Chng 44: Nhim khun ng h hp trn

Ngi dch: DS. Nguyn Vn Chin, tt nghip ti i Hc Dc HN

Ngi hiu nh: Ths.DS. V Th H, H Y Dc Hu
Ngun: Pharmacotherapy Handbook 8th edition (2012), Barbara G.Wells et al, Section 8,
Chapter 41, page 1816.
Ti liu c dch nhm mc ch tng hp cho d n vit sch "Dc iu tr" do Nhp cu
Dc lm sng t chc. Ti liu dch CHA xin php bn quyn t tc gi, nh xut bn M
nn ti liu nn c s dng vi mc ch c nhn. Khng chia s cng cng di mi hnh
thc.
1. Vim tai gia
nh ngha
- Vim tai gia l tnh trng vim nhim khu vc tai gia. Vim tai gia cp bao gm cc triu
chng vim khi pht nhanh tai gia th hin trn lm sng bng mt hay nhiu du hiu sau:
au tai (c xc nh bng cch ko tai mt s tr s sinh), mt thnh gic, st v d cu gt.
Vim tai gia c trn dch (s tch t dch tai gia) khc vi vim tai gia cp ch l khng
c cc du hiu ca nhim trng cp.
- Vim tai gia l bnh ph bin tr s sinh v tr nh. Cc yu t nguy c lm vi khun khng
amoxicillin trong vim tai gia bao gm tr c chm sc ti mt trung tm chm sc tr em,
s dng n thuc khng sinh gn y (trong vng 30 ngy trc) v tr em di 2 tui.
Bnh hc
- Khong 40% n 75% cc trng hp vim tai gia c nguyn nhn l virus. Trong cc trng
hp do vi khun, S. pneumoniae l nguyn nhn ph bin (chim 20 50%). Cc chng khng
in hnh Haemophilus influenzae v Moraxella catarrhalis ln lt chim t 15% n 30% v
t 3% n 20% cc trng hp.
- Vim tai gia cp do vi khun thng theo sau mt t nhim virus ng h hp trn gy suy
gim chc nng vi nh v ph n nim mc vng tai gia.
- T 1% n 50% cc chng S. pneumoniae phn lp khng nhy cm vi penicillin, v c n
mt na s khng penicillin liu cao. Mt na cc chng H. influenzae v 100% cc chng M.
catarrhalis phn lp t ng h hp trn sn sinh ra cc enzym -lactamase.

