{"id":4102,"date":"2018-09-03T23:14:37","date_gmt":"2018-09-03T16:14:37","guid":{"rendered":"https:\/\/yhoccongdong.org\/du-an-khoa-nhi\/2018\/09\/03\/dieu-tri-viem-tai-giua-cap-o-tre-em\/"},"modified":"2024-03-04T13:50:45","modified_gmt":"2024-03-04T06:50:45","slug":"dieu-tri-viem-tai-giua-cap-o-tre-em","status":"publish","type":"post","link":"https:\/\/yhoccongdong.com\/nhi-khoa\/dieu-tri-viem-tai-giua-cap-o-tre-em\/","title":{"rendered":"\u0110i\u1ec1u tr\u1ecb vi\u00eam tai gi\u1eefa c\u1ea5p \u1edf tr\u1ebb em"},"content":{"rendered":"<p style=\"text-align: justify\">Vi\u00eam tai gi\u1eefa c\u1ea5p (AOM) hay c\u00f2n g\u1ecdi l\u00e0 vi\u00eam tai gi\u1eefa m\u1ee7 x\u1ea3y ra th\u01b0\u1eddng xuy\u00ean \u1edf tr\u1ebb em, l\u00e0 ch\u1ea9n \u0111o\u00e1n ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf nh\u1eefng tr\u1ebb \u0111\u01b0\u1ee3c k\u00ea kh\u00e1ng sinh.<\/p>\n<h2 style=\"text-align: justify\">Ch\u1ea9n \u0111o\u00e1n<\/h2>\n<p style=\"text-align: justify\">Ch\u1ea9n \u0111o\u00e1n AOM y\u00eau c\u1ea7u ph\u1ea3i c\u00f3 s\u1ef1 c\u0103ng ph\u1ed3ng m\u00e0ng nh\u0129 ho\u1eb7c c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a vi\u00eam c\u1ea5p t\u00ednh v\u00e0 c\u00f3 s\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a d\u1ecbch trong tai gi\u1eefa.<\/p>\n<h2 style=\"text-align: justify\">\u0110i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng<\/h2>\n<h3 style=\"text-align: justify\">Gi\u1ea3m \u0111au to\u00e0n th\u00e2n v\u00e0 t\u1ea1i ch\u1ed7<\/h3>\n<p style=\"text-align: justify\">S\u1eed d\u1ee5ng ibuprofen ho\u1eb7c acetaminophen \u0111\u1ec3 gi\u1ea3m \u0111au trong AOM. C\u00f3 th\u1ec3 thay th\u1ebf b\u1eb1ng Benzocain, procain, lidocain nh\u1ecf t\u1ea1i ch\u1ed7 v\u1edbi tr\u1ebb t\u1eeb 2 tu\u1ed5i tr\u1edf l\u00ean v\u1edbi \u0111i\u1ec1u ki\u1ec7n m\u00e0ng nh\u0129 ch\u01b0a th\u1ee7ng. Nh\u1ecf t\u1ea1i ch\u1ed7 nh\u1eefng thu\u1ed1c t\u00ea n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng cho tr\u1ebb d\u01b0\u1edbi 2 tu\u1ed5i v\u00ec nguy c\u01a1 thi\u1ebfu m\u00e1u do MetHemoglobin.<\/p>\n<h3 style=\"text-align: justify\">Thu\u1ed1c ch\u1ed1ng sung huy\u1ebft v\u00e0 kh\u00e1ng histamin<\/h3>\n<p style=\"text-align: justify\">Kh\u00f4ng khuy\u1ebfn c\u00e1o c\u00e1c thu\u1ed1c ch\u1ed1ng sung huy\u1ebft v\u00e0 kh\u00e1ng histamin trong \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng AOM \u1edf tr\u1ebb em.<\/p>\n<p style=\"text-align: justify\">C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 l\u1ee3i \u00edch c\u1ee7a kh\u00e1ng histamin v\u00e0 thu\u1ed1c ch\u1ed1ng sung huy\u1ebft m\u0169i trong AOM cho th\u1ea5y ti\u1ec1m n\u0103ng v\u00e0 l\u1ee3i \u00edch trong vi\u1ec7c gi\u1ea3i quy\u1ebft d\u1ecbch trong tai gi\u1eefa l\u00e0 kh\u00f4ng c\u00f3!