{"id":5517,"date":"2019-03-26T10:39:21","date_gmt":"2019-03-26T03:39:21","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=5517"},"modified":"2019-03-26T10:39:21","modified_gmt":"2019-03-26T03:39:21","slug":"khang-sinh-floroquinolon-han-che-chi-dinh-va-bien-phap-phong-ngua-moi","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/khang-sinh-floroquinolon-han-che-chi-dinh-va-bien-phap-phong-ngua-moi\/","title":{"rendered":"Kh\u00e1ng sinh Floroquinolon &#8211; h\u1ea1n ch\u1ebf ch\u1ec9 \u0111\u1ecbnh v\u00e0 bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba m\u1edbi"},"content":{"rendered":"<h2>MHRA: Kh\u00e1ng sinh Floroquinolon &#8211; h\u1ea1n ch\u1ebf ch\u1ec9 \u0111\u1ecbnh v\u00e0 bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba m\u1edbi do ghi nh\u1eadn b\u00e1o c\u00e1o v\u1ec1 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 g\u00e2y t\u00e0n t\u1eadt, k\u00e9o d\u00e0i v\u00e0 kh\u00f4ng h\u1ed3i ph\u1ee5c.<\/h2>\n<p>S\u1eed d\u1ee5ng\u00a0<strong>fluoroquinolon<\/strong>\u00a0c\u00f3 th\u1ec3 g\u00e2y ra ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i g\u00e2y t\u00e0n t\u1eadt, k\u00e9o d\u00e0i v\u00e0 kh\u00f4ng h\u1ed3i ph\u1ee5c g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn h\u1ec7 th\u1ed1ng c\u01a1 x\u01b0\u01a1ng &#8211; th\u1ea7n kinh. Tuy nh\u1eefng ph\u1ea3n \u1ee9ng n\u00e0y ch\u1ec9 xu\u1ea5t hi\u1ec7n v\u1edbi t\u1ea7n xu\u1ea5t r\u1ea5t nh\u1ecf nh\u01b0ng l\u1ea1i \u0111\u1ec3 l\u1ea1i h\u1eadu qu\u1ea3 n\u1eb7ng n\u1ec1 cho ng\u01b0\u1eddi b\u1ec7nh. V\u00ec v\u1eady, MHRA khuy\u1ebfn c\u00e1o ng\u1eebng \u0111i\u1ec1u tr\u1ecb b\u1eb1ng fluoroquinolon n\u1ebfu th\u1ea5y c\u00e1c d\u1ea5u hi\u1ec7u \u0111\u1ea7u ti\u00ean c\u1ee7a c\u00e1c ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i nghi\u00eam tr\u1ecdng, trong \u0111\u00f3 c\u00f3 \u0111au g\u00e2n v\u00e0 vi\u00eam g\u00e2n.<\/p>\n<h2>Khuy\u1ebfn c\u00e1o c\u1ee7a MHRA cho c\u00e1n b\u1ed9 y t\u1ebf:<\/h2>\n<p>Fluoroquinolon d\u00f9ng to\u00e0n th\u00e2n (\u0111\u01b0\u1eddng u\u1ed1ng, ti\u00eam, kh\u00ed dung) hi\u1ebfm khi g\u00e2y ra t\u00e1c d\u1ee5ng ph\u1ee5 k\u00e9o d\u00e0i (v\u00e0i th\u00e1ng ho\u1eb7c nhi\u1ec1u n\u0103m), g\u00e2y t\u00e0n t\u1eadt v\u00e0 kh\u00f4ng h\u1ed3i ph\u1ee5c, \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nhi\u1ec1u h\u1ec7 th\u1ed1ng, c\u01a1 quan, gi\u00e1c quan. Tuy nhi\u00ean MHRA \u0111\u00e3 ghi nh\u1eadn nh\u1eefng b\u00e1o c\u00e1o case nh\u01b0 v\u1eady v\u00e0 khuy\u1ebfn c\u00e1o c\u00e1n b\u1ed9 y t\u1ebf c\u1ea7n th\u1eadn tr\u1ecdng v\u00e0 t\u01b0 v\u1ea5n k\u1ef9 cho b\u1ec7nh nh\u00e2n khi s\u1eed d\u1ee5ng thu\u1ed1c.<\/p>\n<p>Khuy\u1ebfn c\u00e1o b\u1ec7nh nh\u00e2n n\u00ean ng\u1eebng \u0111i\u1ec1u tr\u1ecb n\u1ebfu th\u1ea5y nh\u1eefng d\u1ea5u hi\u1ec7u \u0111\u1ea7u ti\u00ean c\u1ee7a m\u1ed9t ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i nghi\u00eam tr\u1ecdng nh\u01b0 vi\u00eam g\u00e2n, \u0111\u1ee9t g\u00e2n, nh\u01b0\u1ee3c c\u01a1, \u0111au kh\u1edbp, s\u01b0ng kh\u1edbp, vi\u00eam d\u00e2y th\u1ea7n kinh ngo\u1ea1i bi\u00ean, b\u1ec7nh li\u00ean quan \u0111\u1ebfn h\u1ec7 th\u1ed1ng th\u1ea7n kinh trung \u01b0\u01a1ng. Li\u00ean h\u1ec7 ngay v\u1edbi b\u00e1c s\u1ef9 \u0111\u1ec3 \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n th\u00eam.