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Du hiu lm sng
- Tnh d cu gt v ko hoc gi tai thng l cc du hiu u tin chng t tr b vim tai gia
cp.
- chn on vim tai gia cp cn c 3 tiu ch sau: cc triu chng cp khi pht, s trn
dch vng tai gia v tai gia vim nhim. Xc nh s trn dch vng tai gia bng cc du
hiu: mng nh li ln, mng nh mt kh nng n hi hoc b hn ch, mc kh-dch sau
mng nh v chng chy nc tai (bng 44-1).
- Cc triu chng vim tai gia cp s ht sau hn 1 tun. au v st s ht sau 2-3 ngy, vi hu
ht tr khng cn c triu chng sau 7 ngy. S trn dch lu khi hn, 90% s ht sau 3 thng.
Bng 44-1: Triu chng lm sng ca vim tai gia cp do vi khun
Thng tin chung
Cc triu chng khi pht cp tnh ca vim tai gia bao gm chy nc mi, nght mi hoc
ho (nhim lnh)
Triu chng
au, c th au nng (>75% trng hp)
Tr c th d cu gt, git hoc gi tai, kh ng.
St thng xy ra tr nh (c <25% trng hp)
Kim tra cho thy mng nh dy ln, li ra v mt mu sc
Kim tra linh ng ca mng nh cho thy mng nh bt ng; 50% trng hp bt ng c
hai bn.
Dch ng li tai gia (<3% trng hp) thng gi nguyn nhn t vi khun
Xt nghim
Chng Gram, nui cy v nhy cm ca dch ly t tai gia
iu tr
- Mc tiu iu tr l gim au, hn ch s dng khng sinh v ngn nga bin chng. Vim tai
gia cp trc tin cn phn bit vi vim tai gia c trn dch v vim tai gia mn tnh.
- Cn cn nhc d phng vim tai gia cp bng vaccin. Vaccin PCV7 lm gim t 6% n 7%
trng hp xy ra vim tai gia cp trong giai on s sinh. Vaccin ny khng c hiu qu trn
tr ln hn c tin s vim tai gia cp.
- Qun l triu chng au bng thuc gim au. S dng Paracetamol hoc mt thuc gim au
chng vim khng steroid nh ibuprofen sm gim au. Khng nn s dng thuc khng
histamin hoc thuc thng mi do hiu qu rt hn ch.
- Cn quan st trong mt thi gian ngn cn nhc xem c nn s dng phc khng sinh
ngay lp tc trn bnh nhn khng trong trng hp bnh nng hoc in hnh.
- Phc khng sinh c s dng iu tr vim tai gia. Tuy nhin, a s tr em ch cn iu
tr cc triu chng n c.
- Cn cn nhc li li ngy s dng khng sinh (2-3 ngy) tr em t 6 thng n 2 tui nu cc
triu chng bnh khng trm trng v chn on khng chc chn, tr em trn 2 tui m chn
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on khng chc chn. Li li ngy s dng khng sinh lm gim tc dng ph v lm gim
tnh khng khng sinh ca vi khun.
- Khng sinh amoxicillin liu cao (80-90 mg/kg/ngy) l mt la chn iu tr vim tai gia
cp. Trong trng hp bnh nghi ng hoc bit c sinh ra b-lactamase, cn s dng kt hp
vi clavulanate (90 mg/kg/ngy amoxicillin + 6,4 mg/kg/ngy clavulanate chia lm 2 ln). Cc
khuyn co v iu tr vim tai gia cp cp trong bng 44-2.
- Nu tht bi iu tr vi amoxicillin, s dng thuc chng li s bi tit b-lactamase ca H.
influenzae v M. catarrhalis cng nh s khng thuc ca S. pneumoniae nh amoxicillin +
clavulanate liu cao (khuyn co) hoc cefuroxime, cefdinir, cefpodoxime, cefprozil hoc
ceftriaxone tim bp.
- Thi gian iu tr l 5 ngy
- Phu thut chn ng T l phng php hiu qu ngn nga ti pht. Cn nh gi li bnh
nhn sau 3 ngy, hu ht cc tr cc triu chng s bin mt sau 7 ngy.
Bng 44-2: Cc khuyn co s dng khng sinh trong vim tai gia cp
Chn on ban u
Tht bi iu tr sau 48-72 gi
Nh
Nng
Nh
Nng
Amoxicillin
Amoxicillin
Ceftriaxone
La chn u Amoxicillin liu
cao 80-90
calvulanate liu calvulanate liu
(1-3 ngy)
tay
mg/kg/ngy chia
cao, 90
cao, 90
lm 2 ln
mg/kg/ngy
mg/kg/ngy
amoxicillin +
amoxicillin + 6,4
6,4 mg/kg/ngy mg/kg/ngy
clavulanate chia clavulanate chia
lm 2 ln
lm 2 ln
Ceftriaxone
Ceftriaxone
Clindamycin
Khng d ng Cefdinir,
cefuroxime,
(1-3 ngy)
(1-3 ngy)
loi 1
cefpodoxime
Azithromycin,
Clindamycin
Clindamycin
D ng loi 1
clarithromycin
Ch thch:
Nng: St cao trn 39 v/hoc au tai nng
Amoxicillin clavulanate vi t l 90:6,4 hoc 14:1 c mt M, t l 7:1 c mt Canada
(Liu u tin dng 4,5 mg/kg amoxicillin, liu th hai dng 4,5 mg/kg amoxicillin + 6,4
mg/kg clavulanate)
D phng ti nhim khun bng khng sinh
- Vim tai gia ti pht l bnh xy ra t nht 3 t trong 6 thng hoc t nht 4 t trong 1 nm.
Cn quan tm n vic ti nhim khun v tr di 3 tui c nguy c cao mt thnh gic v ri
lon v ngn ng v kh nng nghe. D liu t cc nghin cu thng thng khng ng h vic
d phng.

