{"id":5302,"date":"2019-03-22T09:02:33","date_gmt":"2019-03-22T02:02:33","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=5302"},"modified":"2019-03-22T09:02:33","modified_gmt":"2019-03-22T02:02:33","slug":"huong-dan-su-dung-thuoc-cua-stanford-polymyxin-b-colistin","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/huong-dan-su-dung-thuoc-cua-stanford-polymyxin-b-colistin\/","title":{"rendered":"H\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng thu\u1ed1c c\u1ee7a Stanford \u2013 Polymyxin B & Colistin"},"content":{"rendered":"

CH\u01af\u01a0NG TR\u00ccNH AN TO\u00c0N V\u00c0 PH\u00c1T TRI\u00caN B\u1ec0N V\u1eeeNG V\u1ec0 VI\u1ec6C S\u1eec D\u1ee4NG<\/p>\n

KH\u00c1NG SINH C\u1ee6A STANFORD<\/p>\n

S\u1eeda \u0111\u1ed5i th\u00e1ng 11\/2017<\/p>\n

 <\/p>\n

H\u01af\u1edaNG D\u1eaaN S\u1eec D\u1ee4NG THU\u1ed0C C\u1ee6A STANFORD<\/strong><\/p>\n

POLYMYXIN B & COLISTIN<\/strong><\/p>\n

 <\/p>\n

Ng\u01b0\u1eddi d\u1ecbch<\/strong>\u00a0: V\u0169 Th\u1ecb M\u1ef9 Linh \u2013 sinh vi\u00ean n\u0103m 4 \u0110\u1ea1i h\u1ecdc D\u01b0\u1ee3c H\u00e0 N\u1ed9i.<\/p>\n

Ng\u01b0\u1eddi hi\u1ec7u \u0111\u00ednh<\/strong>\u00a0: \u0110\u1eb7ng Th\u1ecb Ng\u1ecdc Mai, Trung t\u00e2m D\u01b0\u1ee3c l\u00fd l\u00e2m s\u00e0ng \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i.<\/p>\n

Ngu\u1ed3n<\/strong>: STANFORD HEALTH CARE.\u00a0Link<\/a><\/p>\n

\u00a0<\/strong><\/p>\n

V\u1ea4N \u0110\u1ec0: Polymyxin B<\/strong>\u00a0\u0111\u01b0\u1ee3c \u01b0u ti\u00ean d\u00f9ng h\u01a1n\u00a0Colistin (polymyxin E)<\/strong>\u00a0trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p nhi\u1ec5m khu\u1ea9n do tr\u1ef1c khu\u1ea9n gram \u00e2m \u0111a kh\u00e1ng thu\u1ed1c t\u1ea1i SHC (Stanford health care) \u2013 trung t\u00e2m ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe Stanford.<\/p>\n

Ti\u00eau ch\u00ed gi\u1edbi h\u1ea1n danh m\u1ee5c d\u00f9ng thu\u1ed1c\u00a0Polymyxin B<\/strong>\u00a0c\u1ee7a SHC<\/p>\n

    \n
  1. H\u1ed9i ch\u1ea9n v\u00e0 khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng thu\u1ed1c trong b\u1ec7nh truy\u1ec1n nhi\u1ec5m<\/li>\n
  2. Nh\u00f3m x\u01a1 nang<\/li>\n<\/ol>\n

    Ti\u00eau ch\u00ed gi\u1edbi h\u1ea1n danh m\u1ee5c d\u00f9ng thu\u1ed1c\u00a0Colistin\u00a0<\/strong>c\u1ee7a SHC<\/p>\n

      \n
    1. \u0110i\u1ec1u tr\u1ecb nhi\u1ec5m khu\u1ea9n \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u<\/li>\n
    2. D\u00f9ng \u0111\u01b0\u1eddng h\u00edt<\/li>\n<\/ol>\n

