S DUNG KHANG SINH BETA LACTAM TRONG VIEM PHOI BNH ViN

Trng Van Tuan

Viem phoi mac phai BV

HAP - HospitalAcquired Pneumonia Thng xuat hien sau nhap vien 48h
Thng dung :

Beta-lactam (BL) :

Cephalosporin (CS) the he 3, 4 Carbapenem

Fluoroquinolone (FQ) Aminoglycosid, vancomycin ..

Viem phoi mac phai BV e khang nhom beta-lactam

BN nhap vien mang VK khang thuoc lay BN khac e khang KS beta-lactam tren lam sang chu yeu do beta-lactamase

Pseudomonas aeruginosa e khang ceftazidime, ceftriaxone, cefepime Acinetobacter sp e khang ceftriaxone, cefepime, piperacillin-tazobactam Escheria coli e khang cefepime (100%), ceftriaxone Klebsiella sp e khang ceftazidime, ceftriaxone

Nguyen nhan e khang KS

Dung KS khong hp ly ve

nhom thuoc ham lng, nong o lieu, khoang cach dung thi iem dung, thi gian dung phan bo thuoc trong mau/ mo ..

Lam dung KS

S dung KS khong can thiet ..

Lu y khi dung khang sinh

Phan biet c cac the he cua KS (CS, FQ) giup hieu qua, an toan, kinh te Phoi hp thuoc : tranh tng k, tng tac

Tng k : xay ra ngoai c the (oi mau, tua ..) Tng tac : khi s dung thuoc (li hoac hai)

Hieu biet ve PD/ PK cua KS

Dc lc hoc (PD) beta-lactam

Diet khuan do c che sinh tong hp peptidoglycan thanh tb VK

c che hoat tnh transpeptidase (PBPs, penicillin-binding proteins) va carboxypeptidase

Beta-lactam hieu qua tren Gram (+) hn Gram (-) do khac biet he thong thanh phan sinh tong hp peptidoglycan

Dc lc hoc (PD) cephalosporin

CS 1 : hieu qua hn tren Gram (+) CS 3 : a so hieu qua hn tren Gram (-)

CS 4 : hieu qua ca tren Gram (+) va (-)

Dc ong hoc (PK) cephalosporin

CS 3 thung dung trong HAP

Hap thu : sau khi IV 1g, [KS] > 50 mcg/ml

Ceftazidime gan vi protein huyet tng : 10%

Phan bo : nhieu trong phoi, than

Dch nao tuy : CS 3 (cefotaxime, ceftriaxone, ceftazidime)

Dc ong hoc (PK) cephalosporin

Khong chuyen hoa

Thai tr : chu yeu qua than

Ngoai tr cefoperazone, ceftriaxone (qua mat)

Khong can chnh lieu BN suy than

Dc ong hoc (PK) cephalosporin

Tuy t1/ 2 : ieu chnh lieu, khoang cach dung

CS 3 co t1/ 2 ngan 1 h (cefotaxime) : chch cach khoang 6 8 h CS 3 co t1/ 2 trung bnh 1,8 2 h (ceftazidime, cefoperazone) : chch cach khoang 8 12 h CS 3 co t1/ 2 dai 8 h (ceftriaxone) : chch cach khoang 24 h

Vai th du ve tung k incompatibility

Imipenem-cilastin

Khong dung nc cat lam dung moi (solvant) : khong ang trng Khong pha chung Na lactat, moi trng pH acid hoac kiem

Vai th du ve tung k incompatibility

Ceftazidime

+ vancomycine : tua + Na bicarbonat : kem on nh

Vai th du ve tung tac interaction drug

Imipenem-cilastin/ meropenem + sodium valproate

Giam [sodium valproate] gay tai phat ong kinh

Cefepime + aminoglycosid lieu cao

Tang oc tnh than

CHUYEN GIA Y DC
QUYET NH CUOI CUNG khi CHON LA & S DUNG THUOC