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2. Vim hng
-

Vim hng l tnh trng vim nhim cp vng hng ming hoc mi hu m xy ra t 1%
n 2% trong tt c lt thm bnh nhn ngoi tr. Mc d nguyn nhn ch yu l do virus
nhng nguyn nhn do vi khun chnh l Lin cu khun beta tan huyt nhm A (Group A hemolytic Streptococcus - GABHS) hoc S. pyogenes.
Virus (nh rhinovirus, coronavirus v adenovirus) l nguyn nhn ch yu gy ra vim hng
cp. Nguyn nhn do vi khun rt t kh nng xy ra. Trong cc trng hp do vi khun gy
ra, GABHS l nguyn nhn chnh (chim 15-30% cc trng hp nhi khoa v 5-15% cc
trng hp ngi ln).
Cc bin chng nh st thp khp, vim cu thn v phn ng vim khp c th xy ra nu
nguyn nhn gy vim hng l GABHS.

Triu chng lm sng

-

Triu chng ph bin ca vim hng l au hng. Cc triu chng ca vim hng do lin cu
khun nhm A th hin trong bng 44-3. Cc tiu ch thng dng chn on vim hng
do GABHS trong bng 44-4.
Bng 44-3: Triu chng lm sng v chn on vim hng do lin cu khun nhm A
Thng tin chung
au hng t ngt nhng thng t khi
St v cc triu chng ht trong 3-5 ngy
Cc triu chng lm sng tng t nh cc nguyn nhn do virus v cc vi khun khng phi
lin cu khun
Triu chng
au hng
au khi nut
St
au u, nn, bun nn v au bng (c bit tr em)
Vim/ban amidan v hu hng km/khng km theo cht r r
Hch lympho sng, mm
Li g sng , c cc m xut huyt trn m mm, ban sn trn da
Cc triu chng nng khng gi l do lin cu khun nhm A nh ho, tiu chy, vim mng
kt, s mi.
Cc du hiu nghi ng nguyn nhn do virus
Vim mng kt, s mi, ho v tiu chy
Xt nghim
Nui cy m
Xt nghim khng th nhanh

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Bng 44-4: Tiu ch nh gi nguy c vim hng do lin cu khun beta tan huyt
nhm A
Tiu ch
im
o
o
St trn 38 C (101 F)
1
Khng ho
1
Hch c pha trc sng, mm
1
Sng amidan hoc c cht r r
1
Tui
3-14 tui
1
15-44 tui
0
Trn 45 tui
-1
Ch thch:
im
Nguy c nhim lin cu khun
0
1% - 2,5%
1
5% - 10%
2
11% - 17%
3
28% - 35%
4
51% - 53%
- Hng dn iu tr t Hi bnh truyn nhim M, vin hn lm nhi khoa M v Hip hi tim
mch M khuyn co lm xt nghim lin cu khun nhm A trn tt c bnh nhn c du
hiu. Ch nhng trng hp cho kt qu dng tnh nn dng khng sinh. Bn c nn tm
c thm trong Chng 117 sch Pharmacotherapy: A pathophysiologic Approach tm
them thng tin v xt nghim GABHS.
iu tr
-