<\/p>\n<p>Kh\u00f4ng k\u00ea \u0111\u01a1n fluoroquinolon khi b\u1ec7nh nh\u00e2n kh\u00f4ng nhi\u1ec5m khu\u1ea9n, nhi\u1ec5m khu\u1ea9n kh\u00f4ng nghi\u00eam tr\u1ecdng ho\u1eb7c t\u1ef1 gi\u1edbi h\u1ea1n, nhi\u1ec5m khu\u1ea9n nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh (nh\u01b0 trong \u0111\u1ee3t c\u1ea5p vi\u00eam ph\u1ebf qu\u1ea3n m\u1ea1n t\u00ednh v\u00e0 \u0111\u1ee3t c\u1ea5p COPD) tr\u1eeb khi nh\u1eefng kh\u00e1ng sinh kh\u00e1c kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3.<\/p>\n<p>Kh\u00f4ng k\u00ea \u0111\u01a1n ciprofloxacin v\u00e0 levofloxacin cho vi\u00eam b\u00e0ng quang ch\u01b0a c\u00f3 bi\u1ebfn ch\u1ee9ng tr\u1eeb khi nh\u1eefng kh\u00e1ng sinh kh\u00e1c kh\u00f4ng c\u00f3 hi\u1ec7u qu\u1ea3.<\/p>\n<p>\u0110\u1eb7c bi\u1ec7t th\u1eadn tr\u1ecdng khi k\u00ea \u0111\u01a1n fluoroquinolon cho b\u1ec7nh nh\u00e2n tr\u00ean 60 tu\u1ed5i, b\u1ec7nh nh\u00e2n suy th\u1eadn ho\u1eb7c gh\u00e9p t\u1ea1ng do nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng g\u00e2n cao h\u01a1n nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00e1c.<\/p>\n<p>Kh\u00f4ng d\u00f9ng corticoid k\u00e8m v\u1edbi m\u1ed9t thu\u1ed1c fluoroquinolon v\u00ec vi\u1ec7c d\u00f9ng \u0111\u1ed3ng th\u1eddi hai lo\u1ea1i thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 l\u00e0m tr\u1ea7m tr\u1ecdng th\u00eam tri\u1ec7u ch\u1ee9ng vi\u00eam g\u00e2n, \u0111\u1ee9t g\u00e2n do fluoroquinolon.<\/p>\n<h2>H\u1ea1n ch\u1ebf ch\u1ec9 \u0111\u1ecbnh:<\/h2>\n<p>&#8211; Kh\u00e1ng sinh fluoroquinolon \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng nghi\u00eam tr\u1ecdng, \u0111e d\u1ecda t\u00ednh m\u1ea1ng.<\/p>\n<p>&#8211; D\u1ef1a tr\u00ean \u0111\u00e1nh gi\u00e1 v\u1ec1 \u0111\u1ed9 an to\u00e0n c\u1ee7a thu\u1ed1c trong khu v\u1ef1c EU, nh\u1eefng h\u1ea1n ch\u1ebf m\u1edbi trong ch\u1ec9 \u0111\u1ecbnh c\u1ee7a kh\u00e1ng sinh fluoroquinolon \u1edf Anh \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1. C\u00e1n b\u1ed9 y t\u1ebf tr\u01b0\u1edbc khi k\u00ea \u0111\u01a1n c\u1ea7n tham kh\u1ea3o t\u1edd T\u00f3m t\u1eaft \u0110\u1eb7c t\u00ednh S\u1ea3n ph\u1ea9m c\u1ee7a c\u00e1c thu\u1ed1c sau: Ciprofloxacin (Ciproxin), Levofloxacin, Moxifloxacin (Avelox), Ofloxacin (Tarivid)<\/p>\n<p>&#8211; Acid nalidixic tr\u01b0\u1edbc \u0111\u00e2y \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh cho nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ni\u1ec7u, hi\u1ec7n nay ch\u1ec9 \u0111\u1ecbnh n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c c\u1ea5p ph\u00e9p.