y ra. C\u00e1c nguy\u00ean nh\u00e2n virus th\u01b0\u1eddng g\u1eb7p bao g\u1ed3m virus EBV, Adenovirus, Enterovirus, C\u1ee7m A v\u00e0 B, v\u00e0 virus \u00e1 c\u00fam. Vi\u00eam h\u1ecdng do GAS (hay c\u00f2n g\u1ecdi l\u00e0 vi\u00eam h\u1ecdng li\u00ean c\u1ea7u) do vi khu\u1ea9n Streptococcus pyogenes g\u00e2y ra, l\u00e2y truy\u1ec1n t\u1eeb ng\u01b0\u1eddi sang ng\u01b0\u1eddi, \u0111\u1eb7c bi\u1ec7t v\u00e0o m\u00f9a \u0111\u00f4ng, qua \u0111\u01b0\u1eddng gi\u1ecdt b\u1ea3n h\u00f4 h\u1ea5p. Tuy nhi\u00ean, GAS ch\u1ec9 chi\u1ebfm ch\u01b0a \u0111\u1ebfn 1\/3 s\u1ed1 ca vi\u00eam h\u1ecdng c\u1ea5p. Li\u00ean c\u1ea7u nh\u00f3m B, C v\u00e0 G c\u0169ng c\u00f3 th\u1ec3 g\u00e2y vi\u00eam h\u1ecdng v\u1edbi bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng kh\u00f4ng th\u1ec3 ph\u00e2n bi\u1ec7t v\u1edbi GAS. Ng\u01b0\u1eddi l\u00e0 \u1ed5 ch\u1ee9a duy nh\u1ea5t c\u1ee7a vi khu\u1ea9n GAS. Vi khu\u1ea9n th\u01b0\u1eddng l\u00e2y truy\u1ec1n t\u1eeb ng\u01b0\u1eddi nhi\u1ec5m sang ng\u01b0\u1eddi ti\u1ec5n x\u00fac g\u1eafn qua n\u01b0\u1edbc b\u1ecdt, d\u1ecbch v\u1ebft th\u01b0\u01a1ng ho\u1eb7c d\u1ecbch ti\u1ebft m\u0169i. Th\u1eddi gian \u1ee7 b\u1ec7nh c\u1ee7a GAS kho\u1ea3ng 2-5 ng\u00e0y.<\/p>\n<p>C\u00e1c vi khu\u1ea9n kh\u00e1c hi\u1ebfm g\u1eb7p h\u01a1n c\u00f3 th\u1ec3 g\u00e2y vi\u00eam h\u1ecdng \u1edf tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean bao g\u1ed3m Mycoplasma spp., Fusobacterium necrophorum, v\u00e0 Arcanobacterium haemolytium.<\/p>\n<p>\u1ede nh\u1eefng tr\u1ebb v\u1ecb th\u00e0nh ni\u00ean c\u00f3 ho\u1ea1t \u0111\u1ed9ng t\u00ecnh d\u1ee5c ho\u1eb7c tr\u1ebb b\u1ecb l\u1ea1m d\u1ee5ng t\u00ecnh d\u1ee5c, vi\u00eam h\u1ecdng c\u1ea5p c\u00f3 th\u1ec3 do HIV, chlamydia ho\u1eb7c l\u1eadu c\u1ea7u.<\/p>\n<p>T\u1ea1i c\u00e1c qu\u1ed1c gia c\u00f3 t\u1ef7 l\u1ec7 ti\u00eam ch\u1ee7ng th\u1ea5p, b\u1ea1ch h\u1ea7u v\u00e0 s\u1edfi c\u0169ng l\u00e0 nh\u1eefng nguy\u00ean nh\u00e2n c\u00f3 th\u1ec3 g\u00e2y vi\u00eam h\u1ecdng c\u1ea5p. Ngo\u00e0i ra, n\u1ebfu c\u00f3 ti\u1ec1n s\u1eed \u0103n th\u1ecbt \u0111\u1ed9ng v\u1eadt hoang d\u00e3, b\u1ec7nh tularemia c\u0169ng c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t \u0111\u1ebfn.<\/p>\n<p>Nhi\u1ec5m n\u1ea5m Candida l\u00e0 nguy\u00ean nh\u00e2n th\u01b0\u1eddng g\u1eb7p g\u00e2y \u0111au h\u1ecdng \u1edf ng\u01b0\u1eddi suy gi\u1ea3m mi\u1ec5n d\u1ecbch, bao g\u1ed3m nh\u1eefng ng\u01b0\u1eddi \u0111ang \u0111i\u1ec1u tr\u1ecb h\u00f3a tr\u1ecb ho\u1eb7c x\u1ea1 tr\u1ecb v\u00f9ng mi\u1ec7ng \u2014 h\u1ecdng v\u00ec ung th\u01b0.<\/p>\n<h2>SINH L\u00dd B\u1ec6NH<\/h2>\n<p>Vi\u00eam h\u1ecdng c\u1ea5p x\u1ea3y ra do virus ho\u1eb7c vi khu\u1ea9n x\u00e2m nh\u1eadp v\u00e0o ni\u00eam m\u1ea1c h\u1ecdng, g\u00e2y ra t\u00ecnh tr\u1ea1ng vi\u00eam c\u1ee7a v\u00f9ng h\u1ea7u h\u1ecdng. Th\u00f4ng th\u01b0\u1eddng b\u1ec7nh khu tr\u00fa t\u1ea1i v\u00f9ng h\u1ecdng, nh\u01b0ng hi\u1ebfm khi c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t ph\u1ea7n c\u1ee7a nhi\u1ec5m tr\u00f9ng to\u00e0n th\u00e2n (v\u00ed d\u1ee5: b\u1ec7nh IM, tularemia ho\u1eb7c nhi\u1ec5m HIV).<\/p>\n<h2>PH\u00c2N LO\u1ea0I<\/h2>\n<p>Vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u khu\u1ea9n nh\u00f3m A:<\/p>\n<ul>\n<li>C\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0: s\u1ed1t, \u0111au h\u1ecdng, gi\u1ea3 m\u1ea1c \u1edf h\u1ecdng, s\u01b0ng h\u1ea1ch c\u1ed5. v\u00e0 kh\u00f4ng c\u00f3 ho.<\/li>\n<\/ul>\n<p>Vi\u00eam h\u1ecdng do virus:<\/p>\n<ul>\n<li>C\u00e1c nguy\u00ean nh\u00e2n virus th\u01b0\u1eddng g\u1eb7p bao g\u1ed3m: virus SARS-CoV-2, virus EBV, adenovirus, enterovirus, c\u00fam A v\u00e0 B, v\u00e0 virus \u00e1 c\u00fam.<\/li>\n<li>C\u00f3 th\u1ec3 c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 gi\u1ea3 m\u1ea1c \u1edf h\u1ecdng.<\/li>\n<li>T\u0103ng b\u1ea1ch c\u1ea7u \u0111\u01a1n nh\u00e2n nhi\u1ec5m khu\u1ea9n th\u01b0\u1eddng \u0111i k\u00e8m v\u1edbi s\u01b0ng h\u1ea1ch b\u1ea1ch huy\u1ebft v\u00e0 l\u00e1ch to.<\/li>\n<li>Ch\u1ea9n \u0111o\u00e1n \u0111\u01b0\u1ee3c h\u1ed7 tr\u1ee3 v\u1edbi c\u1ea5y d\u1ecbch h\u1ecdng \u00e2m t\u00ednh.<\/li>\n<li>Tri\u1ec7u ch\u1ee9ng bao g\u1ed3m: ho, ch\u1ea3y m\u0169i, kh\u00e0n ti\u1ebfng, lo\u00e9t mi\u1ec7ng, vi\u00eam k\u1ebft m\u1ea1c.<\/li>\n<li>Khi b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng r\u00f5 r\u00e0ng do virus, ch\u1ea9n \u0111o\u00e1n c\u00f3 th\u1ec3 d\u1ef1a v\u00e0o khai th\u00e1c b\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng.<\/li>\n<\/ul>\n<p>Vi\u00eam h\u1ecdng do n\u1ea5m Candida:<\/p>\n<ul>\n<li>Th\u01b0\u1eddng g\u1eb7p \u1edf nh\u1eefng ng\u01b0\u1eddi suy gi\u1ea3m mi\u1ec5n d\u1ecbch.<\/li>\n<li>C\u00f3 th\u1ec3 x\u1ea3y ra trong qu\u00e1 tr\u00ecnh h\u00f3a tr\u1ecb ho\u1eb7c x\u1ea1 tr\u1ecb \u0111\u1ed1i v\u1edbi ung th\u01b0 v\u00f2m mi\u1ec7ng &#8211; h\u1ecdng.<\/li>\n<\/ul>\n<p>B\u1ea1ch h\u1ea7u:<\/p>\n<ul>\n<li>C\u00f3 m\u1ea3ng x\u00e1m \u1edf m\u0169i v\u00e0 h\u1ecdng, m\u1ea3ng n\u00e0y ch\u1ea3y m\u00e1u khi b\u1ecb bong ra.<\/li>\n<li>Hi\u1ebfm g\u1eb7p ngo\u00e0i c\u00e1c qu\u1ed1c gia c\u00f3 thu nh\u1eadp th\u1ea5p v\u00e0 trung b\u00ecnh.<\/li>\n<\/ul>\n<p>S\u1edfi:<\/p>\n<ul>\n<li>Li\u00ean quan \u0111\u1ebfn vi\u00eam k\u1ebft m\u1ea1c, vi\u00eam m\u0169i, ho v\u00e0 ban \u0111\u1eb7c tr\u01b0ng.<\/li>\n<li>Koplik l\u00e0 d\u1ea5u hi\u1ec7u \u0111\u1eb7c hi\u1ec7u c\u1ee7a b\u1ec7nh.<\/li>\n<\/ul>\n<p>B\u1ec7nh tularemia:<\/p>\n<ul>\n<li>Do \u0103n ho\u1eb7c u\u1ed1ng th\u1ef1c ph\u1ea9m, n\u01b0\u1edbc b\u1ecb nhi\u1ec5m khu\u1ea9n.<\/li>\n<li>Tri\u1ec7u ch\u1ee9ng tularemia v\u00f9ng mi\u1ec7ng \u2013 h\u1ecdng bao g\u1ed3m: \u0111au h\u1ecdng, lo\u00e9t mi\u1ec7ng, vi\u00eam amidan v\u00e0 s\u01b0ng h\u1ea1ch b\u1ea1ch huy\u1ebft \u1edf c\u1ed5.<\/li>\n<li>C\u00f3 th\u1ec3 c\u00f3 lo\u00e9t v\u00e0 gi\u1ea3 m\u1ea1c \u1edf v\u00f9ng h\u1ecdng.<\/li>\n<li>C\u00f3 th\u1ec3 ph\u00e1t tri\u1ec3n m\u1ea3ng x\u00e1m, gi\u1ed1ng nh\u01b0 b\u1ec7nh b\u1ea1ch h\u1ea7u.<\/li>\n<li>Kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb penicillin.<\/li>\n<li>Li\u00ean quan \u0111\u1ebfn vi\u1ec7c \u0103n th\u1ecbt s\u1ed1ng ho\u1eb7c ch\u01b0a n\u1ea5u ch\u00edn t\u1eeb \u0111\u1ed9ng v\u1eadt hoang d\u00e3.<\/li>\n<\/ul>\n<p>Vi\u00eam h\u1ecdng do b\u1ec7nh l\u00e2y truy\u1ec1n qua \u0111\u01b0\u1eddng t\u00ecnh d\u1ee5c:<\/p>\n<ul>\n<li>HIV<\/li>\n<li>L\u1eadu<\/li>\n<li>Chlamydia<\/li>\n<\/ul>\n<p>H\u1ed9i ch\u1ee9ng Lemierre:<\/p>\n<ul>\n<li>Th\u01b0\u1eddng do vi khu\u1ea9n Fusobacterium necrophorum g\u00e2y ra.<\/li>\n<li>G\u00e2y huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch c\u1ea3nh nhi\u1ec5m tr\u00f9ng (vi\u00eam t\u1eafc t\u0129nh m\u1ea1ch c\u1ea3nh c\u00f3 m\u1ee7).