<\/p>\n<p style=\"text-align: justify\">Nghi\u00ean c\u1ee9u h\u1ec7 th\u1ed1ng n\u0103m 2007 ch\u1ec9 ra r\u1eb1ng vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1ed1ng sung huy\u1ebft m\u0169i v\u00e0 kh\u00e1ng histamin \u0111\u01a1n \u0111\u1ed9c hay ph\u1ed1i h\u1ee3p l\u00e0m gia t\u0103ng t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c v\u00e0 c\u0169ng kh\u00f4ng c\u1ea3i thi\u1ec7n \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng b\u1ec7nh c\u0169ng nh\u01b0 t\u1ec9 l\u1ec7 ph\u1ea3i can thi\u1ec7p ngo\u1ea1i khoa v\u00ec bi\u1ebfn ch\u1ee9ng. Ngo\u00e0i ra vi\u1ec7c s\u1eed d\u1ee5ng kh\u00e1ng histamin c\u00f2n l\u00e0m k\u00e9o d\u00e0i hi\u1ec7n t\u01b0\u1ee3ng ch\u1ea3y d\u1ecbch tai gi\u1eefa.<\/p>\n<p style=\"text-align: justify\">\u0110\u1ed1i v\u1edbi tr\u1ebb em b\u1ecb AOM v\u00e0 c\u00f3 ho\u1eb7c nghi ng\u1edd vi\u00eam m\u0169i d\u1ecb \u1ee9ng, th\u00ec c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc cho 1 thu\u1ed1c ch\u1ed1ng sung huy\u1ebft m\u0169i v\u00e0 kh\u00e1ng histamin \u0111\u1ec3 gi\u1ea3i quy\u1ebft tri\u1ec7u ch\u1ee9ng t\u1ea1i m\u0169i. Nh\u01b0ng c\u1ea7n thi\u1ebft c\u00e2n nh\u1eafc th\u1eadt k\u0129, so s\u00e1nh l\u1ee3i \u00edch v\u1edbi nh\u1eefng t\u00e1c d\u1ee5ng ngo\u1ea1i \u00fd v\u00e0 kh\u1ea3 n\u0103ng k\u00e9o d\u00e0i th\u1eddi gian ch\u1ea3y d\u1ecbch tai gi\u1eefa c\u1ee7a anti-histamin.<\/p>\n<p style=\"text-align: justify\">Vi\u1ec7n h\u00e0n l\u00e2m nhi khoa hoa k\u00ec (APP) khuy\u1ebfn c\u00e1o kh\u00f4ng n\u00ean cho tr\u1ebb d\u01b0\u1edbi 6 tu\u1ed5i x\u00e0i c\u00e1c thu\u1ed1c tr\u1ecb ho v\u00e0 c\u1ea3m (OTC) v\u00ec nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 nguy hi\u1ec3m t\u00ednh m\u1ea1ng.<\/p>\n<h3 style=\"text-align: justify\">C\u00e1c li\u1ec7u ph\u00e1p kh\u00e1c<\/h3>\n<p style=\"text-align: justify\">\u0110\u00e1nh l\u1ea1c h\u01b0\u1edbng, ch\u01b0\u1eddm n\u00f3ng hay ch\u01b0\u1eddm l\u1ea1nh b\u00ean nh\u1ecf d\u1ea7u oliu hay c\u00e1c th\u1ea3o d\u01b0\u1ee3c kh\u00e1c v\u00e0o tai \u0111\u1ec3 gi\u1ea3m \u0111au. Nh\u1eefng bi\u1ec7n ph\u00e1p n\u00e0y ch\u01b0a c\u00f3 th\u1eed nghi\u1ec7m v\u1ec1 \u0111\u1ed9 an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3.<\/p>\n<h2 style=\"text-align: justify\">Li\u1ec7u ph\u00e1p kh\u00e1ng sinh.<\/h2>\n<p style=\"text-align: justify\">Ngo\u00e0i ki\u1ec3m so\u00e1t \u0111au c\u00f3 2 chi\u1ebfn l\u01b0\u1ee3c trong \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u AOM .<\/p>\n<ul style=\"text-align: justify\">\n<li>\u0110i\u1ec1u tr\u1ecb kh\u00e1ng sinh ngay .<\/li>\n<li>Theo d\u00f5i sau 48-72 gi\u1edd c\u00e1c tri\u1ec7u ch\u1ee9ng x\u1ea5u \u0111i ho\u1eb7c kh\u00f4ng c\u1ea3i thi\u1ec7n th\u00ec d\u00f9ng kh\u00e1ng sinh.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">L\u1ef1a ch\u1ecdn chi\u1ebfn l\u01b0\u1ee3c n\u00e0o th\u00ec ph\u1ee5 thu\u1ed9c v\u00e0o tu\u1ed5i c\u1ee7a tr\u1ebb, kinh nghi\u1ec7m v\u00e0 \u0111\u1ed9 n\u1eb7ng c\u1ee7a b\u1ec7nh.