ETHAMBUTOL Cha��ng Mycobacterium.

Tracuuthuoctay chia sa?� bA�i via??tA� ETHAMBUTOL Cha��ng Mycobacterium.lA� gA�? giA? thua��c bao nhiA?u? cha�� A�a��nh, cA?ch sa�� da�?ng, tA?c da�?ng pha�? thua��c ETHAMBUTOL . Ethambutol A�?�a�?c cha�� A�a��nh A�a�? A�ia�?u tra�� ca?? lao ma��i vA� lao tA?i phA?t vA� bao gia�? cA�ng pha??i dA?ng pha��i ha�?p va��i cA?c thua��c cha��ng lao khA?c nh?� isoniazid, rifampicin, streptomycin vA� pyrazinamid A�a�? ngA?n cha?�n phA?t tria�?n khA?ng thua��c.

ETHAMBUTOL Cha��ng Mycobacterium.

TA?n chung qua��c ta??: Ethambutol.

MA? ATC: J04A K02.

Loa??i thua��c: Cha��ng Mycobacterium.

GiA? thua��c ETHAMBUTOL : BA�nh lua?�n cua��i bA�i via??t A�a�? A�?�a�?c thA?ng bA?o giA?

Da??ng thua��c vA� hA�m l?�a�?ng

ViA?n nA�n 100 mg vA� 400 mg ethambutol hydroclorid.

D?�a�?c lA? vA� c?? cha?? tA?c da�?ng

Ethambutol lA� thua��c cha��ng lao ta��ng ha�?p cA? tA?c da�?ng kA�m khua?�n. Ga?�n nh?� ta??t ca?? cA?c cha��ng Mycobacterium tuberculosis, M. kansasii vA� ma��t sa�� cha��ng M. avium A�a�?u nha??y ca??m va��i ethambutol. Thua��c cA�ng a��c cha?? sa�� phA?t tria�?n ca��a ha?�u ha??t cA?c cha��ng vi khua?�n lao khA?ng isoniazid vA� streptomycin. Na��ng A�a�� a��c cha?? ta��i thia�?u in vitro A�a��i va��i vi khua?�n lao bA�nh th?�a�?ng ta�� 1 – 8 microgam/ml, tA?y theo mA?i tr?�a�?ng nuA?i ca??y. Vi khua?�n lao khA?ng thua��c phA?t tria�?n ra??t nhanh, na??u dA?ng ethambutol A�??n A�a��c. VA� va?�y khA?ng bao gia�? A�?�a�?c dA?ng ethambutol A�??n A�a��c A�a�? A�ia�?u tra�� ba��nh lao mA� pha??i dA?ng pha��i ha�?p va��i cA?c thua��c cha��ng lao khA?c theo h?�a��ng da?�n

A�ia�?u tra�� ca��a Ta�� cha��c y ta?? tha?? gia��i. a�z Via��t Nam, nA?m 1997 ta�� la�� khA?ng ethambutol xa??p xa�� 1,1%.

C?? cha?? tA?c da�?ng ca��a ethambutol lA� a��c cha?? acid mycolic thA?m nha?�p vA�o trong thA�nh ta?? bA�o vi khua?�n lao. NgoA�i ra, thua��c cA?n kA�m hA?m sa�� nhA?n lA?n ca��a vi khua?�n ba?�ng cA?ch ngA?n ca??n ta��ng ha�?p RNA.

D?�a�?c A�a��ng ha�?c

Lia�?u: 25 mg/kg trong 8 tua?�n A�a?�u vA� 15 mg/kg cho tha�?i gian tia??p theo.