<\/li>\n<li>C\u1ea7n \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa.<\/li>\n<\/ul>\n<p>\u00c1p xe th\u00e0nh sau h\u1ecdng:<\/p>\n<ul>\n<li>Tri\u1ec7u ch\u1ee9ng: s\u1ed1t, \u0111au h\u1ecdng, kh\u00f3 nu\u1ed1t, \u0111au ho\u1eb7c c\u1ee9ng c\u1ed5, thay \u0111\u1ed5i gi\u1ecdng n\u00f3i<\/li>\n<li>Ch\u1ea9n \u0111o\u00e1n b\u1eb1ng c\u00e1ch ch\u1ee5p CT<\/li>\n<li>C\u1ea7n nh\u1eadp vi\u1ec7n \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb<\/li>\n<\/ul>\n<h2>TI\u1ebeP C\u1eacN<\/h2>\n<p>Ch\u1ea9n \u0111o\u00e1n b\u1eaft \u0111\u1ea7u b\u1eb1ng vi\u1ec7c khai th\u00e1c b\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng. B\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng r\u00f5 r\u00e0ng do virus th\u00ec kh\u00f4ng c\u1ea7n x\u00e9t nghi\u1ec7m li\u00ean c\u1ea7u khu\u1ea9n nh\u00f3m A. N\u1ebfu kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng nhi\u1ec5m virus, c\u1ea7n th\u1ef1c hi\u1ec7n x\u00e9t nghi\u1ec7m nhanh ph\u00e1t hi\u1ec7n kh\u00e1ng nguy\u00ean v\u00e0\/ho\u1eb7c c\u1ea5y d\u1ecbch h\u1ecdng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh nhi\u1ec5m li\u00ean c\u1ea7u nh\u00f3m A.<\/p>\n<p>Ng\u01b0\u1eddi mang GAS kh\u00f4ng tri\u1ec7u ch\u1ee9ng l\u00e0 ng\u01b0\u1eddi c\u00f3 k\u1ebft qu\u1ea3 c\u1ea5y d\u1ecbch h\u1ecdng d\u01b0\u01a1ng t\u00ednh ho\u1eb7c x\u00e9t nghi\u1ec7m nhanh d\u01b0\u01a1ng t\u00ednh nh\u01b0ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ho\u1eb7c kh\u00f4ng c\u00f3 \u0111\u00e1p \u1ee9ng mi\u1ec5n d\u1ecbch v\u1edbi kh\u00e1ng nguy\u00ean GAS trong x\u00e9t nghi\u1ec7m. \u1ede tr\u1ebb em, n\u1ebfu x\u00e9t nghi\u1ec7m nhanh cho k\u1ebft qu\u1ea3 \u00e2m t\u00ednh, c\u1ea7n \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn l\u1ea1i b\u1eb1ng c\u1ea5y d\u1ecbch h\u1ecdng.<\/p>\n<p>Th\u00f4ng th\u01b0\u1eddng, kh\u00f4ng c\u1ea7n \u0111i\u1ec1u tr\u1ecb \u0111\u1ed1i v\u1edbi nh\u1eefng ng\u01b0\u1eddi mang GAS kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng.<\/p>\n<h3>B\u1ec7nh s\u1eed<\/h3>\n<p>M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 l\u00e2m s\u00e0ng quan tr\u1ecdng c\u00f3 th\u1ec3 g\u1ee3i \u00fd t\u00e1c nh\u00e2n g\u00e2y b\u1ec7nh:<\/p>\n<ul>\n<li>Vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u khu\u1ea9n nh\u00f3m A th\u01b0\u1eddng g\u1eb7p \u1edf tr\u1ebb em v\u00e0 thanh thi\u1ebfu ni\u00ean t\u1eeb 5 \u2013 15 tu\u1ed5i.<\/li>\n<li>B\u1ec7nh th\u01b0\u1eddng g\u1eb7p v\u00e0o m\u00f9a \u0111\u00f4ng (ho\u1eb7c \u0111\u1ea7u m\u00f9a xu\u00e2n) \u1edf c\u00e1c v\u00f9ng kh\u00ed h\u1eadu \u00f4n \u0111\u1edbi. Trong khi \u0111\u00f3, nhi\u1ec5m enterovirus th\u01b0\u1eddng g\u1eb7p h\u01a1n v\u00e0o m\u00f9a h\u00e8 v\u00e0 m\u00f9a thu.<\/li>\n<li>Kh\u00f4ng n\u00ean ch\u1ec9 \u0111\u1ecbnh x\u00e9t nghi\u1ec7m GAS cho tr\u1ebb d\u01b0\u1edbi 3 tu\u1ed5i, v\u00ec th\u1ea5p tim c\u1ea5p r\u1ea5t hi\u1ebfm g\u1eb7p v\u00e0 vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u khu\u1ea9n c\u0169ng kh\u00f4ng th\u01b0\u1eddng g\u1eb7p trong nh\u00f3m tu\u1ed5i n\u00e0y. Tuy nhi\u00ean, n\u1ebfu tr\u1ebb c\u00f3 anh\/ch\u1ecb\/em \u0111ang m\u1eafc GAS th\u00ec c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc x\u00e9t nghi\u1ec7m.<\/li>\n<li>B\u1ec7nh tularemia c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ngh\u0129 ng\u1edd khi c\u00f3 ti\u1ec1n s\u1eed \u0103n th\u1ecbt \u0111\u1ed9ng v\u1eadt hoang d\u00e3 ch\u01b0a \u0111\u01b0\u1ee3c n\u1ea5u ch\u00edn. B\u1ec7nh s\u1eed c\u0169ng c\u00f3 th\u1ec3 ghi nh\u1eadn t\u00ecnh tr\u1ea1ng kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb penicillin tr\u01b0\u1edbc \u0111\u00f3.<\/li>\n<li>HIV, Chlamydia v\u00e0 l\u1eadu c\u1ea7n \u0111\u01b0\u1ee3c xem x\u00e9t l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam h\u1ecdng \u1edf ng\u01b0\u1eddi c\u00f3 quan h\u1ec7 t\u00ecnh d\u1ee5c ho\u1eb7c b\u1ecb l\u1ea1m d\u1ee5ng t\u00ecnh d\u1ee5c, \u0111\u1eb7c bi\u1ec7t l\u00e0 khi k\u1ebft qu\u1ea3 c\u1ea5y GAS \u00e2m t\u00ednh.<\/li>\n<li>Suy gi\u1ea3m mi\u1ec5n d\u1ecbch c\u00f3 th\u1ec3 do t\u1ed5n th\u01b0\u01a1ng m\u00f4 t\u1ea1i ch\u1ed7 (v\u00ed d\u1ee5: x\u1ea1 tr\u1ecb v\u00f9ng mi\u1ec7ng \u2013 h\u1ecdng do ung th\u01b0) ho\u1eb7c do nguy\u00ean nh\u00e2n to\u00e0n th\u00e2n (v\u00ed d\u1ee5: h\u00f3a tr\u1ecb, sau gh\u00e9p t\u1ea1ng, ho\u1eb7c HIV). Vi\u00eam h\u1ecdng do n\u1ea5m Candida (v\u00ed d\u1ee5: t\u01b0a mi\u1ec7ng, th\u01b0\u1eddng do Candida albicans) c\u00f3 th\u1ec3 g\u1eb7p trong b\u1ed1i c\u1ea3nh n\u00e0y. C\u1ea5y vi sinh \u0111\u1ec3 t\u00ecm t\u00e1c nh\u00e2n nghi ng\u1edd l\u00e0 c\u00e1ch \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh ch\u1ea9n \u0111o\u00e1n.<\/li>\n<li>Ti\u00eam ch\u1ee7ng kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 c\u00f3 th\u1ec3 l\u00e0 y\u1ebfu t\u1ed1 g\u1ee3i \u00fd c\u00e1c b\u1ec7nh nh\u01b0 b\u1ea1ch h\u1ea7u ho\u1eb7c s\u1edfi.<\/li>\n<\/ul>\n<h3>Tri\u1ec7u ch\u1ee9ng<\/h3>\n<ul>\n<li>\u0110au h\u1ecdng l\u00e0 tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p.<\/li>\n<li>\u0110au khi nu\u1ed1t.<\/li>\n<li>S\u1ed1t th\u01b0\u1eddng xu\u1ea5t hi\u1ec7n trong vi\u00eam h\u1ecdng, nh\u01b0ng l\u00e0 m\u1ed9t tri\u1ec7u ch\u1ee9ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u.<\/li>\n<li>\u1ede tr\u1ebb em, c\u00f3 th\u1ec3 g\u1eb7p \u0111au \u0111\u1ea7u, bu\u1ed3n n\u00f4n v\u00e0 \u0111au b\u1ee5ng.<\/li>\n<li>Ch\u1ea3y m\u0169i, ngh\u1eb9t m\u0169i, kh\u00e0n ti\u1ebfng, lo\u00e9t mi\u1ec7ng, vi\u00eam k\u1ebft m\u1ea1c v\u00e0 ho c\u00f3 th\u1ec3 g\u1eb7p trong vi\u00eam h\u1ecdng do virus, nh\u01b0ng th\u01b0\u1eddng kh\u00f4ng g\u1eb7p trong vi\u00eam h\u1ecdng do vi khu\u1ea9n.<\/li>\n<\/ul>\n<h3>Kh\u00e1m l\u00e2m s\u00e0ng<\/h3>\n<p>Kh\u00e1m trong vi\u00eam h\u1ecdng c\u1ea5p kh\u00f4ng c\u1ea7n nhi\u1ec1u d\u1ee5ng c\u1ee5, ch\u1ec9 c\u1ea7n \u0111\u00e8n pin v\u00e0 que \u0111\u00e8 l\u01b0\u1ee1i.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-134209\" src=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/anh-viem-hong-cap-1.jpg\" alt=\"Vi\u00eam h\u1ecdng c\u1ea5p\" width=\"1200\" height=\"900\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/anh-viem-hong-cap-1.jpg 1200w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/anh-viem-hong-cap-1-533x400.jpg 533w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/anh-viem-hong-cap-1-1067x800.jpg 1067w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/anh-viem-hong-cap-1-768x576.jpg 768w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/anh-viem-hong-cap-1-350x263.jpg 350w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><\/p>\n<p>C\u00e1c \u0111\u1eb7c \u0111i\u1ec3m quan tr\u1ecdng kh\u00e1c c\u1ea7n l\u01b0u \u00fd:<\/p>\n<ul>\n<li>Kh\u00f4ng c\u00f3 ho c\u00f9ng v\u1edbi h\u1ea1ch c\u1ed5 to l\u00e0 y\u1ebfu t\u1ed1 \u0111\u1eb7c hi\u1ec7u trong d\u1ef1 \u0111o\u00e1n nguy\u00ean nh\u00e2n do li\u00ean c\u1ea7u.