<\/p>\n<ul style=\"text-align: justify\">\n<li>V\u1edbi tr\u1ebb <strong>d\u01b0\u1edbi 6 th\u00e1ng tu\u1ed5i<\/strong> c\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh ngay<\/li>\n<li>V\u1edbi tr\u1ebb <strong>6 th\u00e1ng &#8211; 2 tu\u1ed5i<\/strong> b\u1ecb AOM 2 b\u00ean th\u00ec \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh ngay. N\u1ebfu b\u1ecb 1 b\u00ean m\u00e0 tri\u1ec7u ch\u1ee9ng nh\u1eb9 theo APP (vi\u1ec7n h\u00e0n l\u00e2m nhi khoa Hoa K\u00ec) cho ph\u00e9p theo d\u00f5i ch\u01b0a d\u00f9ng kh\u00e1ng sinh ngay sau khi \u0111\u00e3 th\u1ea3o lu\u1eadn v\u1edbi cha m\u1eb9 tr\u1ebb.<\/li>\n<\/ul>\n<p style=\"padding-left: 30px;text-align: justify\">Tuy nhi\u00ean v\u00ec t\u1ec9 l\u1ec7 th\u1ea5t b\u1ea1i khi theo d\u00f5i (ngh\u0129a l\u00e0 tr\u1edf n\u1eb7ng hay kh\u00f4ng c\u1ea3i thi\u1ec7n) v\u1edbi nh\u1eefng tr\u1ebb n\u00e0y kh\u00e1 cao, n\u00ean t\u1ed1t nh\u1ea5t c\u0169ng l\u00e0 \u0111i\u1ec1u tr\u1ecb kh\u00e1ng sinh ngay cho tr\u1ebb.<\/p>\n<ul style=\"text-align: justify\">\n<li>V\u1edbi tr\u1ebb t\u1eeb 2 tu\u1ed5i tr\u1edf l\u00ean d\u00f9ng kh\u00e1ng sinh ngay khi:\n<ul>\n<li>C\u00f3 v\u1ebb nhi\u1ec5m \u0111\u1ed9c<\/li>\n<li>\u0110au tai dai d\u1eb3ng tr\u00ean 48 gi\u1edd<\/li>\n<li>C\u00f3 s\u1ed1t tr\u00ean 39 \u0111\u1ed9 trong v\u00f2ng 48 gi\u1edd tr\u01b0\u1edbc.<\/li>\n<li>B\u1ecb C\u1ea3 2 tai ho\u1eb7c c\u00f3 ch\u1ea3y m\u1ee7<\/li>\n<li>Kh\u00f4ng \u0111\u1ea3m b\u1ea3o trong vi\u1ec7c theo d\u00f5i.<\/li>\n<\/ul>\n<\/li>\n<li>V\u1edbi tr\u1ebb tr\u00ean 2 tu\u1ed5i c\u00f3 mi\u1ec5n d\u1ecbch b\u00ecnh th\u01b0\u1eddng v\u00e0 kh\u00f4ng c\u00f3 b\u1ea5t th\u01b0\u1eddng gi\u1ea3i ph\u1eabu v\u00f9ng s\u1ecd m\u1eb7t.<\/li>\n<\/ul>\n<p style=\"padding-left: 30px;text-align: justify\">C\u00e1c tri\u1ec7u ch\u1ee9ng AOM nh\u1eb9 v\u00e0 kh\u00f4ng ch\u1ea3y m\u1ee7 th\u00ec c\u00f3 th\u1ec3 theo d\u00f5i kh\u00f4ng d\u00f9ng kh\u00e1ng sinh ngay v\u1edbi \u0111i\u1ec1u ki\u1ec7n ng\u01b0\u1eddi ch\u0103m s\u00f3c hi\u1ec3u \u0111\u01b0\u1ee3c nguy c\u01a1 v\u00e0 l\u1ee3i \u00edch c\u1ee7a c\u00e1ch ti\u1ebfp c\u1eadn n\u00e0y.<\/p>\n<h3 style=\"text-align: justify\">L\u1ef1a\u00a0<strong>ch\u1ecdn kh\u00e1ng sinh<\/strong><\/h3>\n<p style=\"text-align: justify\">Khi c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng kh\u00e1ng sinh<\/p>\n<p style=\"text-align: justify\"><strong>Amoxicillin<\/strong><\/p>\n<p style=\"text-align: justify\">Li\u1ec1u 90 mg\/kg\/ng\u00e0y chia 2 l\u1ea7n n\u1ebfu trong v\u00f2ng 1 th\u00e1ng qua tr\u1ebb kh\u00f4ng d\u00f9ng kh\u00e1ng sinh nh\u00f3m betalactam, kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed AOM t\u00e1i ph\u00e1t v\u00e0 kh\u00f4ng c\u00f3 b\u1ecb vi\u00eam k\u1ebft m\u1ea1c m\u1ee7 k\u00e8m theo.