      L\u00dd DO: Polymyxin B<\/strong>\u00a0v\u00e0\u00a0Colistin\u00a0<\/strong>c\u00f3 ph\u1ed5 t\u00e1c d\u1ee5ng tr\u00ean vi khu\u1ea9n nh\u01b0 nhau. Tuy nhi\u00ean, \u00a0\u00a0\u00a0\u00a0\u00a0Polymyxin B<\/strong>\u00a0c\u00f3 \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c l\u00fd l\u00e2m s\u00e0ng \u01b0u vi\u1ec7t h\u01a1n so v\u1edbi\u00a0Colistin<\/strong><\/p>\n

      Polymyxin B<\/strong>\u00a0l\u00e0 thu\u1ed1c \u1edf d\u1ea1ng c\u00f3 ho\u1ea1t t\u00ednh, trong khi Colistin \u0111\u01b0\u1ee3c d\u00f9ng d\u1ea1ng ti\u1ec1n thu\u1ed1c\u00a0Colistimetat sodium (CMS)<\/strong>\u2013Colistimetat natri<\/strong>\u00a0c\u00f3 th\u1ec3 bi\u1ebfn \u0111\u1ed5i \u0111\u01b0\u1ee3c v\u00e0 bi\u1ebfn \u0111\u1ed5i ch\u1eadm (v\u00e0i gi\u1edd) th\u00e0nh d\u1ea1ng c\u00f3 ho\u1ea1t t\u00ednh<\/p>\n

        \n
      • Polymyxin B<\/strong>\u00a0d\u01b0\u1eddng nh\u01b0 \u00edt \u0111\u1ed9c tr\u00ean th\u1eadn h\u01a1n\u00a0Colistin<\/strong><\/li>\n<\/ul>\n

        C\u00c1CH TH\u1ee8C:\u00a0<\/strong>Li\u1ec1u\u00a0Polymyxin B<\/strong>\u00a0v\u00e0\u00a0Colistin<\/strong>\u00a0kh\u00f4ng th\u1ec3 thay th\u1ebf\u00a0<\/strong>\u0111\u01b0\u1ee3c cho nhau<\/p>\n

          \n
        • Li\u1ec1u\u00a0Polymixin B<\/strong>\u00a0th\u01b0\u1eddng d\u00f9ng l\u00e0 \u201c\u0111\u01a1n v\u1ecb\u201d, kh\u00f4ng ph\u1ea3i \u201cmg\u201d<\/li>\n
        • Ch\u00fa \u00fd v\u1edbi\u00a0Polymyxin B<\/strong>\u00a0m\u1ed7i 500 000 \u0111\u01a1n v\u1ecb \u0111\u01b0\u1ee3c pha lo\u00e3ng trong 300-500ml dung m\u00f4i: m\u1ed9t li\u1ec1u \u0111i\u1ec3n h\u00ecnh c\u00f3 th\u1ec3 t\u1ea1o th\u00e0nh 1 l\u00edt dung d\u1ecbch.<\/li>\n
        • N\u1ebfu MIC (n\u1ed3ng \u0111\u1ed9 \u1ee9c ch\u1ebf t\u1ed1i thi\u1ec3u) \u2265 2 n\u00ean trao \u0111\u1ed5i l\u1ea1i v\u1edbi d\u01b0\u1ee3c s\u0129 chuy\u00ean b\u1ec7nh nhi\u1ec5m khu\u1ea9n \u0111\u1ec3 c\u00f3 chi\u1ebfn l\u01b0\u1ee3c thay th\u1ebf li\u1ec1u.<\/li>\n<\/ul>\n

          GI\u00c1M S\u00c1T:\u00a0<\/strong>\u0110\u1ed9c t\u00ednh tr\u00ean h\u1ec7 th\u1ea7n kinh<\/p>\n