<\/li>\n<li>Nhi\u1ec5m virus c\u00f3 th\u1ec3 ph\u00e2n bi\u1ec7t nh\u1edd s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 ch\u1ea3y m\u0169i, ngh\u1eb9t m\u0169i v\u00e0 ho.<\/li>\n<li>C\u1ea7n ngh\u0129 \u0111\u1ebfn b\u1ea1ch h\u1ea7u n\u1ebfu c\u00f3 m\u1ea3ng x\u00e1m \u1edf h\u1ecdng ho\u1eb7c trong h\u1ed1c m\u0169i. C\u1ea5y vi sinh \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh.<\/li>\n<\/ul>\n<h3>X\u00e9t nghi\u1ec7m<\/h3>\n<p>X\u00e9t nghi\u1ec7m nhanh kh\u00e1ng nguy\u00ean GAS v\u00e0 c\u1ea5y d\u1ecbch h\u1ecdng l\u00e0 nh\u1eefng c\u00f4ng c\u1ee5 r\u1ea5t h\u1eefu \u00edch trong \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u, gi\u00fap tr\u00e1nh l\u1ea1m d\u1ee5ng kh\u00e1ng sinh. C\u1ea5y d\u1ecbch h\u1ecdng \u0111\u01b0\u1ee3c coi l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng, \u0111\u1eb7c bi\u1ec7t h\u1eefu \u00edch khi nghi ng\u1edd l\u00e2m s\u00e0ng nhi\u1ec1u \u0111\u1ebfn GAS ho\u1eb7c c\u00e1c b\u1ec7nh c\u00f3 th\u1ec3 do c\u00e1c lo\u1ea1i li\u00ean c\u1ea7u kh\u00e1c ho\u1eb7c vi khu\u1ea9n kh\u00e1c nh\u01b0 Arcanobacterium haemolyticum. Tuy nhi\u00ean, c\u00f3 m\u1ed9t s\u1ed1 l\u01b0u \u00fd khi s\u1eed d\u1ee5ng c\u00e1c x\u00e9t nghi\u1ec7m n\u00e0y:<\/p>\n<ul>\n<li>X\u00e9t nghi\u1ec7m nhanh kh\u00e1ng nguy\u00ean GAS cho ph\u00e9p \u0111\u00e1nh gi\u00e1 ngay t\u1ea1i th\u1eddi \u0111i\u1ec3m ch\u0103m s\u00f3c.<\/li>\n<li>K\u1ebft qu\u1ea3 d\u01b0\u01a1ng t\u00ednh nh\u01b0ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111\u1eb7c tr\u01b0ng (s\u1ed1t, kh\u00f4ng ho, gi\u1ea3 m\u1ea1c amidan, s\u01b0ng h\u1ea1ch c\u00f3 \u0111au) nhi\u1ec1u kh\u1ea3 n\u0103ng ch\u1ec9 ph\u1ea3n \u00e1nh t\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi mang GAS kh\u00f4ng g\u00e2y b\u1ec7nh. Do \u0111\u00f3, ch\u1ec9 n\u00ean l\u00e0m x\u00e9t nghi\u1ec7m khi c\u00e1c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ph\u00f9 h\u1ee3p g\u1ee3i \u00fd GAS g\u00e2y ra.<\/li>\n<li>X\u00e9t nghi\u1ec7m nhanh GAS c\u00f3 \u0111\u1ed9 nh\u1ea1y t\u1eeb 70% \u0111\u1ebfn 90% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u kho\u1ea3ng 95% so v\u1edbi c\u1ea5y d\u1ecbch h\u1ecdng. Tuy nhi\u00ean, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u00f3 th\u1ec3 th\u1ea5p h\u01a1n \u1edf tr\u1ebb em m\u1edbi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb GAS g\u1ea7n \u0111\u00e2y.<\/li>\n<li>N\u1ebfu x\u00e9t nghi\u1ec7m nhanh GAS \u00e2m t\u00ednh nh\u01b0ng v\u1eabn nghi ng\u1edd vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u, n\u00ean l\u00e0m c\u1ea5y d\u1ecbch h\u1ecdng, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf tr\u1ebb em do c\u00f3 nguy c\u01a1 m\u1eafc b\u1ec7nh th\u1ea5p tim.<\/li>\n<li>NICE khuy\u1ebfn c\u00e1o kh\u00f4ng s\u1eed d\u1ee5ng test nhanh li\u00ean c\u1ea7u \u1edf nh\u1eefng tr\u1ebb t\u1eeb 5 tu\u1ed5i tr\u1edf l\u00ean c\u00f3 \u0111au h\u1ecdng, v\u00ec hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng c\u1ee7a x\u00e9t nghi\u1ec7m n\u00e0y kh\u00f4ng v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi vi\u1ec7c s\u1eed d\u1ee5ng c\u00e1c thang \u0111i\u1ec3m, \u0111\u1ed3ng th\u1eddi c\u0169ng kh\u00f4ng c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb hay ki\u1ec3m so\u00e1t kh\u00e1ng sinh m\u1ed9t c\u00e1ch r\u00f5 r\u1ec7t.<\/li>\n<li>X\u00e9t nghi\u1ec7m PCR c\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi c\u1ea5y d\u1ecbch h\u1ecdng, nh\u01b0ng cho k\u1ebft qu\u1ea3 nhanh h\u01a1n. Ngo\u00e0i ra, vi\u1ec7c s\u1eed d\u1ee5ng PCR \u1edf tr\u1ebb em nghi ng\u1edd GAS trong ch\u0103m s\u00f3c ban \u0111\u1ea7u gi\u00fap s\u1eed d\u1ee5ng kh\u00e1ng sinh h\u1ee3p l\u00fd h\u01a1n. Tuy nhi\u00ean, x\u00e9t nghi\u1ec7m PCR nhanh t\u1ea1i ph\u00f2ng kh\u00e1m hi\u1ec7n ch\u01b0a \u0111\u01b0\u1ee3c tri\u1ec3n khai r\u1ed9ng r\u00e3i.<\/li>\n<li>C\u1ea5y d\u1ecbch h\u1ecdng \u0111\u1eb7c bi\u1ec7t h\u1eefu \u00edch khi test nhanh li\u00ean c\u1ea7u \u00e2m t\u00ednh nh\u01b0ng l\u00e2m s\u00e0ng v\u1eabn nghi ng\u1edd nhi\u1ec5m GAS. X\u00e9t nghi\u1ec7m nhanh kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c c\u00e1c lo\u1ea1i li\u00ean c\u1ea7u khu\u1ea9n kh\u00e1c ho\u1eb7c Arcanobacterium haemolyticum, v\u1ed1n c\u00f3 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng gi\u1ed1ng v\u1edbi vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u.<\/li>\n<li>C\u00e1c vi khu\u1ea9n kh\u00e1c nh\u01b0 Haemophilus influenzae, t\u1ee5 c\u1ea7u, n\u00e3o m\u00f4 c\u1ea7u v\u00e0 ph\u1ebf c\u1ea7u kh\u00f4ng ph\u1ea3i l\u00e0 nguy\u00ean nh\u00e2n g\u00e2y vi\u00eam h\u1ecdng c\u1ea5p v\u00e0 kh\u00f4ng n\u00ean \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh ho\u1eb7c b\u00e1o c\u00e1o trong k\u1ebft qu\u1ea3 c\u1ea5y d\u1ecbch h\u1ecdng.<\/li>\n<\/ul>\n<p>X\u00e9t nghi\u1ec7m ki\u1ec3m tra kh\u1ecfi b\u1ec7nh (b\u1eb1ng c\u1ea5y d\u1ecbch h\u1ecdng ho\u1eb7c x\u00e9t nghi\u1ec7m nhanh kh\u00e1ng nguy\u00ean GAS sau \u0111i\u1ec1u tr\u1ecb) kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh th\u01b0\u1eddng quy, tr\u1eeb c\u00e1c tr\u01b0\u1eddng h\u1ee3p c\u00f3 nguy c\u01a1 cao b\u1ecb suy th\u1eadn c\u1ea5p ho\u1eb7c t\u00e1i ph\u00e1t tri\u1ec7u ch\u1ee9ng ph\u00f9 h\u1ee3p v\u1edbi nhi\u1ec5m GAS. Tuy nhi\u00ean, trong vi\u00eam h\u1ecdng do l\u1eadu c\u1ea7u, c\u1ea7n l\u00e0m x\u00e9t nghi\u1ec7m ki\u1ec3m tra kh\u1ecfi b\u1ec7nh sau \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>\u0110\u1ed1i v\u1edbi ng\u01b0\u1eddi l\u1edbn c\u00f3 tri\u1ec7u ch\u1ee9ng vi\u00eam h\u1ecdng, kh\u00f4ng ph\u1ea3i l\u00fac n\u00e0o c\u0169ng c\u1ea7n l\u00e0m x\u00e9t nghi\u1ec7m. Thay v\u00e0o \u0111\u00f3, t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng vi\u00eam h\u1ecdng n\u00ean \u0111\u01b0\u1ee3c s\u00e0ng l\u1ecdc b\u1eb1ng c\u00e1c thang \u0111i\u1ec3m l\u00e2m s\u00e0ng d\u1ef1 \u0111o\u00e1n nh\u01b0 Centor, McIsaac ho\u1eb7c FeverPAIN.<\/p>\n<p>Thang \u0111i\u1ec3m Centor:<\/p>\n<ul>\n<li>C\u00f3 s\u1ed1t<\/li>\n<li>Kh\u00f4ng ho<\/li>\n<li>Gi\u1ea3 m\u1ea1c ho\u1eb7c xu\u1ea5t ti\u1ebft amidan<\/li>\n<li>S\u01b0ng \u0111au h\u1ea1ch c\u1ed5 tr\u01b0\u1edbc<\/li>\n<\/ul>\n<p>Ng\u01b0\u1eddi l\u1edbn kh\u00f4ng c\u00f3 ho\u1eb7c ch\u1ec9 c\u00f3 1 \u0111i\u1ec3m trong Centor th\u00ec kh\u00f4ng c\u1ea7n l\u00e0m x\u00e9t nghi\u1ec7m ho\u1eb7c \u0111i\u1ec1u tr\u1ecb GAS. Nh\u1eefng ng\u01b0\u1eddi c\u00f3 t\u1eeb hai \u0111i\u1ec3m tr\u1edf l\u00ean n\u00ean \u0111\u01b0\u1ee3c l\u00e0m test nhanh GAS. N\u1ebfu \u0111i\u1ec1u tr\u1ecb th\u1ea5t b\u1ea1i \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng x\u00e9t nghi\u1ec7m x\u00e1c \u0111\u1ecbnh nhi\u1ec5m GAS, c\u1ea7n c\u1ea5y d\u1ecbch h\u1ecdng \u0111\u1ec3 t\u00ecm vi khu\u1ea9n kh\u00e1c ngo\u00e0i GAS v\u00e0 ki\u1ec3m tra l\u1ea1i c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh do virus.