<\/p>\n<p style=\"text-align: justify\"><strong>Amox-clav<\/strong><\/p>\n<p style=\"text-align: justify\">Cho nh\u1eefng tr\u1ebb trong v\u00f2ng 1 th\u00e1ng qua c\u00f3 d\u00f9ng kh\u00e1ng sinh nh\u00f3m betalactam, c\u00f3 vi\u00eam k\u1ebft m\u1ea1c m\u1ee7 k\u00e8m theo, c\u00f3 ti\u1ec1n s\u1eed vi\u00eam tai gi\u1eefa t\u00e1i ph\u00e1t<\/p>\n<p style=\"text-align: justify\">Li\u1ec1u l\u00e0 90 mg\/kg\/ng\u00e0y v\u1edbi Amox v\u00e0 6.4 mg\/kg\/ng\u00e0y v\u1edbi clavulanic.<\/p>\n<p style=\"text-align: justify\">Li\u1ec1u t\u1ed1i \u0111a c\u1ee7a Amox l\u00e0 3g\/ng\u00e0y.<\/p>\n<p style=\"text-align: justify\">V\u1edbi tr\u1ebb tr\u00ean 16 tu\u1ed5i c\u00f3 th\u1ec3 d\u00f9ng \u0111\u1ebfn li\u1ec1u 1-2 gram amoxicillin m\u1ed7i 12 gi\u1edd v\u00e0 62.5 \u0111\u1ebfn 125 mg m\u1ed7i 12 gi\u1edd.<\/p>\n<p style=\"text-align: justify\"><strong>N\u1ebfu<\/strong> <strong>tr\u1ebb d\u1ecb \u1ee9ng penicillin<\/strong><\/p>\n<p style=\"text-align: justify\"><strong>D\u1ecb \u1ee9ng penicillin kh\u00f4ng ph\u1ea3i type 1<\/strong> (type 1: s\u1ed1c ph\u1ea3n v\u1ec7, ph\u00f9 m\u1ea1ch, co th\u1eaft ph\u1ebf qu\u1ea3n, m\u1ec1 \u0111ay c\u1ea5p) t\u1ee9c l\u00e0 lo\u1ea1i ph\u1ea3n \u1ee9ng ch\u1eadm th\u00ec c\u00f3 th\u1ec3 d\u00f9ng:<\/p>\n<ul style=\"text-align: justify\">\n<li>Cefdinir 14 mg\/kg per day orally in one or two doses (maximum 600 mg\/day)<\/li>\n<li>Cefpodoxime 10 mg\/kg orally in two doses (maximum 400 mg\/day)<\/li>\n<li>Cefuroxime suspension 30 mg\/kg per day orally divided in two doses (maximum 1 g\/day)<\/li>\n<li>Cefuroxime tablets 250 mg orally every 12 hours<\/li>\n<li>Ceftriaxone 50 mg\/kg intramuscularly once per day (maximum 1 g\/day) for one to three doses<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>N\u1ebfu b\u1ecb d\u1ecb \u1ee9ng type 1<\/strong> (lo\u1ea1i ph\u1ea3n \u1ee9ng nhanh) th\u00ec d\u00f9ng Macrolide ho\u1eb7c Lincosamide \u0111\u1ec3 thay th\u1ebf.<\/p>\n<p style=\"text-align: justify\">Tuy nhi\u00ean 2 nh\u00f3m n\u00e0y b\u1ecb ph\u1ebf c\u1ea7u \u0111\u1ec1 kh\u00e1ng kh\u00e1 cao (25-30 %) v\u00e0 n\u00f3 c\u0169ng kh\u00f4ng hi\u1ec7u qu\u1ea3 trong vi\u00eam tai gi\u1eefa do HIB.<\/p>\n<ul style=\"text-align: justify\">\n<li>Azithromycin li\u1ec1u 10 mg\/kg trong ng\u00e0y \u0111\u1ea7u (max 500 mg) v\u00e0 5 mg\/kg\/ng\u00e0y (max 250 mg\/ng\u00e0y) t\u1eeb ng\u00e0y th\u1ee9 2 &#8211; th\u1ee9 5.<\/li>\n<li>Clarythromycin 15 mg\/kg\/ng\u00e0y (max 1 g\/ng\u00e0y)<\/li>\n<li>Erythromycin- sulfisoxazole: 50 mg\/kg\/ng\u00e0y chia 3-4 l\u1ea7n, t\u1ed1i \u0111a 2 gam Ery\/ng\u00e0y 6 gram sulfisoxazole\/ng\u00e0y<\/li>\n<li>Li\u1ec1u t\u1ed1i \u01b0u c\u1ee7a Clindamycin trong \u0111i\u1ec1u tr\u1ecb AOM th\u00ec ch\u01b0a ch\u1eafc ch\u1eafn. Theo APP 15- 25mg\/kg\/ng\u00e0y cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh. 30-40 mg\/ kg\/ ngay cho nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng. (Li\u1ec1u t\u1ed1i \u0111a 1.8 gram\/ng\u00e0y)<\/li>\n<li>Trimethoprim-sulfamethoxazole: c\u00f3 th\u1ec3 h\u1eefu \u00edch v\u1edbi nh\u1eefng v\u00f9ng m\u00e0 ph\u1ebf c\u1ea7u ch\u01b0a kh\u00e1ng v\u1edbi n\u00f3 .