Mc tiu iu tr: ci thin triu chng lm sng, gim thiu tc dng ph ca thuc, trnh
ly lan, ngn nga bin chng st thp khp cp v cc bin chng c m nh p xe quanh
amidan, vim hch bch huyt c v vim xng chn.
S dng khng sinh ch nn dng trn bnh nhn c nhng du hiu lm sng v c im
dch t hc vim hng do GABHS, c bit khi kt qu xt nghim GABHS dng tnh. S
dng Penicillin iu tr vim hng do GABHS (Bng 44-5). Bng 44-6 th hin liu lng
iu tr khi ti nhim khun. Bng 44-7 th hin mc bng chng trong chn on vim
hng do lin cu khun nhm A.
Bi v triu chng au l l do chnh khin bnh nhn i khm bc s, cc thuc gim au
nh paracetamol v cc NSAID c khuyn co mnh gim au trn bnh nhn. Tuy
nhin, paracetamol l la chn tt hn do cc NSAID c th lm tng nguy c nhim khun
m mm lan ta hoc hi chng shock nhim c.
Trn bnh nhn d ng vi penicillin, thay th bng mt thuc nhm macrolid nh
erythromycin hoc thuc cephalosporin th h 1 nh cephalexin (nu phn ng d ng khng

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phi qua trung gian IgE). Macrolid mi nh azithromycin v clarithromycin c hiu qu

tng ng vi erythromycin v t gy ra tc dng khng mong mun trn ng tiu ha.
- Nu bnh nhn khng ung c, tim bp benzathin penicillin c th c dng, mc d
gy au khi tim v thuc ny khng c sn Canada.
- Thi gian s dng phc khng sinh iu tr vim hng do lin cu khun nhm A l 10
ngy loi b ti a vi khun.
Bng 44-5: Hng dn v liu dng cc khng sinh s dng trong vim hng
Thuc
Liu ngi ln
Liu tr nh
Thi gian Mc
iu tr
bng
chng
Cc khng sinh u
tin
Penicillin V
250mg x 3-4 ln/ngy 50mg/kg/ngy chia ra 10 ngy
IB
hoc 500mg x 2
3 ln/ngy
ln/ngy
Penicillin
12 triu n v tim
0,6 triu n v cho
1 liu duy IB
benzathine
bp
cn nng 27kg
nht
(50.000 n v/kg)
Penicillin G
12 triu n v
1 liu duy
procaine +
(benzathine 0,9 triu
nht
Penicillin G
n v, procaine 0,3
benzathine
triu n v)
Khng sinh kt hp
Amoxicillin
500mg x 3 ln/ngy
40-50mg/kg/ngy chia 10 ngy
IB
ra 3 ln/ngy
Amoxicillin gii
775mg/ngy
775mg/ngyb
10 ngy
IIaB
phng ko di
Cephalexina
250-500mg ng
25-50mg/kg/ngy chia 10 ngy
IB
ung 4 ln/ngy
lm 4 ln/ngy
Clindamycina
20mg/kg/ngy chia ra
10 ngy
IIaB
lm 3 ln (ti a
1,8g/ngy)
a
Azithromycin
12mg/kg/ngy dng 1
5 ngy
IIaB
ln (ti a 500mg)
Clarythromycina
15mg/kg/ngy chia
10 ngy
IIaB
lm 2 ln (ti a
250mg x 2 ln/ngy)
Erythromycina
C sn trong cng
C sn trong cng
10 ngy
IIaB
thc ch phm
thc ch phm
Ch thch:
a
Khng sinh thay th khi bnh nhn d ng vi penicillin
b
Ch dng tr t 2 tui tr ln
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Mc khuyn co
Loi I: Khi cc bng chng v/hoc s ng thun ch ra phng php iu tr l c li, hu
ch v hiu qu
Loi II: Khi cc bng chng mu thun nhau v/hoc cc kin khng thng nht cho thy
phng php iu tr l c li, hu ch v hiu qu
Loi IIa: Mc bng chng/ kin ng h s hu ch/ hiu qu
Loi IIb: S hu ch/hiu qu t c khng nh t cc bng chng/ Loi III: Cc bng
chng/s ng thun ch ra phng php iu tr l khng hu ch/hiu qu v trong mt s
trng hp cn c hi
Mc bng chng
Loi A: Cc d liu ly t s lng ln th nghim lm sng ngu nhin hoc phn tch meta
Loi B: D liu ly t mt th nghim lm sng ngu nhin hoc cc nghin cu khng ngu
nhin
Loi C: Cc d liu ly t cc bo co ca lm sng, s ng thun ca chuyn gia
Bng 44-6: Cc khng sinh v liu dng s dng cho cc t vim hng ti pht
Thuc
Liu ngi ln
Liu tr em
Clindamycin
600mg/ngy ng ung
20mg/kg/ngy ng ung
chia lm 2-4 ln
chia lm 3 ln/ngy (ti a
1,8g/ngy)
Amoxicillin-clavulanate
500mg x 2 ln/ngy ng
40mg/kg/ngy chia lm 3 ln
ung
ng ung
Penicillin benzathine
1,2 triu n v tim bp 1
0,6 triu n v nu cn nng
ln
27kg (50.000 n v/kg)
Penicillin benzathine v
Nh trn
Nh trn
rifampin
Rifampin 20mg/kg/ngy
Liu rifampin nh ngi ln
ng ung chia lm 2 ln
trong 4 ngy cui s dng
penicillin (ti a
600mg/ngy)
Bng 44-7: Nguyn l chn on v iu tr da trn bng chng i vi lin cu
khun nhm A
Cc khuyn co
Mc
Vic s dng xt nghim chn on c chn lc ch trn nhng bnh nhn c
c im lm sng gi nhim lin cu nhm A s lm tng t l xt nghim
A-II
dng tnh cng nh kt qu l dng tnh tht s, khng phi dng tnh gi
Chn on lm sng khng th chc chn ngay c bi nhng chuyn gia lm
A-II
sng c kinh nghim nht; cn phi yu cu xc nh vi khun
Tiu chun chn on v nui cy dch m hng c nhy t 90% n 95%
A-II
nu c lm ng cch
Chn on v iu tr nhanh c th lm gim s ly lan, cho php bnh nhn
A-II
c th tr li lm vic, hc tp sm hn v lm gim cc t cp honh hnh
Trang 7/11