<\/p>\n<p>Thang \u0111i\u1ec3m McIsaac:<\/p>\n<p>H\u1ec7 th\u1ed1ng McIsaac l\u00e0 b\u1ea3n \u0111i\u1ec1u ch\u1ec9nh c\u1ee7a Centor nh\u1eb1m ph\u1ea3n \u00e1nh t\u1ef7 l\u1ec7 GAS cao h\u01a1n \u1edf tr\u1ebb em.<\/p>\n<ul>\n<li>S\u01b0ng ho\u1eb7c c\u00f3 gi\u1ea3 m\u1ea1c amidan (c\u1ed9ng 1 \u0111i\u1ec3m)<\/li>\n<li>S\u01b0ng \u0111au h\u1ea1ch c\u1ed5 tr\u01b0\u1edbc (c\u1ed9ng 1 \u0111i\u1ec3m)<\/li>\n<li>Kh\u00f4ng ho (c\u1ed9ng 1 \u0111i\u1ec3m)<\/li>\n<li>Nhi\u1ec7t \u0111\u1ed9 &gt; 38\u00b0C (c\u1ed9ng 1 \u0111i\u1ec3m)<\/li>\n<li>Tu\u1ed5i 3 \u2013 14 (c\u1ed9ng 1 \u0111i\u1ec3m)<\/li>\n<li>Tu\u1ed5i 15 \u2013 44 (kh\u00f4ng c\u1ed9ng \u0111i\u1ec3m)<\/li>\n<li>Tu\u1ed5i \u2265 45 (tr\u1eeb 1 \u0111i\u1ec3m)<\/li>\n<\/ul>\n<p>T\u01b0\u01a1ng t\u1ef1 Centor, \u0111i\u1ec3m McIsaac c\u00e0ng cao th\u00ec nguy c\u01a1 nhi\u1ec5m GAS c\u00e0ng cao.<\/p>\n<p>Thang \u0111i\u1ec3m FeverPAIN:<\/p>\n<ul>\n<li>S\u1ed1t (trong v\u00f2ng 24 gi\u1edd qua)<\/li>\n<li>C\u00f3 m\u1ee7 tr\u00ean amidan<\/li>\n<li>Kh\u1edfi ph\u00e1t s\u1edbm (trong v\u00f2ng 3 ng\u00e0y k\u1ec3 t\u1eeb khi kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng)<\/li>\n<li>Amidan vi\u00eam n\u1eb7ng<\/li>\n<li>Kh\u00f4ng ho ho\u1eb7c kh\u00f4ng vi\u00eam m\u0169i h\u1ecdng<\/li>\n<\/ul>\n<p>M\u1ed7i ti\u00eau ch\u00ed FeverPAIN \u0111\u01b0\u1ee3c t\u00ednh 1 \u0111i\u1ec3m, v\u1edbi t\u1ed5ng \u0111i\u1ec3m t\u1ed1i \u0111a l\u00e0 5. \u0110i\u1ec3m c\u00e0ng cao cho th\u1ea5y tri\u1ec7u ch\u1ee9ng c\u00e0ng n\u1eb7ng v\u00e0 kh\u1ea3 n\u0103ng nguy\u00ean nh\u00e2n vi khu\u1ea9n (li\u00ean c\u1ea7u khu\u1ea9n) c\u00e0ng cao. \u0110i\u1ec3m 0 ho\u1eb7c 1: kh\u1ea3 n\u0103ng ph\u00e2n l\u1eadp Strep kho\u1ea3ng 13\u201318%. \u0110i\u1ec3m 2\u20133: kh\u1ea3 n\u0103ng ph\u00e2n l\u1eadp Strep kho\u1ea3ng 34\u201340%. \u0110i\u1ec3m 4 ho\u1eb7c 5: kh\u1ea3 n\u0103ng ph\u00e2n l\u1eadp \u0111\u01b0\u1ee3c Strep kho\u1ea3ng 63\u201365%.<\/p>\n<p>NICE khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thang \u0111i\u1ec3m Centor v\u00e0 FeverPAIN. M\u1eb7c d\u00f9 c\u00e1c h\u1ec7 th\u1ed1ng thang \u0111i\u1ec3m n\u00e0y kh\u00f4ng ph\u1ea3i l\u00e0 c\u00f4ng c\u1ee5 ch\u1ea9n \u0111o\u00e1n tuy\u1ec7t \u0111\u1ed1i, nh\u01b0ng ch\u00fang gi\u00fap t\u0103ng kh\u1ea3 n\u0103ng d\u1ef1 \u0111o\u00e1n tr\u01b0\u1edbc x\u00e9t nghi\u1ec7m, \u0111\u1ed3ng th\u1eddi h\u1ea1n ch\u1ebf vi\u1ec7c ph\u00e1t hi\u1ec7n nh\u1eefng tr\u01b0\u1eddng h\u1ee3p ch\u1ec9 mang m\u1ea7m b\u1ec7nh GAS m\u00e0 kh\u00f4ng c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng trong vi\u00eam h\u1ecdng do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c.<\/p>\n<h2>X\u00c9T NGHI\u1ec6M<\/h2>\n<table style=\"height: 430px; width: 100%; border-collapse: collapse;\" border=\"1\">\n<tbody>\n<tr style=\"height: 21px;\">\n<td style=\"width: 67.3116%; text-align: center; height: 21px;\"><strong>X\u00e9t nghi\u1ec7m<\/strong><\/td>\n<td style=\"width: 32.6884%; text-align: center; height: 21px;\"><strong>K\u1ebft qu\u1ea3<\/strong><\/td>\n<\/tr>\n<tr style=\"height: 367px;\">\n<td style=\"width: 67.3116%; height: 367px;\"><strong>Test nhanh li\u00ean c\u1ea7u<\/strong><\/p>\n<ul>\n<li>Test nhanh GAS cho ph\u00e9p \u0111\u00e1nh gi\u00e1 ngay l\u1eadp t\u1ee9c, v\u1edbi \u0111\u1ed9 nh\u1ea1y kho\u1ea3ng 70\u201390% v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u kho\u1ea3ng 95% so v\u1edbi c\u1ea5y d\u1ecbch h\u1ecdng.<\/li>\n<li>\u1ede tr\u1ebb em m\u1edbi \u0111i\u1ec1u tr\u1ecb GAS g\u1ea7n \u0111\u00e2y, \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u c\u1ee7a x\u00e9t nghi\u1ec7m nhanh c\u00f3 th\u1ec3 b\u1ecb gi\u1ea3m.<\/li>\n<li>Khi nghi ng\u1edd nhi\u1ec5m GAS, n\u1ebfu x\u00e9t nghi\u1ec7m nhanh cho k\u1ebft qu\u1ea3 \u00e2m t\u00ednh, n\u00ean l\u00e0m th\u00eam c\u1ea5y d\u1ecbch h\u1ecdng, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u1edf tr\u1ebb em do nguy c\u01a1 m\u1eafc b\u1ec7nh th\u1ea5p tim cao h\u01a1n.<\/li>\n<li>K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m d\u01b0\u01a1ng t\u00ednh nh\u01b0ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111i\u1ec3n h\u00ecnh (s\u1ed1t, kh\u00f4ng ho, gi\u1ea3 m\u1ea1c amidan, s\u01b0ng h\u1ea1ch c\u1ed5 \u0111au) th\u01b0\u1eddng ch\u1ec9 ph\u1ea3n \u00e1nh t\u00ecnh tr\u1ea1ng mang m\u1ea7m b\u1ec7nh GAS v\u00e0 kh\u00f4ng c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng. V\u00ec v\u1eady, ch\u1ec9 n\u00ean x\u00e9t nghi\u1ec7m khi tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng ph\u00f9 h\u1ee3p v\u1edbi nhi\u1ec5m GAS. Vi\u1ec7c x\u00e9t nghi\u1ec7m \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng th\u00edch h\u1ee3p th\u01b0\u1eddng d\u1eabn \u0111\u1ebfn ch\u1ea9n \u0111o\u00e1n sai v\u00e0 l\u1ea1m d\u1ee5ng kh\u00e1ng sinh kh\u00f4ng c\u1ea7n thi\u1ebft.<\/li>\n<li>K\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m th\u01b0\u1eddng c\u00f3 trong v\u00f2ng t\u1eeb 10-20 ph\u00fat.<\/li>\n<li>NICE khuy\u1ebfn c\u00e1o kh\u00f4ng s\u1eed d\u1ee5ng test nhanh GAS \u1edf tr\u1ebb t\u1eeb 5 tu\u1ed5i tr\u1edf l\u00ean b\u1ecb \u0111au h\u1ecdng, v\u00ec hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng kh\u00f4ng v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi c\u00e1c h\u1ec7 th\u1ed1ng thang \u0111i\u1ec3m l\u00e2m s\u00e0ng, \u0111\u1ed3ng th\u1eddi kh\u00f4ng gi\u00fap c\u1ea3i thi\u1ec7n ki\u1ec3m so\u00e1t kh\u00e1ng sinh.<\/li>\n<\/ul>\n<\/td>\n<td style=\"width: 32.6884%; height: 367px;\">D\u01b0\u01a1ng t\u00ednh trong nhi\u1ec5m GAS v\u00e0 \u1edf ng\u01b0\u1eddi mang m\u1ea7m b\u1ec7nh kh\u00f4ng tri\u1ec7u ch\u1ee9ng.<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 67.3116%; height: 21px;\"><strong>PCR <\/strong><\/p>\n<ul>\n<li>C\u00f3 \u0111\u1ed9 nh\u1ea1y v\u00e0 \u0111\u1ed9 \u0111\u1eb7c hi\u1ec7u t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi c\u1ea5y h\u1ecdng, nh\u01b0ng cho k\u1ebft qu\u1ea3 nhanh h\u01a1n (ngay c\u1ea3 trong ch\u0103m s\u00f3c ban \u0111\u1ea7u). Tuy nhi\u00ean, x\u00e9t nghi\u1ec7m PCR nhanh t\u1ea1i ph\u00f2ng kh\u00e1m hi\u1ec7n v\u1eabn ch\u01b0a ph\u1ed5 bi\u1ebfn r\u1ed9ng r\u00e3i.<\/li>\n<\/ul>\n<\/td>\n<td style=\"width: 32.6884%; height: 21px;\">D\u01b0\u01a1ng t\u00ednh trong nhi\u1ec5m GAS.