<\/li>\n<\/ul>\n<p style=\"padding-left: 30px;text-align: justify\">Nh\u01b0ng thu\u1ed1c n\u00e0y kh\u00f4ng n\u00ean d\u00f9ng cho nh\u1eefng ca nghi ng\u1edd AOM do li\u00ean c\u1ea7u (c\u00f3 l\u1ee7ng m\u00e0ng nh\u0129)<\/p>\n<ul>\n<li style=\"text-align: justify\">C\u00e1c quinolon (ofloxacin, ciprofloxacin) nh\u1ecf t\u1ea1i ch\u1ed7 c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi \u0111\u01b0\u1eddng u\u1ed1ng trong tr\u01b0\u1eddng h\u1ee3p vi\u00eam tai gi\u1eefa c\u00f3 ch\u1ea3y m\u1ee7 v\u00e0 \u0111\u1eb7t \u1ed1ng th\u00f4ng nh\u0129 h\u1ea7u, v\u00e0 vi\u00eam tai gi\u1eefa m\u1ea1n t\u00ednh. Kh\u00f4ng c\u00f3 nghi\u00ean c\u1ee9u v\u1ec1 vi\u1ec7c nh\u1ecf Quinolon trong tr\u01b0\u1eddng h\u1ee3p AOM ho\u1eb7c l\u1ee7ng m\u00e0ng nh\u0129 m\u1edbi.<\/li>\n<\/ul>\n<h3 style=\"text-align: justify\"><strong>Th\u1eddi gian d\u00f9ng kh\u00e1ng sinh<\/strong><\/h3>\n<ul>\n<li style=\"text-align: justify\">10 ng\u00e0y v\u1edbi tr\u1ebb:\n<ul>\n<li style=\"text-align: justify\">D\u01b0\u1edbi 2 tu\u1ed5i v\u00e0\/ho\u1eb7c<\/li>\n<li style=\"text-align: justify\">C\u00f3 l\u1ee7ng m\u00e0ng nh\u0129 v\u00e0\/ho\u1eb7c<\/li>\n<li style=\"text-align: justify\">Ti\u1ec1n s\u1eed AOM t\u00e1i ph\u00e1t.<\/li>\n<\/ul>\n<\/li>\n<li style=\"text-align: justify\">5-7 ng\u00e0y v\u1edbi tr\u1ebb tr\u00ean 2 tu\u1ed5i kh\u00f4ng c\u00f3 l\u1ee7ng m\u00e0ng nh\u0129 v\u00e0 kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed vi\u00eam tai gi\u1eefa t\u00e1i ph\u00e1t.<\/li>\n<\/ul>\n<h2 style=\"text-align: justify\"><strong>Li\u1ec7u ph\u00e1p theo d\u00f5i<\/strong><\/h2>\n<p style=\"text-align: justify\">\u00c1p d\u1ee5ng cho tr\u1ebb tr\u00ean 2 tu\u1ed5i c\u01a1 \u0111\u1ecba b\u00ecnh th\u01b0\u1eddng (mi\u1ec5n d\u1ecbch b\u00ecnh th\u01b0\u1eddng, kh\u00f4ng c\u00f3 b\u1ea5t th\u01b0\u1eddng s\u1ecd m\u1eb7t) m\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u1eb9 v\u1edbi t\u00ecnh tr\u1ea1ng vi\u00eam ch\u1ec9 1 b\u00ean tai (kh\u00f4ng c\u00f3 \u0111au n\u1eb7ng hay s\u1ed1t tr\u00ean 39 \u0111\u1ed9 trong v\u00f2ng 48 gi\u1edd qua), kh\u00f4ng c\u00f3 ch\u1ea3y m\u1ee7 tai .<\/p>\n<p style=\"text-align: justify\">Ch\u1ecdn ch\u1ecdn gi\u1ea3i ph\u00e1p n\u00e0y khi ng\u01b0\u1eddi ch\u0103m s\u00f3c tr\u1ebb hi\u1ec3u r\u00f5 v\u00e0 \u0111\u1ed3ng \u00fd v\u1edbi c\u00e1c nguy c\u01a1 c\u0169ng nh\u01b0 l\u1ee3i \u00edch c\u1ee7a ph\u01b0\u01a1ng ph\u00e1p. Sau 48-72 gi\u1edd c\u00e1c tri\u1ec7u ch\u1ee9ng x\u1ea5u \u0111i ho\u1eb7c kh\u00f4ng c\u1ea3i thi\u1ec7n th\u00ec ch\u1ec9 \u0111\u1ecbnh kh\u00e1ng sinh.<\/p>\n<h2 style=\"text-align: justify\"><strong>Theo d\u00f5i<\/strong><\/h2>\n<h3 style=\"text-align: justify\">C\u00e1c tri\u1ec7u ch\u1ee9ng dai d\u1eb3ng<\/h3>\n<p style=\"text-align: justify\">N\u1ebfu c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng c\u1ea3i thi\u1ec7n sau 48-72 gi\u1edd d\u00f9ng kh\u00e1ng sinh th\u00ec c\u1ea7n \u0111\u01b0\u1ee3c t\u00e1i kh\u00e1m \u0111\u1ec3 b\u00e1c s\u0129 t\u00ecm nguy\u00ean nh\u00e2n kh\u00e1c g\u00e2y ra t\u00ecnh tr\u1ea1ng n\u00e0y, ho\u1eb7c c\u00e2n nh\u1eafc \u0111\u1ed5i kh\u00e1ng sinh kh\u00e1c.