            \n
          • C\u00f3 th\u1ec3 x\u1ea3y ra ngay trong nh\u1eefng ng\u00e0y \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u00f3 th\u1ec3 ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u ho\u1eb7c v\u00e0o t\u1ed1c \u0111\u1ed9 truy\u1ec1n. \u0110\u1ed9c t\u00ednh c\u00f3 th\u1ec3 l\u00e0 ch\u00f3ng m\u1eb7t, y\u1ebfu c\u01a1, l\u00fa l\u1eabn, \u0111au \u0111\u1ea7u, r\u1ed1i lo\u1ea1n th\u1ecb gi\u00e1c, m\u1ea5t \u0111i\u1ec1u h\u00f2a \u0111\u1ed9ng t\u00e1c, b\u1ec7nh d\u1ecb c\u1ea3m.<\/li>\n
          • ADEs (Adverse drug events): Nh\u1eefng bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i thu\u1ed1c m\u1ee9c \u0111\u1ed9 nh\u1eb9 \u00a0th\u01b0\u1eddng kh\u00f4ng nguy h\u1ea1i v\u00e0 tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng khi ng\u1eebng d\u00f9ng thu\u1ed1c<\/li>\n
          • Qu\u1ea3n l\u00fd: truy\u1ec1n t\u1ed1c \u0111\u1ed9 ch\u1eadm, d\u00f9ng li\u1ec1u th\u1ea5p h\u01a1n.<\/li>\n<\/ul>\n

             <\/p>\n

            \u00a0<\/strong><\/p>\n

            \u00a0<\/strong><\/p>\n

            \u00a0<\/strong><\/p>\n

            \u00a0<\/strong><\/p>\n

            \u00a0<\/strong><\/p>\n

            \u00a0<\/strong><\/p>\n

            \u00a0<\/strong><\/p>\n

            \u00a0<\/strong><\/p>\n

            \u00a0<\/strong><\/p>\n

            \u00a0<\/strong><\/p>\n

            \u00a0<\/strong><\/p>\n

            \u00a0<\/strong><\/p>\n

            LI\u1ec0U<\/strong><\/p>\n\n\n\n\n\n\n\n\n
            \u00a0<\/strong><\/td>\n\u0110\u01b0\u1eddng d\u00f9ng<\/strong><\/td>\n\u2265 80<\/strong>ml\/ph\u00fat<\/strong><\/td>\n50-79<\/strong>ml\/ph\u00fat<\/strong><\/td>\n30-49<\/strong>ml\/ph\u00fat<\/strong><\/td>\n10-29<\/strong>ml\/ph\u00fat<\/strong><\/td>\nIHD<\/strong><\/td>\n<\/tr>\n
            CRRT<\/strong><\/td>\n<\/tr>\n
            \u00a0<\/strong>Polymyxin B<\/strong><\/p>\n

            S\u1eed d\u1ee5ng c\u00e2n n\u1eb7ng th\u1ef1c t\u1ebf; c\u00e2n n\u1eb7ng \u0111\u00e3 \u0111i\u1ec1u ch\u1ec9nh v\u1edbi BN b\u00e9o ph\u00ec<\/td>\n

            		\u00a0<\/strong>Ti\u00eam- truy\u1ec1n t\u0129nh m\u1ea1ch<\/td>\n7,500 \u2013 12,500\u00a0<\/strong>\u0111\u01a1n v\u1ecb<\/strong>\/kg m\u1ed7i 12<\/strong>h<\/strong>\u00a0<\/strong><\/td>\nKh\u00f4ng c\u00f3 d\u1eef li\u1ec7u; trao \u0111\u1ed5i v\u1edbi d\u01b0\u1ee3c s\u0129 chuy\u00ean khoa nhi\u1ec5m khu\u1ea9n<\/td>\n<\/tr>\n
            \u00a0<\/strong>Colistin<\/strong><\/p>\n