<\/td>\n<\/tr>\n<tr style=\"height: 21px;\">\n<td style=\"width: 67.3116%; height: 21px;\"><strong>C\u1ea5y d\u1ecbch h\u1ecdng<\/strong><\/p>\n<ul>\n<li>C\u1ea5y d\u1ecbch h\u1ecdng t\u00ecm GAS l\u00e0 x\u00e9t nghi\u1ec7m nh\u1ea1y (90\u201395%) v\u00e0 \u0111\u1eb7c hi\u1ec7u nh\u1ea5t \u0111\u1ec3 ph\u00e1t hi\u1ec7n GAS. \u0110\u00e2y \u0111\u01b0\u1ee3c xem l\u00e0 ti\u00eau chu\u1ea9n v\u00e0ng, \u0111\u1eb7c bi\u1ec7t h\u1eefu \u00edch khi nghi ng\u1edd l\u00e2m s\u00e0ng cao ho\u1eb7c c\u00f3 th\u1ec3 do c\u00e1c lo\u1ea1i li\u00ean c\u1ea7u khu\u1ea9n kh\u00e1c ho\u1eb7c vi khu\u1ea9n kh\u00e1c nh\u01b0 Arcanobacterium haemolyticum g\u00e2y ra.<\/li>\n<li>C\u1ea5y d\u1ecbch h\u1ecdng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u1edf tr\u1ebb em c\u00f3 test nhanh GAS \u00e2m t\u00ednh nh\u01b0ng tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng v\u1eabn ph\u00f9 h\u1ee3p v\u1edbi vi\u00eam h\u1ecdng do GAS.<\/li>\n<li>C\u1ea5y d\u1ecbch h\u1ecdng \u0111\u1eb7c bi\u1ec7t h\u1eefu \u00edch khi test nhanh \u00e2m t\u00ednh nh\u01b0ng l\u00e2m s\u00e0ng v\u1eabn ngh\u0129 \u0111\u1ebfn nhi\u1ec5m GAS. X\u00e9t nghi\u1ec7m nhanh kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c c\u00e1c lo\u1ea1i li\u00ean c\u1ea7u khu\u1ea9n kh\u00e1c ho\u1eb7c Arcanobacterium haemolyticum \u2014 nh\u1eefng t\u00e1c nh\u00e2n c\u00f3 th\u1ec3 g\u00e2y vi\u00eam h\u1ecdng v\u1edbi bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng kh\u00f4ng th\u1ec3 ph\u00e2n bi\u1ec7t v\u1edbi GAS.<\/li>\n<\/ul>\n<\/td>\n<td style=\"width: 32.6884%; height: 21px;\">D\u01b0\u01a1ng t\u00ednh trong GAS.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>TI\u1ebeP C\u1eacN \u0110I\u1ec0U TR\u1eca<\/h2>\n<p>Thu\u1ed1c gi\u1ea3m \u0111au v\u00e0 thu\u1ed1c g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng nh\u01b0 \u0111au h\u1ecdng, \u0111au \u0111\u1ea7u v\u00e0 s\u1ed1t, tuy nhi\u00ean kh\u00f4ng n\u00ean d\u00f9ng aspirin cho tr\u1ebb em v\u00ec nguy c\u01a1 li\u00ean quan \u0111\u1ebfn h\u1ed9i ch\u1ee9ng Reye. S\u00fac mi\u1ec7ng v\u1edbi n\u01b0\u1edbc mu\u1ed1i ch\u01b0a \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3, nh\u01b0ng c\u0169ng kh\u00f4ng g\u00e2y h\u1ea1i. X\u1ecbt g\u00e2y t\u00ea ho\u1eb7c vi\u00ean ng\u1eadm g\u00e2y t\u00ea c\u00f3 th\u1ec3 gi\u00fap gi\u1ea3m \u0111au t\u1ea1m th\u1eddi do vi\u00eam h\u1ecdng. M\u1ed9t nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c cho th\u1ea5y lidocain kh\u00f4ng gi\u00fap c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng. Tuy nhi\u00ean, nhi\u1ec1u nghi\u00ean c\u1ee9u kh\u00e1c cho th\u1ea5y thu\u1ed1c g\u00e2y t\u00ea t\u1ea1i ch\u1ed7 c\u00f3 l\u1ee3i, gi\u00fap gi\u1ea3m tri\u1ec7u ch\u1ee9ng v\u00e0 gi\u1ea3m s\u1eed d\u1ee5ng kh\u00e1ng sinh kh\u00f4ng c\u1ea7n thi\u1ebft. D\u1eef li\u1ec7u trong ph\u00f2ng th\u00ed nghi\u1ec7m cho th\u1ea5y b\u00ean c\u1ea1nh t\u00e1c d\u1ee5ng gi\u1ea3m \u0111au, m\u1ed9t s\u1ed1 vi\u00ean ng\u1eadm ch\u1ee9a amylmetacresol v\u00e0 2,4-dichlorobenzyl alcohol c\u00f2n c\u00f3 th\u1ec3 c\u00f3 ho\u1ea1t t\u00ednh di\u1ec7t virus.<\/p>\n<p>\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh ch\u1ec9 n\u00ean \u00e1p d\u1ee5ng cho nh\u1eefng b\u1ec7nh nh\u00e2n x\u00e1c \u0111\u1ecbnh nhi\u1ec5m GAS th\u00f4ng qua c\u00e1c x\u00e9t nghi\u1ec7m vi sinh (test nhanh d\u01b0\u01a1ng t\u00ednh, PCR ho\u1eb7c c\u1ea5y d\u1ecbch h\u1ecdng), v\u00e0 kh\u00f4ng n\u00ean ch\u1ec9 d\u1ef1a v\u00e0o ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng. Kh\u00f4ng n\u00ean d\u00f9ng kh\u00e1ng sinh cho b\u1ec7nh nh\u00e2n c\u00f3 k\u1ebft qu\u1ea3 test nhanh \u00e2m t\u00ednh. Kh\u00e1ng sinh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n nh\u1eb1m r\u00fat ng\u1eafn th\u1eddi gian b\u1ec7nh, gi\u1ea3m l\u00e2y lan v\u00e0 ph\u00f2ng ng\u1eeba bi\u1ebfn ch\u1ee9ng nh\u01b0 rheumatic fever. N\u1ebfu tri\u1ec7u ch\u1ee9ng vi\u00eam h\u1ecdng kh\u00f4ng c\u1ea3i thi\u1ec7n sau 3\u20134 ng\u00e0y \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh, n\u00ean xem x\u00e9t c\u00e1c ch\u1ea9n \u0111o\u00e1n kh\u00e1c.<\/p>\n<p>Vi\u1ec7c s\u1eed d\u1ee5ng corticosteroid trong \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng vi\u00eam h\u1ecdng c\u1ea5p, m\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p c\u1ee7a Cochrane cho th\u1ea5y khi k\u1ebft h\u1ee3p corticosteroid v\u1edbi kh\u00e1ng sinh, kh\u1ea3 n\u0103ng kh\u1ecfi ho\u00e0n to\u00e0n tri\u1ec7u ch\u1ee9ng \u0111au sau 24 gi\u1edd t\u0103ng l\u00ean 2,4 l\u1ea7n. Tuy nhi\u00ean, b\u00e0i t\u1ed5ng h\u1ee3p n\u00e0y c\u0169ng l\u01b0u \u00fd r\u1eb1ng thi\u1ebfu c\u00e1c nghi\u00ean c\u1ee9u b\u00e1o c\u00e1o v\u1ec1 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n v\u00e0 thi\u1ebfu d\u1eef li\u1ec7u tr\u00ean qu\u1ea7n th\u1ec3 tr\u1ebb em, l\u00e0 l\u00fd do c\u1ea7n th\u1eadn tr\u1ecdng khi s\u1eed d\u1ee5ng corticosteroid, do l\u1ee3i \u00edch l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u00e1ng k\u1ec3. M\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p kh\u00e1c ph\u00e1t hi\u1ec7n r\u1eb1ng nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u00f9ng li\u1ec1u corticosteroid th\u1ea5p, \u0111\u01a1n li\u1ec1u th\u00ec c\u00f3 kh\u1ea3 n\u0103ng gi\u1ea3m \u0111au sau 24 gi\u1edd g\u1ea5p 2 l\u1ea7n, v\u00e0 kh\u1ea3 n\u0103ng h\u1ebft \u0111au sau 48 gi\u1edd t\u0103ng 1,5 l\u1ea7n. Trong m\u1ed9t nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean m\u00f9 \u0111\u00f4i c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng kh\u00e1ng sinh, vi\u1ec7c s\u1eed d\u1ee5ng corticosteroid \u0111\u01b0\u1eddng u\u1ed1ng kh\u00f4ng gi\u00fap c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng sau 24 gi\u1edd, nh\u01b0ng c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c c\u1ea3i thi\u1ec7n tri\u1ec7u ch\u1ee9ng sau 48 gi\u1edd. Tuy nhi\u00ean, kh\u00f4ng c\u00f3 t\u00e1c \u0111\u1ed9ng \u0111\u1ebfn vi\u1ec7c ng\u01b0\u1eddi b\u1ec7nh quay l\u1ea1i kh\u00e1m, s\u1ed1 ng\u00e0y ngh\u1ec9 h\u1ecdc ho\u1eb7c l\u00e0m vi\u1ec7c, ho\u1eb7c vi\u1ec7c tr\u00ec ho\u00e3n s\u1eed d\u1ee5ng kh\u00e1ng sinh. Vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c kh\u00e1ng vi\u00eam, bao g\u1ed3m corticosteroid \u1edf ng\u01b0\u1eddi b\u1ecb vi\u00eam h\u1ecdng c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng nguy c\u01a1 xu\u1ea5t hi\u1ec7n c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 \u00e1p xe quanh amidan, nhi\u1ec5m tr\u00f9ng huy\u1ebft, huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch, v\u00e0 g\u00e3y x\u01b0\u01a1ng b\u1ec7nh l\u00fd. Do l\u1ee3i \u00edch h\u1ea1n ch\u1ebf v\u00e0 nguy c\u01a1 g\u00e2y h\u1ea1i \u0111\u00e1ng k\u1ec3, IDSA hi\u1ec7n kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng corticosteroid trong \u0111i\u1ec1u tr\u1ecb vi\u00eam h\u1ecdng c\u1ea5p.