<\/p>\n<p style=\"text-align: justify\">Tr\u1ebb d\u00f9ng li\u1ec7u ph\u00e1p theo d\u00f5i n\u1ebfu sau 48-72 gi\u1edd m\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng x\u1ea5u \u0111i ho\u1eb7c kh\u00f4ng c\u1ea3i thi\u1ec7n th\u00ec ph\u1ea3i cho kh\u00e1ng sinh.<\/p>\n<h3 style=\"text-align: justify\">C\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u00e3 h\u1ebft<\/h3>\n<ul>\n<li style=\"text-align: justify\">Tr\u1ebb d\u01b0\u1edbi 2 tu\u1ed5i t\u00e1i kh\u00e1m sau 8-12 tu\u1ea7n sau khi \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n. C\u00f3 80-90 % tr\u1ebb d\u1ecbch tai gi\u1eefa s\u1ebd r\u00fat h\u1ebft sau kho\u1ea3ng th\u1eddi gian n\u00e0y.<\/li>\n<li style=\"text-align: justify\">Tr\u1ebb t\u1eeb 2 tu\u1ed5i tr\u1edf l\u00ean m\u00e0 c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 ng\u00f4n ng\u1eef c\u0169ng nh\u01b0 h\u1ecdc t\u1eadp c\u1ea7n t\u00e1i kh\u00e1m sau 8-12 tu\u1ea7n k\u1ec3 t\u1eeb ng\u00e0y \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n.<\/li>\n<li style=\"text-align: justify\">Tr\u1ebb t\u1eeb 2 tu\u1ed5i tr\u1edf l\u00ean m\u00e0 kh\u00f4ng c\u00f3 v\u1ea5n \u0111\u1ec1 v\u1ec1 ng\u00f4n ng\u1eef hay h\u1ecdc t\u1eadp th\u00ec ki\u1ec3m tra l\u1ea1i v\u00e0o l\u1ea7n kh\u00e1m \u0111\u1ecbnh k\u00ec ti\u1ebfp theo, ho\u1eb7c c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t n\u1ebfu c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng gi\u1ea3m s\u1ee9c nghe dai d\u1eb3ng.<\/li>\n<\/ul>\n<p style=\"text-align: justify\">M\u1ee5c \u0111\u00edch c\u1ee7a vi\u1ec7c theo d\u00f5i n\u00e0y l\u00e0 \u0111\u1ec3 xem d\u1ecbch trong tai gi\u1eefa \u0111\u00e3 r\u00fat h\u1ebft ch\u01b0a. D\u1ecbch tai gi\u1eefa l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn c\u1ee7a \u0111i\u1ebfc d\u1eabn truy\u1ec1n. Th\u01b0\u1eddng d\u1ecbch tai gi\u1eefa r\u00fat h\u1ebft sau nhi\u1ec1u tu\u1ea7n t\u1edbi nhi\u1ec1u th\u00e1ng<\/p>\n<h2 style=\"text-align: justify\"><strong>Tr\u01b0\u1eddng h\u1ee3p l\u1ee7ng m\u00e0ng<\/strong> nh\u0129<\/h2>\n<p style=\"text-align: justify\">Th\u01b0\u1eddng m\u00e0ng nh\u0129 s\u1ebd li\u1ec1n nhanh ch\u00f3ng sau v\u00e0i gi\u1edd \u0111\u1ebfn v\u00e0i ng\u00e0y.<\/p>\n<p style=\"text-align: justify\">N\u1ebfu hi\u1ec7n t\u01b0\u1ee3ng \u0111au t\u00e1i ph\u00e1t ho\u1eb7c dai d\u1eb3ng th\u00ec c\u1ea7n t\u00ecm nguy\u00ean nh\u00e2n g\u00e2y \u0111au kh\u00e1c ngo\u00e0i AOM, v\u00ec 1 khi m\u00e0ng nh\u0129 \u0111\u00e3 l\u1ee7ng \u00e1p l\u1ef1c tai gi\u1eefa \u0111\u00e3 gi\u1ea3m th\u00ec tr\u1ebb kh\u00f4ng c\u00f2n \u0111au n\u1eefa. N\u1ebfu c\u00f2n \u0111au th\u00ec c\u00f3 th\u1ec3 l\u00e0 nguy\u00ean nh\u00e2n kh\u00e1c nh\u01b0:<\/p>\n<ul>\n<li style=\"text-align: justify\">Nhi\u1ec5m tr\u00f9ng lan r\u1ed9ng nh\u01b0 vi\u00eam xoang ch\u0169m ch\u1eb3ng h\u1ea1n<\/li>\n<li style=\"text-align: justify\">Vi\u00eam tai ngo\u00e0i do d\u1ecbch ch\u1ea3y t\u1eeb tai gi\u1eefa, Quinolon nh\u1ecf c\u00f3 th\u1ec3 c\u00f3 l\u1ee3i trong t\u00ecnh tr\u1ea1ng n\u00e0y.