            S\u1eed d\u1ee5ng c\u00e2n n\u1eb7ng l\u00fd t\u01b0\u1edfng<\/p>\n

            Li\u1ec1u nh\u01b0 Colistin d\u1ea1ng ho\u1ea1t \u0111\u1ed9ng<\/td>\n

            		\u00a0<\/strong>Ti\u00eam-truy\u1ec1n t\u0129nh m\u1ea1ch<\/td>\n5 mg\/kg\/ng\u00e0y<\/strong>
            \n<\/strong>chia l\u00e0m\u00a0<\/strong>2-3\u00a0<\/strong>l\u1ea7n<\/strong>\u00a0<\/strong><\/td>\n            		1.25\u20131.9 mg\/kg<\/strong>
            \nm\u1ed7i 12<\/strong>h<\/strong>\u00a0<\/strong><\/td>\n            		2.5 mg\/kg<\/strong>
            \n<\/strong>m\u1ed7i\u00a0<\/strong>24<\/strong>h<\/strong>
            \nho\u1eb7c
            \n1.25 mg\/kg
            \n<\/strong>m\u1ed7i\u00a0<\/strong>12h<\/strong>\u00a0<\/strong><\/td>\n            		1.5 mg\/kg<\/strong>
            \nm\u1ed7i 36<\/strong>h<\/strong>\u00a0<\/strong><\/td>\n            		1.5 mg\/kg<\/strong>
            \n<\/strong>m\u1ed7i\u00a0<\/strong>24-48h<\/strong>\u00a0<\/strong><\/td>\n<\/tr>\n
            2.5 mg\/kg<\/strong>
            \n<\/strong>m\u1ed7i\u00a0<\/strong>12-24<\/strong>h<\/strong>\u00a0<\/strong><\/td>\n<\/tr>\n
            H\u00edt<\/td>\n150 mg h\u00edt m\u1ed7i 12<\/strong>h<\/strong>\u00a0<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

            \u00a0<\/strong><\/p>\n

            *Ch\u00fa th\u00edch:\u00a0<\/strong>IHD\u00a0\u00a0 \u00a0(Intermittent hemodialysis) : l\u1ecdc m\u00e1u ng\u1eaft qu\u00e3ng.<\/p>\n

            CRRT (Continuous renal replacement therapies) : li\u1ec7u ph\u00e1p l\u1ecdc m\u00e1u li\u00ean t\u1ee5c.<\/p>\n

            QUY \u0110\u1ed4I<\/strong><\/p>\n

            \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Colistimetat natri<\/strong>\u00a01mg = ~12,500 units c\u1ee7a\u00a0Colistimetat natri<\/strong><\/p>\n

            \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Colistimetat natri<\/strong>\u00a0~ 2.67mg = 1mg\u00a0colistin d\u1ea1ng c\u00f3 ho\u1ea1t t\u00ednh<\/strong><\/p>\n

            1 mg\u00a0colistin d\u1ea1ng c\u00f3 ho\u1ea1t t\u00ednh<\/strong>\u00a0= 30,000 IU\u00a0colistin<\/strong><\/p>\n

            1 mg\u00a0polymyxin B<\/strong>\u00a0= 10,000 IU\u00a0polymyxin B<\/strong><\/p>\n

            TH\u00d4NG TIN T\u00c0I LI\u1ec6U<\/strong><\/p>\n

              \n
            1. T\u00e1c gi\u1ea3 g\u1ed1c\/ ng\u00e0y: Lina Meng, PharmD, BCPS, BCCCP, Emily Mui, PharmD,
              \nBCPS, Stan Deresinski, MD, 02\/2015<\/li>\n
            2. Thu\u1ed9c ch\u01b0\u01a1ng tr\u00ecnh: Ch\u01b0\u01a1ng tr\u00ecnh qu\u1ea3n l\u00fd kh\u00e1ng sinh<\/li>\n
            3. Y\u00eau c\u1ea7u xem x\u00e9t v\u00e0 gia h\u1ea1n<\/li>\n<\/ol>\n

              T\u00e0i li\u1ec7u s\u1ebd \u0111\u01b0\u1ee3c xem x\u00e9t l\u1ea1i 3 n\u0103m\/l\u1ea7n v\u00e0 c\u00f3 th\u1ec3 thay d\u1ed5i theo y\u00eau c\u1ea7u c\u1ee7a lu\u1eadt ph\u00e1p ho\u1eb7c c\u1ee7a th\u1ef1c h\u00e0nh<\/p>\n