<\/p>\n<p>Vi\u00eam h\u1ecdng c\u1ea5p l\u00e0 nguy\u00ean nh\u00e2n \u0111\u1ee9ng h\u00e0ng th\u1ee9 ba d\u1eabn \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh kh\u00f4ng h\u1ee3p l\u00fd. \u1ede ng\u01b0\u1eddi l\u1edbn, ph\u01b0\u01a1ng ph\u00e1p k\u00ea \u0111\u01a1n kh\u00e1ng sinh tr\u00ec ho\u00e3n gi\u00fap h\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng kh\u00e1ng sinh. Tuy nhi\u00ean, c\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y c\u00f3 th\u1ec3 kh\u00f4ng ph\u00f9 h\u1ee3p \u1edf tr\u1ebb em, do nguy c\u01a1 cao b\u1ecb rheumatic fever. Nhi\u1ec1u s\u00e1ng ki\u1ebfn nh\u1eb1m h\u1ea1n ch\u1ebf vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh kh\u00f4ng \u0111\u00fang \u0111\u00e3 cho th\u1ea5y hi\u1ec7u qu\u1ea3 trong vi\u1ec7c gi\u1ea3m k\u00ea \u0111\u01a1n kh\u00e1ng sinh kh\u00f4ng c\u1ea7n thi\u1ebft m\u00e0 kh\u00f4ng l\u00e0m t\u0103ng s\u1ed1 l\u1ea7n b\u1ec7nh nh\u00e2n quay l\u1ea1i kh\u00e1m ho\u1eb7c l\u00e0m gi\u1ea3m s\u1ef1 h\u00e0i l\u00f2ng c\u1ee7a ng\u01b0\u1eddi b\u1ec7nh. Tuy nhi\u00ean, m\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y r\u1eb1ng 26% c\u00e1c tr\u01b0\u1eddng h\u1ee3p vi\u00eam h\u1ecdng \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n kh\u00e1ng sinh kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng ch\u1ea9n \u0111o\u00e1n nhi\u1ec5m khu\u1ea9n.<\/p>\n<p><strong>Vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u A (GAS) <\/strong><\/p>\n<p>M\u1ee5c ti\u00eau c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u nh\u00f3m A l\u00e0 \u0111\u1ec3 ph\u00f2ng ng\u1eeba rheumatic fever, gi\u1ea3m m\u1ee9c \u0111\u1ed9 n\u1eb7ng v\u00e0 th\u1eddi gian c\u1ee7a tri\u1ec7u ch\u1ee9ng, c\u0169ng nh\u01b0 ng\u0103n ng\u1eeba s\u1ef1 l\u00e2y lan b\u1ec7nh. Vi khu\u1ea9n GAS l\u00e2y lan qua ti\u1ebfp x\u00fac v\u1edbi d\u1ecbch ti\u1ebft t\u1eeb \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p c\u1ee7a ng\u01b0\u1eddi b\u1ecb nhi\u1ec5m. T\u1ef7 l\u1ec7 l\u00e2y nhi\u1ec5m t\u1eeb ng\u01b0\u1eddi m\u1eafc GAS sang ng\u01b0\u1eddi ti\u1ebfp x\u00fac g\u1ea7n v\u00e0o kho\u1ea3ng 35%. Th\u1eddi gian \u1ee7 b\u1ec7nh l\u00e0 t\u1eeb 2 \u0111\u1ebfn 5 ng\u00e0y. Trong th\u1eddi gian n\u00e0y, b\u1ec7nh c\u00f3 th\u1ec3 l\u00e2y truy\u1ec1n sang ng\u01b0\u1eddi kh\u00e1c. Tuy nhi\u00ean, 90% b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f2n kh\u1ea3 n\u0103ng l\u00e2y nhi\u1ec5m trong v\u00f2ng 24 gi\u1edd sau khi b\u1eaft \u0111\u1ea7u d\u00f9ng kh\u00e1ng sinh. Vi\u1ec7c d\u00f9ng kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 ti\u1ec1n s\u1eed rheumatic fever \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o nh\u1eb1m gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t rheumatic fever v\u00e0 gi\u1ea3m nguy c\u01a1 m\u1eafc b\u1ec7nh th\u1ea5p tim. M\u1ed9t b\u00e0i t\u1ed5ng quan Cochrane k\u1ebft lu\u1eadn r\u1eb1ng kh\u00e1ng sinh ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n sau khi \u0111\u00e3 \u0111\u00e1nh gi\u00e1 t\u1eebng b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3, v\u00e0 ch\u1ec9 trong tr\u01b0\u1eddng h\u1ee3p vi\u00eam h\u1ecdng c\u00f3 kh\u1ea3 n\u0103ng do vi khu\u1ea9n g\u00e2y ra.<\/p>\n<p>Li\u00ean c\u1ea7u nh\u00f3m A kh\u00f4ng kh\u00e1ng beta-lactam, v\u00ec v\u1eady \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng penicillin ho\u1eb7c amoxicillin, tr\u1eeb khi ng\u01b0\u1eddi b\u1ec7nh b\u1ecb d\u1ecb \u1ee9ng v\u1edbi penicillin, trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00f3 c\u00f3 th\u1ec3 d\u00f9ng macrolid, cephalosporin ho\u1eb7c clindamycin m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng. \u0110\u00e3 c\u00f3 b\u00e1o c\u00e1o v\u1ec1 kh\u00e1ng macrolid v\u00e0 kh\u00e1ng clindamycin \u1edf tr\u1ebb em. Doxycycline v\u00e0 trimethoprim\/sulfamethoxazole kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o d\u00f9ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb. Phenoxymethylpenicillin \u0111\u01b0\u1eddng u\u1ed1ng l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb \u01b0u ti\u00ean, \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong 10 ng\u00e0y. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 ho\u00e0n t\u1ea5t li\u1ec7u tr\u00ecnh 10 ng\u00e0y b\u1eb1ng thu\u1ed1c u\u1ed1ng, c\u00f3 th\u1ec3 ti\u00eam b\u1eafp m\u1ed9t li\u1ec1u benzylpenicillin duy nh\u1ea5t. \u1ede tr\u1ebb em, amoxicillin \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 th\u1ec3 thay th\u1ebf, v\u00ec v\u1ecb c\u1ee7a n\u00f3 d\u1ec5 ch\u1ecbu h\u01a1n so v\u1edbi phenoxymethylpenicillin.<\/p>\n<p>Amoxicillin n\u00ean \u0111\u01b0\u1ee3c tr\u00e1nh s\u1eed d\u1ee5ng khi nghi ng\u1edd c\u00f3 nhi\u1ec5m EBV, v\u00ec nguy c\u01a1 xu\u1ea5t hi\u1ec7n ph\u00e1t ban nghi\u00eam tr\u1ecdng. Li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb khuy\u1ebfn c\u00e1o b\u1eb1ng kh\u00e1ng sinh beta-lactam \u0111\u01b0\u1eddng u\u1ed1ng \u1edf tr\u1ebb em l\u00e0 10 ng\u00e0y. Tuy nhi\u00ean, m\u1eb7c d\u00f9 c\u00e1c h\u01b0\u1edbng d\u1eabn l\u00e2m s\u00e0ng khuy\u1ebfn c\u00e1o d\u00f9ng trong 10 ng\u00e0y, \u0111\u00e3 c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y li\u1ec7u tr\u00ecnh ng\u1eafn h\u01a1n (t\u1eeb 3\u20136 ng\u00e0y) b\u1eb1ng penicillin \u0111\u01b0\u1eddng u\u1ed1ng c\u0169ng hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng trong \u0111i\u1ec1u tr\u1ecb vi\u00eam h\u1ecdng c\u1ea5p, m\u00e0 kh\u00f4ng l\u00e0m t\u0103ng nguy c\u01a1 vi\u00eam c\u1ea7u th\u1eadn h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u ho\u1eb7c rheumatic fever. M\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y: li\u1ec7u tr\u00ecnh 3 ng\u00e0y v\u1edbi azithromycin ho\u1eb7c 5 ng\u00e0y v\u1edbi cefaclor mang l\u1ea1i hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng v\u00e0 ti\u1ec7t khu\u1ea9n t\u01b0\u01a1ng \u0111\u01b0\u01a1ng so v\u1edbi li\u1ec7u tr\u00ecnh 10 ng\u00e0y amoxicillin. Tuy nhi\u00ean, nghi\u00ean c\u1ee9u n\u00e0y kh\u00f4ng \u0111\u00e1nh gi\u00e1 t\u1ef7 l\u1ec7 m\u1eafc rheumatic fever ho\u1eb7c th\u1ea5p tim. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c ph\u00e1t hi\u1ec7n r\u1eb1ng: penicillin V d\u00f9ng trong 5 ng\u00e0y kh\u00f4ng thua k\u00e9m v\u1ec1 m\u1eb7t hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng so v\u1edbi penicillin V d\u00f9ng trong 10 ng\u00e0y (\u1edf c\u00e1c li\u1ec1u kh\u00e1c nhau), nh\u01b0ng c\u0169ng kh\u00f4ng \u0111\u00e1nh gi\u00e1 \u1ea3nh h\u01b0\u1edfng l\u00ean t\u1ef7 l\u1ec7 m\u1eafc rheumatic fever ho\u1eb7c th\u1ea5p tim. V\u00ec b\u1eb1ng ch\u1ee9ng hi\u1ec7n t\u1ea1i v\u1eabn \u0111ang \u0111\u01b0\u1ee3c ho\u00e0n thi\u1ec7n, c\u00e1c li\u1ec7u tr\u00ecnh kh\u00e1ng sinh ng\u1eafn ng\u00e0y n\u00ean \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn thay th\u1ebf \u0111ang n\u1ed5i l\u00ean, ch\u1ee9 ch\u01b0a ph\u1ea3i l\u00e0 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb ch\u00ednh th\u1ee9c \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o.