Ethambutol A�?�a�?c ha??p thu nhanh (75 – 80%) qua A�?�a�?ng tiA?u hA?a. Sau khi ua��ng lia�?u A�??n 25 mg/kg tha�? tra�?ng A�?�a�?c 2 – 4 gia�? thA� A�a??t na��ng A�a��

A�a��nh trong huya??t thanh lA� 5 microgam/ml vA� sau 24 gia�? khA?ng cA?n phA?t hia��n A�?�a�?c na��ng A�a�� thua��c trong huya??t thanh. Thua��c phA?n ba�� vA�o ta??t ca?? cA?c mA?, bao ga��m ca?? pha��i, tha?�n vA� ha��ng ca?�u. Thua��c vA�o da��ch nA?o ta��y khi mA�ng nA?o ba�� viA?m, thua��c cA�ng qua nhau thai vA� vA�o sa�?a ma??. Tha�? tA�ch phA?n ba�� Vd = 1,6 lA�t/kg. Na��a A�a�?i tha??i tra�� ca��a thua��c sau khi ua��ng lA� 3 – 4 gia�? vA� cA? tha�? kA�o dA�i A�a??n 8 gia�? na??u suy tha?�n. Ethambutol chuya�?n hA?a 1 pha?�n a�Y gan ba?�ng quA? trA�nh hydroxyl hA?a, ta??o thA�nh da?�n cha??t aldehyd vA� acid dicarboxylic. Ethambutol tha??i tra�� qua n?�a��c tia�?u ta��i 80% trong vA?ng 24 gia�? (khoa??ng 50% a�Y da??ng khA?ng chuya�?n hA?a vA� 15% a�Y da??ng chuya�?n hA?a khA?ng cA? hoa??t tA�nh). Loa??i tra�� A�?�a�?c ethambutol ba?�ng tha?�m phA?n phA?c ma??c vA� a�Y ma��c A�a�� A�t h??n ba?�ng tha?�m phA?n tha?�n nhA?n ta??o.

Cha�� A�a��nh thua��cA�ETHAMBUTOL

Ethambutol A�?�a�?c cha�� A�a��nh A�a�? A�ia�?u tra�� ca?? lao ma��i vA� lao tA?i phA?t vA� bao gia�? cA�ng pha??i dA?ng pha��i ha�?p va��i cA?c thua��c cha��ng lao khA?c nh?� isoniazid, rifampicin, streptomycin vA� pyrazinamid A�a�? ngA?n cha?�n phA?t tria�?n khA?ng thua��c.

Cha��ng cha�� A�a��nh

Ng?�a�?i ba��nh viA?m dA?y tha?�n kinh tha�� giA?c vA� ng?�a�?i cA? tia�?n sa�� quA? ma?�n ca??m va��i ethambutol.

Tha?�n tra�?ng

Va��i ng?�a�?i ba��nh gia??m cha��c nA?ng tha?�n pha??i gia??m lia�?u, da��a vA�o na��ng A�a�� ethambutol trong huya??t thanh.

Tha?�n tra�?ng va��i ng?�a�?i cA? ba��nh a�Y ma??t (nh?� A�a�?c tha��y tinh tha�?, cA?c tA�nh tra??ng tA?i phA?t viA?m ma??t, ba��nh lA? vA�ng ma??c do A�A?i thA?o A�?�a�?ng), ng?�a�?i giA� vA� tra?� em, nha??t lA� tra?� em d?�a��i 6 tua��i vA� khA? phA?t hia��n vA� A�A?nh giA? cA?c bia??n A�a��i va�? cha��c nA?ng tha�� giA?c.

Tha�?i ka�? mang thai

Ma?�c dA? ethambutol qua A�?�a�?c nhau thai nh?�ng ch?�a cA? nguy c?? nA�o A�?�a�?c thA?ng bA?o vA� dA?ng thua��c trong tha�?i ka�? mang thai.

Tha�?i ka�? cho con bA?

KhA?ng dA?ng cho tra?� nha�? vA� tra?� khA?ng tha�? cho bia??t ra��i loa??n tha�� giA?c.

TA?c da�?ng khA?ng mong mua��n (ADR)

Ethambutol ra??t A�t gA?y cA?c ADR. Lia�?u hA�ng ngA�y 25 mg/kg tha�? tra�?ng gA?y

A�a��c ra??t A�t (d?�a��i 2% ng?�a�?i ba��nh cA? ADR. Cha�� ya??u th?�a�?ng ga?�p ADR a�Y ng?�a�?i ba��nh dA?ng lia�?u trA?n 25 mg/kg tha�? tra�?ng/ngA�y.