ca bnh.
Phn ln cc xt nghim tm khng nguyn nhanh c chnh xc > 95%
(gim thiu cc n thuc cho ngi khng bnh) v c nhy t 80% n
A-II
90% khi so snh vi nui cy t nhin
S dng khng sinh ban u sm s lm gim c cc triu chng bnh
nhanh hn. Vic tr hon s dng khng sinh (nu ch kt qu nui cy) c th
A-I
an ton trong vng 9 ngy k t ngy cc triu chng khi pht v vn ngn
nga c bin chng chnh nh st thp khp.
Ch thch:
Xp loi
mnh khuyn co: T A-E
Bng chng ng h: A-tt, B-trung bnh, C-km
Bng chng phn i: D-trung bnh, E-tt
Cht lng bng chng: T I-III
Loi I: C t nht mt th nghim lm sng ngu nhin c i chng
Loi II: C t nht mt th nghim lm sng c thit k nghin cu tt, khng ngu nhin
hoc mt nghin cu hi cu hoc mt nghin cu phn tch case c i chng hoc t cc
bo co lin tc trong mt thi gian rng hoc t kt qu rt t t mt th nghim khng c
i chng.
Loi III: kin ca chuyn gia
nh gi kt qu iu tr
- Hu ht bnh nhn t khi; tuy nhin, s dng phc khng sinh sm trong cc trng hp
nhim GABHS s y nhanh thi gian khi bnh. Cc triu chng thng thng s khi
trong vng 3-4 ngy ngay c khi khng iu tr. Thng l khng cn thit lm xt nghim
theo di trn nhng trng hp b bnh u tin (index cases) hoc nhng c nhn khng c
triu chng khi tip xc vi nhng bnh nhn ny.
3. Vim xoang
-