<\/p>\n<h2>\u0110I\u1ec0U TR\u1eca<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-134215\" src=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/anh-viem-hong-cap-2.jpg\" alt=\"Vi\u00eam h\u1ecdng c\u1ea5p\" width=\"1200\" height=\"900\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/anh-viem-hong-cap-2.jpg 1200w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/anh-viem-hong-cap-2-533x400.jpg 533w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/anh-viem-hong-cap-2-1067x800.jpg 1067w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/anh-viem-hong-cap-2-768x576.jpg 768w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2025\/08\/anh-viem-hong-cap-2-350x263.jpg 350w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><\/p>\n<p>&nbsp;<\/p>\n<table style=\"width: 100%; border-collapse: collapse;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 100%;\" colspan=\"2\"><strong><span style=\"font-size: 14.4px;\">C\u1ea5p<\/span><\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 20.4684%;\"><span style=\"font-size: 14.4px;\">Kh\u00f4ng ph\u00e1t hi\u1ec7n GAS ho\u1eb7c kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed rheumatic fever<\/span><\/td>\n<td style=\"width: 79.5316%;\"><span style=\"color: #333333;\"><span style=\"font-size: 14.4px;\">\u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 + Tr\u00ec ho\u00e3n ho\u1eb7c kh\u00f4ng d\u00f9ng kh\u00e1ng sinh<br \/>\n<\/span><\/span><span style=\"color: #333333;\"><span style=\"font-size: 14.4px;\">Trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p khi x\u00e9t nghi\u1ec7m nhanh li\u00ean c\u1ea7u khu\u1ea9n nh\u00f3m A cho k\u1ebft qu\u1ea3 \u00e2m t\u00ednh, m\u1ed9t c\u00e1ch ti\u1ebfp c\u1eadn h\u1ee3p l\u00fd l\u00e0 kh\u00f4ng d\u00f9ng kh\u00e1ng sinh, v\u00e0 theo d\u00f5i l\u1ea1i v\u00e0o ng\u00e0y h\u00f4m sau n\u1ebfu k\u1ebft qu\u1ea3 c\u1ea5y d\u1ecbch h\u1ecdng d\u01b0\u01a1ng t\u00ednh. C\u1ea5y d\u1ecbch h\u1ecdng n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n cho t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n c\u00f3 x\u00e9t nghi\u1ec7m test nhanh \u00e2m t\u00ednh GAS nh\u01b0ng c\u00f3 tri\u1ec7u ch\u1ee9ng ph\u00f9 h\u1ee3p v\u1edbi vi\u00eam h\u1ecdng li\u00ean c\u1ea7u. M\u1ed9t ph\u00e2n t\u00edch t\u1ed5ng h\u1ee3p t\u1eeb Cochrane k\u1ebft lu\u1eadn r\u1eb1ng kh\u00e1ng sinh ch\u1ec9 n\u00ean \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n sau khi \u0111\u00e1nh gi\u00e1 t\u1eebng b\u1ec7nh nh\u00e2n m\u1ed9t c\u00e1ch c\u1ee5 th\u1ec3 v\u00e0 ch\u1ec9 khi vi\u00eam h\u1ecdng c\u00f3 kh\u1ea3 n\u0103ng l\u00e0 do vi khu\u1ea9n g\u00e2y ra.<\/span><\/span><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 20.4684%;\"><span style=\"font-size: 14.4px;\">Ph\u00e1t hi\u1ec7n GAS ho\u1eb7c c\u00f3 ti\u1ec1n s\u1eed rheumatic fever<\/span><\/td>\n<td style=\"width: 79.5316%;\"><strong><span style=\"color: #333333;\"><span style=\"font-size: 14.4px;\">\u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 + \u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh<\/span><\/span><\/strong><\/p>\n<p><em><strong><span style=\"color: #333333;\"><span style=\"font-size: 14.4px;\">L\u1ef1a ch\u1ecdn \u0111\u1ea7u tay<\/span><\/span><\/strong><\/em><\/p>\n<p>Phenoxymethylpenicillin Tr\u1ebb em \u2264 27 kg: 250 mg u\u1ed1ng 2\u20133 l\u1ea7n\/ng\u00e0y trong 10 ng\u00e0y. Tr\u1ebb em &gt; 27 kg v\u00e0 ng\u01b0\u1eddi l\u1edbn: 500 mg u\u1ed1ng 2\u20133 l\u1ea7n\/ng\u00e0y trong 10 ng\u00e0y.<\/p>\n<p>HO\u1eb6C<\/p>\n<p>Benzathine benzylpenicillin: Tr\u1ebb em &lt; 27 kg: 600.000 \u0111\u01a1n v\u1ecb ti\u00eam b\u1eafp m\u1ed9t li\u1ec1u; tr\u1ebb \u2265 27 kg v\u00e0 ng\u01b0\u1eddi l\u1edbn: 1,2 tri\u1ec7u \u0111\u01a1n v\u1ecb ti\u00eam b\u1eafp m\u1ed9t li\u1ec1u.<\/p>\n<p>HO\u1eb6C<\/p>\n<p>Amoxicillin: Tr\u1ebb em: 50 mg\/kg\/ng\u00e0y, u\u1ed1ng chia 2 l\u1ea7n trong 10 ng\u00e0y, t\u1ed1i \u0111a 1000 mg\/ng\u00e0y; Ng\u01b0\u1eddi l\u1edbn: 500 mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y trong 10 ng\u00e0y.<\/p>\n<p><em><strong>L\u1ef1a ch\u1ecdn h\u00e0ng th\u1ee9 hai<\/strong><\/em><\/p>\n<p>Azithromycin: Tr\u1ebb em: 12 mg\/kg (t\u1ed1i \u0111a 300 mg\/li\u1ec1u) u\u1ed1ng 1 l\u1ea7n ng\u00e0y 1, sau \u0111\u00f3 6 mg\/kg (t\u1ed1i \u0111a 250 mg\/li\u1ec1u) u\u1ed1ng 1 l\u1ea7n h\u00e0ng ng\u00e0y trong 4 ng\u00e0y; Ng\u01b0\u1eddi l\u1edbn: 500 mg u\u1ed1ng 1 l\u1ea7n v\u00e0o ng\u00e0y 1, sau \u0111\u00f3 250 mg u\u1ed1ng 1 l\u1ea7n h\u00e0ng ng\u00e0y trong 4 ng\u00e0y.<\/p>\n<p>HO\u1eb6C<\/p>\n<p>Clarithromycin: Tr\u1ebb em: 15 mg\/kg\/ng\u00e0y, u\u1ed1ng chia 2 l\u1ea7n m\u1ed7i 12 gi\u1edd trong 10 ng\u00e0y, t\u1ed1i \u0111a 500 mg\/ng\u00e0y; Ng\u01b0\u1eddi l\u1edbn: 250 mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y trong 10 ng\u00e0y.<\/p>\n<p>HO\u1eb6C<\/p>\n<p>Cefalexin: Tr\u1ebb em: 25\u201350 mg\/kg\/ng\u00e0y, u\u1ed1ng chia 2 li\u1ec1u m\u1ed7i 12 gi\u1edd trong 10 ng\u00e0y, t\u1ed1i \u0111a 1000 mg\/ng\u00e0y; Ng\u01b0\u1eddi l\u1edbn: 500 mg u\u1ed1ng 2 l\u1ea7n\/ng\u00e0y trong 10 ng\u00e0y.<\/p>\n<p>HO\u1eb6C<\/p>\n<p>Cefadroxil: Tr\u1ebb em: 30 mg\/kg\/ng\u00e0y, u\u1ed1ng chia 1\u20132 l\u1ea7n trong 10 ng\u00e0y, t\u1ed1i \u0111a 1000 mg\/ng\u00e0y; Ng\u01b0\u1eddi l\u1edbn: 1000 mg\/ng\u00e0y, u\u1ed1ng chia 1\u20132 l\u1ea7n trong 10 ng\u00e0y.<\/p>\n<p>HO\u1eb6C<\/p>\n<p>Clindamycin: Tr\u1ebb em: 20 mg\/kg\/ng\u00e0y, u\u1ed1ng chia 3 l\u1ea7n m\u1ed7i 8 gi\u1edd trong 10 ng\u00e0y, t\u1ed1i \u0111a 1800 mg\/ng\u00e0y; Ng\u01b0\u1eddi l\u1edbn: 300\u2013600 mg u\u1ed1ng m\u1ed7i 8 gi\u1edd trong 10 ng\u00e0y.<\/p>\n<p>Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh ch\u1ec9 n\u00ean \u00e1p d\u1ee5ng cho c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e3 x\u00e1c nh\u1eadn vi\u00eam h\u1ecdng do c\u0103n nguy\u00ean vi sinh (v\u00ed d\u1ee5: li\u00ean c\u1ea7u nh\u00f3m A) th\u00f4ng qua c\u00e1c x\u00e9t nghi\u1ec7m nh\u01b0 test nhanh, PCR ho\u1eb7c c\u1ea5y d\u1ecbch h\u1ecdng, v\u00e0 kh\u00f4ng n\u00ean d\u1ef1a v\u00e0o ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng \u0111\u01a1n thu\u1ea7n. Kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng kh\u00e1ng sinh cho c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 k\u1ebft qu\u1ea3 test nhanh \u00e2m t\u00ednh. Kh\u00e1ng sinh c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n nh\u1eb1m r\u00fat ng\u1eafn th\u1eddi gian tri\u1ec7u ch\u1ee9ng, gi\u1ea3m l\u00e2y lan v\u00e0 ng\u0103n ng\u1eeba c\u00e1c bi\u1ebfn ch\u1ee9ng nh\u01b0 rheumatic fever. N\u1ebfu c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng c\u1ea3i thi\u1ec7n sau 3 ho\u1eb7c 4 ng\u00e0y \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh th\u00edch h\u1ee3p, c\u1ea7n xem x\u00e9t c\u00e1c ch\u1ea9n \u0111o\u00e1n kh\u00e1c.