<\/li>\n<\/ul>\n<h2 style=\"text-align: justify\">\u0110<strong>i\u1ec1u tr\u1ecb th\u1ea5t b\u1ea1i<\/strong><\/h2>\n<p style=\"text-align: justify\">\u0110\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng tr\u1edf n\u00ean x\u1ea5u h\u01a1n ho\u1eb7c kh\u00f4ng c\u1ea3i thi\u1ec7n sau 48-72 gi\u1edd d\u00f9ng kh\u00e1ng sinh.<\/p>\n<p style=\"text-align: justify\">Th\u1ea5t b\u1ea1i c\u00f3 th\u1ec3 l\u00e0 do \u0111i\u1ec1u tr\u1ecb kh\u00f4ng \u0111\u1ea7y \u0111\u1ee7 h\u1ee3p l\u00ed ho\u1eb7c c\u00f3 nguy\u00ean nh\u00e2n kh\u00e1c. Trong tr\u01b0\u1eddng h\u1ee3p th\u1ea5t b\u1ea1i do \u0111i\u1ec1u tr\u1ecb ch\u01b0a \u0111\u1ea7y \u0111\u1ee7 h\u1ee3p l\u00ed th\u00ec \u0111\u1ed5i kh\u00e1ng sinh<\/p>\n<p style=\"text-align: justify\">Th\u1ea5t b\u1ea1i khi \u0111ang d\u00f9ng amoxicillin li\u1ec1u cao th\u00ec \u0111\u1ed5i sang amox-clav li\u1ec1u cao. V\u00ec amox-clav c\u00f2n hi\u1ec7u l\u1ef1c v\u1edbi HIB s\u1ea3n xu\u1ea5t men beta-lactamase v\u00e0 Moraxella catarrhalis. \u0110\u1ed1i v\u1edbi ph\u1ebf c\u1ea7u th\u00ec amox v\u00e0 amox-clav c\u00f3 hi\u1ec7u qu\u1ea3 nh\u01b0 nhau.<\/p>\n<p style=\"text-align: justify\">N\u1ebfu th\u1ea5t b\u1ea1i v\u1edbi amox-clav th\u00ec c\u00f3 th\u1ec3 thay th\u1ebf b\u1eb1ng c\u00e1c cephalosporin ho\u1eb7c quinolon, tuy nhi\u00ean ngo\u00e0i tr\u1eeb ceftriaxone th\u00ec c\u00e1c kh\u00e1ng sinh cephalosporin thay th\u1ebf th\u00ec hi\u1ec7u qu\u1ea3 k\u00e9m v\u1edbi ph\u1ebf c\u1ea7u kh\u00e1ng thu\u1ed1c. (Vi\u1ec7c d\u00f9ng c\u00e1c cepha n\u00e0y xem trong ph\u1ea7n d\u1ecb \u1ee9ng penicillin kh\u00f4ng ph\u1ea3i type 1.)<\/p>\n<p style=\"text-align: justify\">Levofloxacin 10 mg\/ kg\/ m\u1ed7i 12 gi\u1edd trong 10 ng\u00e0y cho tr\u1ebb t\u1eeb 6 th\u00e1ng t\u1edbi 5 tu\u1ed5i. Ho\u1eb7c 10 mg\/ kg u\u1ed1ng ng\u00e0y 1 l\u1ea7n trong 10 ng\u00e0y v\u1edbi tr\u1ebb tr\u00ean 5 tu\u1ed5i. Li\u1ec1u t\u1ed1i \u0111a t\u1eeb 500 &#8211; 750 mg \/ ng\u00e0y .<\/p>\n<p style=\"text-align: justify\">Levofloxacin n\u00ean \u0111\u01b0\u1ee3c \u0111\u1ec3 d\u00e0nh cho nh\u1eefng tr\u1ebb AOM dai d\u1eb3ng khi \u0111i\u1ec1u tr\u1ecb thu\u1ed1c kh\u00e1c. V\u1ea5n \u0111\u1ec1 kh\u00f3 kh\u0103n hi\u1ec7n nay l\u00e0 levofloxacin \u0111\u00e3 \u0111\u01b0\u1ee3c k\u00ea toa qu\u00e1 nhi\u1ec1u trong b\u1ec7nh l\u00ed h\u00f4 h\u1ea5p ng\u01b0\u1eddi l\u1edbn d\u1eabn t\u1edbi ph\u1ebf c\u1ea7u kh\u00e1ng levofloxacin.<\/p>\n<p style=\"text-align: justify\">Macrolide, Trimethoprime &#8211; sulfamethoxazole, lincosamide kh\u00f4ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o trong tr\u01b0\u1eddng h\u1ee3p th\u1ea5t b\u1ea1i v\u1edbi amox, amox-clav li\u1ec1u cao.