Vim xoang (sinusitis) l tnh trng vim v/hoc nhim khun vng nim mc xoang cnh
mi. Thut ng vim mi xoang (rhinosinusitis) cng c mt s chuyn gia s dng v
vim xoang in hnh cng nh hng bi vng nim mc mi. Virus l nguyn nhn chnh
gy bnh. Vic phn bit nguyn nhn do virus hay vi khun rt quan trng c nhng
quyt nh iu tr ng n.
Vim xoang cp do vi khun thng cng gy ra do cng nhm vi khun gy ra vim tai
gia: S. pneumonia v H. influenza. Cc tc nhn ny chim n 70% cc trng hp do vi
khun gy ra c tr em v ngi ln.

Trang 8/11

Triu chng lm sng

-

Triu chng lm sng in hnh ca vim xoang do vi khun c th hin trong bng 44-8.
Bng 44-8: Cc triu chng lm sng v chn on vim xoang do vi khun
Du hiu chung
Tnh trng nhim khun ng h hp trn khng c hiu ko di t 7 n 14 ngy
Triu chng
Cp tnh
Ngi ln:
S mi, nght mi
au hm rng, au vng mt, xoang lan ta (c bit l mt bn), v tnh trng trm
trng hn sau t ci thin ban u
Cc triu chng nng hoc dai dng (ko di trn 7 ngy) c kh nng l do vi khun v
cn c iu tr bng khng sinh
Tr em:
S mi v ho ko di t 10 n 14 ngy hoc cc triu chng nng nh st cao 39oC
hoc sng/au vng mt l nhng du hiu cn phi s dng khng sinh.
Mn tnh
Cc triu chng tng t nh vim xoang cp nhng khng in hnh
Chy nc mi vi tnh trng trm trng
C th b ho khan mn tnh, vim thanh qun v au u
Nhim khun mn tnh hoc ti pht 3 n 4 ln trong mt nm v cc thuc thng mi,
xng hi khng c hiu qu.
Cc xt nghim
Nhum chng Gram, nui cy, nhy cm vi khng sinh ca dch chy ra hoc dch th ra
nu chc xoang c tin hnh

iu tr
- Mc tiu iu tr vim xoang cp: lm gim triu chng. duy tr trng thi thng thong cc
xoang, hc, hn ch vic s dng khng sinh, iu tr nhim khun vi phc khng sinh
thch hp, gim ti thiu thi gian b bnh, ngn nga bin chng, ngn nga din bin bnh
chuyn sang mn tnh.
- Cc thuc thng mi dng phun sng nh phenylephrine v oxymetazoline c tc dng
lm gim tnh trng vim bng cch gy co mch thng c s dng. Tuy nhin, khng
nn s dng thuc qu 3 ngy trnh tnh trng gy nght mi bt li trm trng hn. C
th s dng thm thuc thng mi ng ung khi cc hc, xoang mi thng thong. Ra
mi bng nc mui sinh l v xng bng hi nc ng kh dung lm tng m vng
nim mc. Thuc long m (nh guaifenesin) c th s dng lm gim tnh nht cc cht
bi tit trong mi. Khng nn s dng cc thuc khng histamine do tc dng khng
cholinergic nh lm kh nim mc, ri lon thanh thi cc cht bi tit ca nim mc.
- Liu php khng sinh lm gim v loi tr triu chng tt hn so vi gi dc tuy nhin hiu
qu khng cao.
Trang 9/11