<\/p>\n<p>M\u1ee5c ti\u00eau c\u1ee7a \u0111i\u1ec1u tr\u1ecb vi\u00eam h\u1ecdng do li\u00ean c\u1ea7u khu\u1ea9n nh\u00f3m A l\u00e0 nh\u1eb1m ph\u00f2ng ng\u1eeba rheumatic fever v\u00e0 th\u1ea5p tim, gi\u1ea3m m\u1ee9c \u0111\u1ed9 n\u1eb7ng v\u00e0 th\u1eddi gian tri\u1ec7u ch\u1ee9ng, c\u0169ng nh\u01b0 ng\u0103n ng\u1eeba l\u00e2y lan.<\/p>\n<p>GAS kh\u00f4ng c\u00f3 t\u00ecnh tr\u1ea1ng kh\u00e1ng kh\u00e1ng sinh nh\u00f3m beta-lactam, do \u0111\u00f3 c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng penicillin ho\u1eb7c amoxicillin, tr\u1eeb khi b\u1ec7nh nh\u00e2n b\u1ecb d\u1ecb \u1ee9ng v\u1edbi penicillin \u2014 trong tr\u01b0\u1eddng h\u1ee3p \u0111\u00f3 c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng macrolide, cephalosporin ho\u1eb7c clindamycin m\u1ed9t c\u00e1ch th\u1eadn tr\u1ecdng. \u0110\u00e3 c\u00f3 b\u00e1o c\u00e1o v\u1ec1 t\u00ecnh tr\u1ea1ng kh\u00e1ng macrolide v\u00e0 kh\u00e1ng clindamycin \u1edf tr\u1ebb em. Kh\u00f4ng khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng doxycycline v\u00e0 trimethoprim\/sulfamethoxazole trong \u0111i\u1ec1u tr\u1ecb vi\u00eam h\u1ecdng do GAS.<\/p>\n<p>Phenoxymethylpenicillin d\u1ea1ng u\u1ed1ng l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay, d\u00f9ng trong th\u1eddi gian 10 ng\u00e0y. \u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 ho\u00e0n th\u00e0nh li\u1ec7u tr\u00ecnh u\u1ed1ng k\u00e9o d\u00e0i 10 ng\u00e0y, c\u00f3 th\u1ec3 ti\u00eam b\u1eafp m\u1ed9t li\u1ec1u duy nh\u1ea5t benzylpenicillin. \u1ede tr\u1ebb em, c\u00f3 th\u1ec3 thay th\u1ebf b\u1eb1ng amoxicillin d\u1ea1ng u\u1ed1ng do amoxicillin c\u00f3 v\u1ecb d\u1ec5 u\u1ed1ng h\u01a1n so v\u1edbi phenoxymethylpenicillin. Kh\u00f4ng n\u00ean d\u00f9ng amoxicillin trong \u0111i\u1ec1u tr\u1ecb vi\u00eam h\u1ecdng do GAS n\u1ebfu b\u1ec7nh nh\u00e2n \u0111\u1ed3ng th\u1eddi nhi\u1ec5m EBV, do kh\u1ea3 n\u0103ng g\u00e2y ph\u00e1t ban. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb khuy\u1ebfn c\u00e1o v\u1edbi nh\u00f3m beta-lactam d\u1ea1ng u\u1ed1ng \u1edf tr\u1ebb em l\u00e0 10 ng\u00e0y.<\/p>\n<p>M\u1eb7c d\u00f9 c\u00e1c h\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh khuy\u1ebfn c\u00e1o li\u1ec7u tr\u00ecnh \u0111i\u1ec1u tr\u1ecb k\u00e9o d\u00e0i, nh\u01b0ng \u0111\u00e3 c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y m\u1ed9t li\u1ec7u tr\u00ecnh ng\u1eafn h\u01a1n (t\u1ee9c 3-6 ng\u00e0y) v\u1edbi penicillin \u0111\u01b0\u1eddng u\u1ed1ng v\u1eabn hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi li\u1ec7u tr\u00ecnh 10 ng\u00e0y trong \u0111i\u1ec1u tr\u1ecb vi\u00eam h\u1ecdng c\u1ea5p, m\u00e0 kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng cho th\u1ea5y l\u00e0m t\u0103ng nguy c\u01a1 vi\u00eam c\u1ea7u th\u1eadn h\u1eadu nhi\u1ec5m li\u00ean c\u1ea7u ho\u1eb7c rheumatic fever. M\u1ed9t nghi\u00ean c\u1ee9u cho th\u1ea5y li\u1ec7u tr\u00ecnh 3 ng\u00e0y v\u1edbi azithromycin ho\u1eb7c 5 ng\u00e0y v\u1edbi cefaclor mang l\u1ea1i hi\u1ec7u qu\u1ea3 kh\u1ecfi tri\u1ec7u ch\u1ee9ng v\u00e0 ti\u1ec7t khu\u1ea9n t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi li\u1ec7u tr\u00ecnh 10 ng\u00e0y d\u00f9ng amoxicillin. Tuy nhi\u00ean, nghi\u00ean c\u1ee9u n\u00e0y kh\u00f4ng \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c t\u1ef7 l\u1ec7 rheumatic fever ho\u1eb7c th\u1ea5p tim. M\u1ed9t nghi\u00ean c\u1ee9u kh\u00e1c cho th\u1ea5y penicillin V (phenoxymethylpenicillin) d\u00f9ng trong 5 ng\u00e0y c\u00f3 hi\u1ec7u qu\u1ea3 l\u00e2m s\u00e0ng kh\u00f4ng thua k\u00e9m so v\u1edbi d\u00f9ng trong 10 ng\u00e0y (v\u1edbi li\u1ec1u l\u01b0\u1ee3ng kh\u00e1c nhau), m\u1eb7c d\u00f9 nghi\u00ean c\u1ee9u n\u00e0y c\u0169ng kh\u00f4ng \u0111\u00e1nh gi\u00e1 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ef7 l\u1ec7 rheumatic fever ho\u1eb7c th\u1ea5p tim. Do b\u1eb1ng ch\u1ee9ng v\u1eabn \u0111ang ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u, c\u00e1c li\u1ec7u tr\u00ecnh kh\u00e1ng sinh ng\u1eafn h\u01a1n n\u00ean \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn thay th\u1ebf \u0111ang n\u1ed5i l\u00ean, ch\u1ee9 ch\u01b0a ph\u1ea3i l\u00e0 ph\u01b0\u01a1ng \u00e1n \u0111i\u1ec1u tr\u1ecb ch\u00ednh \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o.<\/p>\n<p>Chi\u1ebfn l\u01b0\u1ee3c d\u00f9ng phenoxymethylpenicillin v\u1edbi li\u1ec1u cao trong th\u1eddi gian ng\u1eafn c\u00f3 th\u1ec3 gi\u00fap ph\u1ee5c h\u1ed3i nhanh h\u01a1n v\u00e0 c\u00f3 th\u1ec3 tr\u1edf th\u00e0nh m\u1ed9t h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb trong t\u01b0\u01a1ng lai \u0111\u1ed1i v\u1edbi vi\u00eam h\u1ecdng \u2013 vi\u00eam amidan do li\u00ean c\u1ea7u khu\u1ea9n nh\u00f3m A d\u01b0\u01a1ng t\u00ednh.<\/p>\n<p>Vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng sinh d\u1ef1 ph\u00f2ng \u1edf nh\u1eefng ng\u01b0\u1eddi c\u00f3 ti\u1ec1n s\u1eed rheumatic fever \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o nh\u1eb1m gi\u1ea3m nguy c\u01a1 t\u00e1i ph\u00e1t rheumatic fever.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"<p>L\u01b0\u1ee3t d\u1ecbch: NT HN T\u00d3M T\u1eaeT Vi\u00eam h\u1ecdng \u0111\u1eb7c tr\u01b0ng v\u1edbi kh\u1edfi ph\u1ea3i \u0111\u1ed9t ng\u1ed9t c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111au h\u1ecdng: kh\u00f4ng ho, ngh\u1eb9t m\u0169i ho\u1eb7c ch\u1ea3y m\u0169i g\u1ee3i \u00fd nguy\u00ean nh\u00e2n do vi khu\u1ea9n, Ch\u1ea9n \u0111o\u00e1n b\u1eaft \u0111\u1ea7u b\u1eb1ng khai th\u00e1c b\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng, \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng x\u00e9t nghi\u1ec7m nhanh ph\u00e1t [&#8230;]\n","protected":false},"author":1,"featured_media":134222,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-134207","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134207","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=134207"}],"version-history":[{"count":4,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134207\/revisions"}],"predecessor-version":[{"id":134225,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/134207\/revisions\/134225"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/134222"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=134207"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=134207"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=134207"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}