Th?�a�?ng ga?�p, ADR > 1/100

TA?ng acid uric mA?u nha??t lA� trong 2 tua?�n A�a?�u. CA? tha�? cA? sa��t, A�au kha��p.

A?t ga?�p, 1/1000 < ADR < 1/100

Ma??t: ViA?m dA?y tha?�n kinh tha�� giA?c, gia??m tha�� la��c vA� khA?ng phA?n bia��t A�?�a�?c mA�u A�a�? va��i mA�u xanh lA? cA?y.

Hia??m ga?�p, ADR < 1/1000

ToA�n thA?n: A?au A�a?�u, sa��t, A�au kha��p vA� cA?c pha??n a��ng da.

MA?u: Gia??m ba??ch ca?�u, gia??m tia�?u ca?�u.

TiA?u hA?a: Bua��n nA?n, nA?n, chA?n A?n, A�au ba�?ng.

ViA?m gan, quA? ma?�n ngoA�i da, viA?m tha?�n kinh ngoa??i vi (ra??t A�t ga?�p).

H?�a��ng da?�n cA?ch xa�� trA� ADR

ViA?m dA?y tha?�n kinh tha�� giA?c sau nhA?n ca?�u th?�a�?ng pha�? thua��c lia�?u, hay ga?�p khi ng?�a�?i ba��nh dA?ng lia�?u > 25 mg/kg tha�? tra�?ng sau 2 thA?ng A�ia�?u tra��. Tuy nhiA?n viA?m dA?y tha?�n kinh tha�� giA?c cA�ng cA? tha�? ga?�p cha�� sau vA�i ngA�y A�ia�?u tra��. NA?i chung ADR th?�a�?ng ma??t A�i khi nga��ng thua��c, nh?�ng A�ngoa??i la�� cA�ng cA? ma��t sa�� ra??t A�t tr?�a�?ng ha�?p kA�o dA�i A�a??n 1 nA?m hoa?�c h??n A�na�?a, tha?�m chA� nha�?ng tr?�a�?ng ha�?p nA�y cA? tha�? khA?ng ha��i pha�?c. Bia??n A�a��i tha��

giA?c cA? tha�? xa??y ra a�Y ma��t bA?n hoa?�c ca?? hai bA?n ma??t. VA� va?�y trong tha�?i gian dA?ng thua��c pha??i kia�?m tra cha��c nA?ng nhA�n ca��a ta��ng bA?n ma??t vA� ca?? hai ma??t. DA?ng hydroxocobalamin vA� cyanocobalamin A�a�? A�ia�?u tra�� ma??t tha�� la��c kA�o dA�i cA? ka??t qua?? tha??t th?�a�?ng.

Lia�?u l?�a�?ng vA� cA?ch dA?ng

Thua��c cA? tha�? ua��ng cA?ng va��i tha��c A?n, na??u ba�� kA�ch a��ng A�?�a�?ng tiA?u hA?a.

Na??u ua��ng lia�?u thua��c hA�ng ngA�y chia lA�m nhia�?u la?�n, sa?? khA?ng A�a??t na��ng A�a�� A�ia�?u tra�� trong huya??t thanh, vA� va?�y, pha??i ua��ng ethambutol ma��t la?�n duy nha??t trong ngA�y.

DA?ng A�ia�?u tra�� ba��nh lao, pha��i ha�?p va��i cA?c thua��c cha��ng lao khA?c nh?� isoniazid, rifampicin, streptomycin vA� pyrazinamid theo phA?c A�a�� A�ia�?u tra��

A�a�? trA?nh phA?t tria�?n khA?ng thua��c.

Lia�?u th?�a�?ng dA?ng cho ng?�a�?i la��n vA� tra?� em ta�� 6 tua��i tra�Y lA?n.