<\/p>\n<p>&#8211; Kh\u00f4ng n\u00ean k\u00ea \u0111\u01a1n fluoroquinolon \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh (nh\u01b0 \u0111\u1ee3t c\u1ea5p vi\u00eam ph\u1ebf qu\u1ea3n m\u1ea1n t\u00ednh hay \u0111\u1ee3t c\u1ea5p COPD) tr\u1eeb khi nh\u1eefng kh\u00e1ng sinh kh\u00e1c th\u01b0\u1eddng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho c\u00e1c b\u1ec7nh nhi\u1ec5m tr\u00f9ng n\u00e0y kh\u00f4ng ph\u00f9 h\u1ee3p (b\u1ec7nh nh\u00e2n kh\u00e1ng kh\u00e1ng sinh \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u, ho\u1eb7c kh\u00e1ng sinh \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u g\u00e2y t\u00e1c d\u1ee5ng ph\u1ee5 d\u1eabn \u0111\u1ebfn ng\u1eebng \u0111i\u1ec1u tr\u1ecb, ho\u1eb7c khi kh\u00e1ng sinh \u01b0u ti\u00ean h\u00e0ng \u0111\u1ea7u ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh tr\u00ean m\u1ed9t c\u00e1 nh\u00e2n, ho\u1eb7c khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh h\u00e0ng \u0111\u1ea7u th\u1ea5t b\u1ea1i).<\/p>\n<h2>\u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a c\u00e1c ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u00e0 khuy\u1ebfn c\u00e1o h\u01b0\u1edbng x\u1eed tr\u00ed n\u1ebfu xu\u1ea5t hi\u1ec7n vi\u00eam g\u00e2n<\/h2>\n<p>&#8211; C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 nghi\u00eam tr\u1ecdng \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o g\u1ed3m: vi\u00eam g\u00e2n, \u0111\u1ee9t g\u00e2n, \u0111au kh\u1edbp, \u0111au \u0111\u1ea7u chi, r\u1ed1i lo\u1ea1n d\u00e1ng \u0111i, b\u1ec7nh th\u1ea7n kinh li\u00ean quan \u0111\u1ebfn d\u1ecb c\u1ea3m (c\u1ea3m gi\u00e1c nh\u1ed9t nh\u1ea1t, ch\u00e2m ch\u00edch nh\u01b0 b\u1ecb ki\u1ebfn b\u00f2), tr\u1ea7m c\u1ea3m, m\u1ec7t m\u1ecfi, suy gi\u1ea3m tr\u00ed nh\u1edb, r\u1ed1i lo\u1ea1n gi\u1ea5c ng\u1ee7, gi\u1ea3m th\u00ednh gi\u00e1c, th\u1ecb gi\u00e1c, v\u1ecb gi\u00e1c v\u00e0 kh\u1ee9u gi\u00e1c. Trong c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 v\u1ec1 h\u1ec7 th\u1ed1ng c\u01a1 x\u01b0\u01a1ng th\u00ec vi\u00eam g\u00e2n, \u0111\u1ee9t g\u00e2n \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o nhi\u1ec1u nh\u1ea5t; trong c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 v\u1ec1 h\u1ec7 th\u1ed1ng th\u1ea7n kinh th\u00ec d\u1ecb c\u1ea3m \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o nhi\u1ec1u nh\u1ea5t.<\/p>\n<p>&#8211; T\u1ed5n th\u01b0\u01a1ng g\u00e2n, \u0111\u1eb7c bi\u1ec7t l\u00e0 g\u00e2n Achilles c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n trong v\u00f2ng 48 gi\u1edd sau khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng fluoroquinolon nh\u01b0ng c\u00e1c d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a c\u00e1c ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i kh\u00e1c c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n v\u00e0i th\u00e1ng sau khi \u0111\u00e3 ng\u1eebng \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>&#8211; Ngay khi xu\u1ea5t hi\u1ec7n nh\u1eefng d\u1ea5u hi\u1ec7u \u0111\u1ea7u ti\u00ean c\u1ee7a vi\u00eam g\u00e2n (VD: s\u01b0ng \u0111au, nhi\u1ec5m tr\u00f9ng), n\u00ean ng\u1eebng \u0111i\u1ec1u tr\u1ecb fluoroquinolon v\u00e0 xem x\u00e9t c\u00e1c bi\u1ec7n ph\u00e1p thay th\u1ebf. Kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng corticoid n\u1ebfu c\u00f3 d\u1ea5u hi\u1ec7u vi\u00eam g\u00e2n.