<\/p>\n<h2 style=\"text-align: justify\">AOM t\u00e1i ph\u00e1t<\/h2>\n<p style=\"text-align: justify\">\u0110\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 c\u00f3 s\u1ef1 xu\u1ea5t hi\u1ec7n c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a AOM s\u1edbm sau khi \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng tr\u01b0\u1edbc \u0111\u00f3,vi\u1ec7c \u0111i\u1ec1u tr\u1ecb AOM t\u00e1i ph\u00e1t n\u00ean bao ph\u1ee7 h\u1ebft c\u00e1c t\u00e1c nh\u00e2n kh\u00e1ng thu\u1ed1c, \u0111\u1eb7c bi\u1ec7t l\u00e0 ph\u1ebf c\u1ea7u kh\u00e1ng thu\u1ed1c .<\/p>\n<p style=\"text-align: justify\">Khi AOM t\u00e1i ph\u00e1t trong v\u00f2ng 15 ng\u00e0y k\u1ec3 t\u1eeb khi k\u1ebft th\u00fac li\u1ec7u tr\u00ecnh kh\u00e1ng sinh tr\u01b0\u1edbc \u0111\u00f3, kh\u00e1ng sinh \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn s\u1ebd l\u00e0:<\/p>\n<ul>\n<li style=\"text-align: justify\">Ceftriaxone 50 mg\/kg\/ng\u00e0y x 3 ng\u00e0y.<\/li>\n<li style=\"text-align: justify\">Levofloxacin<\/li>\n<\/ul>\n<p style=\"text-align: justify\">N\u1ebfu AOM t\u00e1i ph\u00e1t sau 15 ng\u00e0y k\u1ec3 t\u1eeb khi ho\u00e0n t\u1ea5t li\u1ec7u tr\u00ecnh kh\u00e1ng sinh \u0111\u1ee3t tr\u01b0\u1edbc th\u00ec th\u01b0\u1eddng \u0111\u00f3 l\u00e0 do t\u00e1c nh\u00e2n kh\u00e1c ch\u1ee9 kh\u00f4ng ph\u1ea3i do vi khu\u1ea9n c\u1ee7a \u0111\u1ee3t b\u1ec7nh tr\u01b0\u1edbc. \u1ede tr\u01b0\u1eddng h\u1ee3p n\u00e0y, m\u1eb7c d\u00f9 tr\u1ebb c\u00f3 nguy c\u01a1 cao m\u1eafc ph\u1ea3i vi khu\u1ea9n kh\u00f4ng \u0111i\u1ec3n h\u00ecnh nh\u01b0ng ch\u00fang t\u00f4i v\u1eabn khuy\u1ebfn c\u00e1o \u0111i\u1ec1u tr\u1ecb kh\u1edfi \u0111\u1ea7u v\u1edbi amox-clav, th\u1eadm ch\u00ed \u0111\u1ee3t tr\u01b0\u1edbc tr\u1ebb \u0111\u00e3 \u0111\u01b0\u1ee3c d\u00f9ng kh\u00e1ng sinh n\u00e0y r\u1ed3i. \u0110\u1eb7t \u1ed1ng th\u00f4ng nh\u0129 h\u1ea7u khi t\u00e1i ph\u00e1t 3 l\u1ea7n trong v\u00f2ng 6 th\u00e1ng ho\u1eb7c 4 l\u1ea7n trong v\u00f2ng 12 th\u00e1ng.<\/p>\n<h2 style=\"text-align: justify\">T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<p style=\"text-align: justify\"><a href=\"https:\/\/www.facebook.com\/diendannhikhoa\/posts\/518683568329168\" target=\"_blank\" rel=\"noopener\">https:\/\/www.facebook.com\/diendannhikhoa\/posts\/518683568329168<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Vi\u00eam tai gi\u1eefa c\u1ea5p (AOM) x\u1ea3y ra th\u01b0\u1eddng xuy\u00ean \u1edf tr\u1ebb em, l\u00e0 ch\u1ea9n \u0111o\u00e1n ph\u1ed5 bi\u1ebfn nh\u1ea5t \u1edf nh\u1eefng tr\u1ebb \u0111\u01b0\u1ee3c k\u00ea kh\u00e1ng sinh.<\/p>\n","protected":false},"author":14,"featured_media":4103,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[6104],"tags":[4380,4987,5678],"series":[3454],"coauthors":[2652],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.8 - 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