                \n
              1. L\u1ecbch s\u1eed s\u1eeda \u0111\u1ed5i, xem x\u00e9t: 11\/2017 Lina Meng, PharmD<\/li>\n
              2. Ph\u00ea duy\u1ec7t<\/li>\n
              3. Ti\u1ec3u ban kh\u00e1ng khu\u1ea9n: 11\/2017<\/li>\n
              4. P&T: 12\/2017 (\u0111ang ch\u1edd x\u1eed l\u00fd)<\/li>\n<\/ol>\n

                T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n

                  \n
                1. Micromedex online, accessed 2\/17\/2016
                  \n2. Falagas ME, Kasiakou SK. Toxicity of polymyxins: a systematic review of the evidence from old and recent studies. Critical care. 2006 Feb 13;10(1):R27.
                  \n3. Nelson, Brian C., et al. \u201cClinical outcomes associated with polymyxin B dose in patients with bloodstream infections due to carbapenem-resistant Gram-negative rods.\u201d Antimicrobial agents and chemotherapy 59.11 (2015): 7000-7006.
                  \n4. Pai MP. Polymyxin B dosing in obese and underweight adults. Clin Infect Dis 2013;57:1785.
                  \n5. Rigatto, Maria Helena, et al. \u201cRenal failure in patients treated with colistin versus polymyxin B: a multicenter prospective cohort study.\u201d Antimicrobial Agents and Chemotherapy (2016): AAC-02634.
                  \n6. Rigatto, Maria Helena, et al. \u201cClinical features and mortality of patients on renal replacement therapy receiving polymyxin B.\u201d International journal of antimicrobial agents (2015).
                  \n7. Rigatto, Maria Helena, et al. \u201cRisk factors for acute kidney injury (AKI) in patients treated with polymyxin B and influence of AKI on mortality: a multicentre prospective cohort study.\u201d Journal of Antimicrobial Chemotherapy (2015): dku561.
                  \n8. Sandri, Ana M., et al. \u201cPopulation pharmacokinetics of intravenous polymyxin B in critically ill patients: implications for selection of dosage regimens.\u201d Clinical infectious diseases 57.4 (2013): 524-531.
                  \n9. Sandri, Ana M., et al. \u201cPharmacokinetics of polymyxin B in patients on continuous venovenous haemodialysis.\u201d Journal of Antimicrobial Chemotherapy (2012): dks437.
                  \n10. Zavascki, Alexandre P., et al. \u201cPharmacokinetics of intravenous polymyxin B in critically ill patients.\u201d Clinical infectious diseases 47.10 (2008): 1298-1304.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

                  CH\u01af\u01a0NG TR\u00ccNH AN TO\u00c0N V\u00c0 PH\u00c1T TRI\u00caN B\u1ec0N V\u1eeeNG V\u1ec0 VI\u1ec6C S\u1eec D\u1ee4NG KH\u00c1NG SINH C\u1ee6A STANFORD S\u1eeda \u0111\u1ed5i th\u00e1ng 11\/2017   H\u01af\u1edaNG D\u1eaaN S\u1eec D\u1ee4NG THU\u1ed0C C\u1ee6A STANFORD POLYMYXIN B & COLISTIN   Ng\u01b0\u1eddi d\u1ecbch\u00a0: V\u0169 Th\u1ecb M\u1ef9 Linh \u2013 sinh vi\u00ean n\u0103m 4 \u0110\u1ea1i h\u1ecdc D\u01b0\u1ee3c H\u00e0 N\u1ed9i. Ng\u01b0\u1eddi hi\u1ec7u \u0111\u00ednh\u00a0: \u0110\u1eb7ng Th\u1ecb […]\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5302","post","type-post","status-publish","format-standard","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5302","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=5302"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5302\/revisions"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=5302"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=5302"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=5302"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}