HA�ng ngA�y: 15 mg/kg tha�? tra�?ng, ua��ng 1 la?�n; hoa?�c lia�?u cA?ch quA?ng, 30 mg/kg tha�? tra�?ng, tua?�n dA?ng 3 la?�n, hoa?�c 45 mg/kg tha�? tra�?ng, tua?�n dA?ng 2 la?�n.

Ng?�a�?i ba��nh suy tha?�n:

Lia�?u vA� sa�� la?�n dA?ng thua��c ca?�n gia??m tA?y theo ma��c A�a�� suy tha?�n. Ma��t sa�� nhA� lA?m sA�ng ga�?i A? ra?�ng, na??u A�a�� thanh tha??i creatinin ta�� 70 – 100 ml/phA?t thA� dA?ng lia�?u khA?ng quA? 15 mg/kg tha�? tra�?ng/ngA�y. Na??u A�a�� thanh tha??i < 70 ml/phA?t thA� lia�?u dA?ng pha??i gia??m h??n na�?a. Ma��t sa�� nhA� lA?m sA�ng khA?c la??i ga�?i A? ra?�ng, khoa??ng cA?ch gia�?a cA?c lia�?u th?�a�?ng dA?ng pha??i cA?ch nhau ta�� 24 – 36 gia�? na??u ng?�a�?i ba��nh cA? A�a�� thanh tha??i creatinin ta�� 10 – 50 ml/phA?t, vA� cA?ch 48 gia�? na??u A�a�� thanh tha??i d?�a��i 10 ml/phA?t.

T?�??ng tA?c thua��c

Va��i isoniazid vA� cA?c thua��c A�a��c tha?�n kinh khA?c (thA� da�? disulfiram, cloroquin, hydralazin…): DA?ng A�a��ng tha�?i ethambutol va��i cA?c thua��c A�A? cA? tha�? tA?ng nguy c?? A�a��c tha?�n kinh, nh?� viA?m dA?y tha?�n kinh tha�� giA?c vA� ngoa??i biA?n.

Va��i cA?c antacid: NhA?m hydroxyd lA�m gia??m ha??p thu ethambutol a�Y ma��t sa�� ng?�a�?i ba��nh.

A?a�� a��n A�a��nh vA� ba??o qua??n

Da??ng viA?n nA�n ethambutol hydroclorid pha??i ba??o qua??n trA?nh A?nh sA?ng, A�a?�c bia��t trA?nh a?�m, A�a��ng trong la�? nA?t kA�n a�Y nhia��t A�a�� ta�� 15 – 30C.

QuA? lia�?u vA� xa�� trA�

Da??u hia��u vA� tria��u cha��ng: KhA?ng tha??y da??u hia��u nga�� A�a��c ca??p va��i lia�?u dA?ng bA�nh th?�a�?ng. Nga�� A�a��c ca??p th?�a�?ng xa??y ra khi dA?ng lia�?u cao h??n 10 g va��i cA?c tria��u cha��ng th?�a�?ng ga?�p nh?�: bua��n nA?n, A�au ba�?ng, sa��t, lA? la?�n, a??o giA?c vA� cA?c ba��nh lA? khA?c ca��a tha?�n kinh tha�� giA?c.

Xa�� trA�: Khi nga�� A�a��c ethambutol, pha??i nhanh chA?ng ra��a da?? dA�y vA� tia??n hA�nh tha?�m phA?n tha?�n nhA?n ta??o hoa?�c tha?�m phA?n phA?c ma??c A�a�? gia??m nhanh na��ng A�a�� thua��c trong mA?u.

ThA?ng tin qui cha??

Ethambutol cA? trong danh ma�?c thua��c thia??t ya??u Via��t Nam ban hA�nh la?�n tha�� 4 nA?m 1999.

Thua��c pha??i A�?�a�?c kA? A�??n vA� bA?n theo A�??n.

Ngua��n d?�a�?c th?� qua��c gia

Tham kha??o hA�nh a??nh cA?c dA?ng thua��c ETHAMBUTOL Cha��ng Mycobacterium.

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