Amoxicillin l la chn u tin trong iu tr vim xoang do vi khun v tnh hiu qu - chi
ph vt tri trong trng hp cp thng thng, v vic s dng cc tc nhn ph rng mi
hn ban u l khng ph hp. Tip cn iu tr vim xoang cp do vi khun th hin trong
bng 44-9. Liu lng th hin trong bng 44-10.
- Khuyn co s dng phc khng sinh t 10 n 14 ngy, hoc t nht 7 ngy sau khi
kim sot tt cc triu chng.
Bng 44-9: Cc khuyn co vic s dng khng sinh iu tr vim xoang cp do vi khun
Tht bi iu tr hoc
Nghi ng nguyn
phc khng sinh
nhn l S.
Thng thng
trc dung 4 n pneumoniae khng
6 tun
penicillin
Amoxicillin
Amoxicillin clavulante Amoxicillin (liu
(liu cao) hoc
cao) hoc
La chn u
cephalosporin
clindamycin
Fluoroquinolone ng
Fluoroquinolone
La chn thay h hp
ng h hp
th
Cephalosporin
Cephalosporin
Clindamycin hoc
Khng phi d
Fluoroquinolone
ng type 1
ng h hp
Clarithromycin,
Fluoroquinolone ng
Clindamycin hoc
azithromycin,
h hp
Fluoroquinolone
trimethoprim,
ng h hp
sulfamethoxazole,
D ng type 1
doxycycline, hoc mt
fluoroquinolone ng
h hp
-

Bng 44-10: Khuyn co v liu cc khng sinh s dng trong vim xoang cp do vi khun
Thuc
Liu trn ngi ln
Liu trn tr em
Amoxicillin
Liu thp: 500mgx3 ln/ngy
Liu thp: 45mg/kg/ngy chia ra 3 ln/ngy
Liu cao: 2gx 2 ln/ngy
Liu cao: 90mg/kg/ngy chia ra 2 ln/ngy
Amoxicillin
Liu thp: 500/125 mg x 3
Liu thp: 45mg/kg/ngy amoxicillin v
clavulanate
ln/ngy
3,2mg/kg/ngy clavulanate chia ra 3
Liu cao: 2g/125 mg x 2
ln/ngy
ln/ngy
Liu cao: 90mg/kg/ngy amoxicillin v
6,4mg/kg/ngy clavulanate chia ra 2
ln/ngy
Cefuroxime
250 500 mg x 2 ln/ngy
15mg/kg/ngy chia ra 2 ln/ngy
Cefador
250 500 mg x 3 ln/ngy
20mg/kg/ngy chia ra 3 ln/ngy
Cefexime
200 400 mg x 2 ln/ngy
8mg/kg/ngy dung 1 ln hoc chia ra 2
ln/ngy
Cefdinir
600 mg dng 1 ln hoc chia ra 14mg/kg/ngy dng 1 ln hoc chia ra 2
Trang 10/11

Cefpodoxime
Cefprozil
Doxycyclin
Trimethoprime

sulfamethoxaz
ole
Clindamycin
Clarithromycin
Azithromycin

2 ln/ngy
200 mg x 2 ln/ngy
250 500 mg x 2 ln/ngy
100 mg sau mi 12 ting
160/800 mg sau mi 12 ting

ln/ngy
10mg/kg/ngy chia ra 2 ln/ngy (khng
qu 400mg/ngy)
15-30mg/kg/ngy chia ra 2 ln/ngy
6-8mg/kg/ngy trimethoprime, 3040mg/kg/ngy sulfamethoxazole chia ra 2
ln/ngy

150 450 mg sau mi 6 ting

30-40mg/kg/ngy chia ra 3 ln/ngy
250 500 mg x 2 ln/ngy
15mg/kg/ngy chia ra 2 ln/ngy
Ngy u: 500mg
Ngy u: 10mg/kg/ngy
Ngy 2-5: 250mg
Ngy 2-5: 5mg/kg/ngy
Levofloxacin
500mg/ngy
Xem chng 117, nhim khun ng h hp trn, tc gi Christopher Frei, Bradi Frei
v George Zhanel bit thm chi tit v vn ny.

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