<\/p>\n<h2>Th\u1eadn tr\u1ecdng khi k\u00ea \u0111\u01a1n fluoroquinolon tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao<\/h2>\n<p>B\u1ec7nh nh\u00e2n tr\u00ean 60 tu\u1ed5i, b\u1ec7nh nh\u00e2n suy th\u1eadn ho\u1eb7c \u0111\u00e3 gh\u00e9p t\u1ea1ng, b\u1ec7nh nh\u00e2n \u0111ang \u0111i\u1ec1u tr\u1ecb b\u1eb1ng corticoid l\u00e0 nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng c\u00f3 nguy c\u01a1 cao t\u1ed5n th\u01b0\u01a1ng g\u00e2n. Tr\u00e1nh d\u00f9ng \u0111\u1ed3ng th\u1eddi fluoroquinolon v\u00e0 corticoid v\u00ec c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 vi\u00eam g\u00e2n, \u0111\u1ee9t g\u00e2n.<\/p>\n<h2>H\u01b0\u1edbng d\u1eabn k\u00ea \u0111\u01a1n<\/h2>\n<p>C\u00e1n b\u1ed9 y t\u1ebf c\u1ea7n tham kh\u1ea3o c\u00e1c h\u01b0\u1edbng d\u1eabn ch\u00ednh th\u1ee9c v\u1ec1 c\u00e1ch s\u1eed d\u1ee5ng kh\u00e1ng sinh ph\u00f9 h\u1ee3p nh\u01b0 H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t c\u00e1c nhi\u1ec5m khu\u1ea9n th\u00f4ng th\u01b0\u1eddng (trong \u0111\u00f3 c\u00f3 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean\/d\u01b0\u1edbi v\u00e0 nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ni\u1ec7u) c\u1ee7a NICE v\u00e0 T\u1ed5 ch\u1ee9c Y t\u1ebf c\u00f4ng c\u1ed9ng Anh.<\/p>\n<p>Ngu\u1ed3n:\u00a0<a href=\"https:\/\/www.gov.uk\/drug-safety-update\/fluoroquinolone-antibiotics-new-restrictions-and-precautions-for-use-due-to-very-rare-reports-of-disabling-and-potentially-long-lasting-or-irreversible-side-effects\" rel=\"noopener\">https:\/\/www.gov.uk\/drug-safety-update\/fluoroquinolone-antibiotics-new-restrictions-and-precautions-for-use-due-to-very-rare-reports-of-disabling-and-potentially-long-lasting-or-irreversible-side-effects<\/a><\/p>\n<p>Ng\u01b0\u1eddi t\u1ed5ng h\u1ee3p: V\u00f5 Th\u1ecb Th\u00f9y \u2013 Nguy\u1ec5n Ph\u01b0\u01a1ng Th\u00fay &#8211; Trung T\u00e2m C\u1ea3nh Gi\u00e1c D\u01b0\u1ee3c Qu\u1ed1c Gia.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>MHRA: Kh\u00e1ng sinh Floroquinolon &#8211; h\u1ea1n ch\u1ebf ch\u1ec9 \u0111\u1ecbnh v\u00e0 bi\u1ec7n ph\u00e1p ph\u00f2ng ng\u1eeba m\u1edbi do ghi nh\u1eadn b\u00e1o c\u00e1o v\u1ec1 c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 g\u00e2y t\u00e0n t\u1eadt, k\u00e9o d\u00e0i v\u00e0 kh\u00f4ng h\u1ed3i ph\u1ee5c. S\u1eed d\u1ee5ng\u00a0fluoroquinolon\u00a0c\u00f3 th\u1ec3 g\u00e2y ra ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i g\u00e2y t\u00e0n t\u1eadt, k\u00e9o d\u00e0i v\u00e0 kh\u00f4ng h\u1ed3i ph\u1ee5c g\u00e2y \u1ea3nh h\u01b0\u1edfng [&#8230;]\n","protected":false},"author":1,"featured_media":5518,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5517","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\/5517","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=5517"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5517\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/5518"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=5517"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=5517"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=5517"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}