XỬ TRÍ VIÊM PHỔI CỘNG ĐỒNG
TRONG KỶ NGUYÊN KHÁNG THUỐC
Nguyễn Văn Thành. MD; PhD
Ho Chi Minh city 9-2013
MÔ HÌNH TỬ VONG
TOÀN CẦU (WHO 2004)
Mô hình tử vong toàn cầu 2004 (WHO)
Nhiễm khuẩn hô hấp là lý do
nhiều nhất đi khám
Source: Verispan PDDA 2004
165
119
65
51
28
0
20
40
60
80
100
120
140
160
180
Respiratory
infections
Hypertension Disorders of
lipid
metabolism
Diabetes

Bắc PhiKeniaNew Zealand
Mê-hi-côArập SaudiPê- ru
Mỹ IsrealBắc Phi
Thổ Nhĩ KỳBrazinScandinavia
RumaniÁc-hen-ti-naBenelux
BungariCanadaThụy Sỹ
Cộng hòa SlovacHungaryAnh
Tây Ban Nha
Bồ Đào Nha
Đức
Pháp IrlandÝ
Cao (>30%)Trung bình (10-30%)
Thấp (<10%)
F. Paradisi et al. 2001 CMI. 7 (S 4). 34-42.
Kháng của Pneumococi với penicillin
ANSORP (1996 ∼ 2001)
(SOAR Viet Nam 2011)
S.PNEUMONIAE KHÁNG THUỐC
ANSORP News: A multicenter study on antibiotic resistance of 204 S. pneumoniae in Vietnam
< 0.250.12< 0.030.03India
0.250.250.030.25Philippines
1422Malaysia
1422China
1412Singapore
1822Thailand
1824Taiwan
1824Hong Kong
1844Korea
2884Vietnam
CeftriaxoneCefuroximeAmoxicillinPenicillin

Rate / MICs
Major
areas
Clinical
failures
Clinical
relevance
in RTI therapy
Penicillins / Asia Very few Not significant
Cephalosporins variable Asia Few Not significant
Macrolides / Asia
Increasing
Reports
Relatively
significant
Fluoroquinolones /
Asia
(HK)
Few
(levofloxacin)
Undetermined
Summary : clinical impact of pneumococcal resistance
H. influenzae tạo beta-lactamase
Hoban D et al. JAC 50 suppl S1 49, 2002
From PROTEKT surveillance (1999-2000)
Quốc gia
(Số chủng)
% chủng beta-lactamase [+]
H. influenzae M. catarrhalis
Korea (51) 64.7 100

Am Ampicillin
Az Azithromycin
Bt Sulphamethoxazole-
trimethoprim
BLM β-lactamase
production
H. influenzae with antibiotic resistance:
multicenter study in HCMC, Vietnam
(P.H.Van et al, 2005)
H. Influenzae
kháng thuốc
(SOAR Viet Nam 2011)
M.pneumoniae kháng macrolide
< 16 tuổi 16-19 tuổi > 20 tuổi với CAP
Miyashita N et al. Int J Antimicrob Agents 2010, 36(4): 384–385.
Fifty-three
Mycoplasma pneumoniae
strains were
isolated from pediatric patients in Shanghai
Yang Liu et al., Antimicrobial agents and chemotherapy May 2009
Time course of Mycoplasma pneumoniae (DNA copy number) in
the nasopharynx of nine patients with macrolide-sensitive M.
pneumoniae pneumonia before and after antimicrobial therapy
Y Kawai et al. Respirology (2012) 17, 354–362
The microbiological and clinical efficacies
of macrolides for treating patients with MR
M. pneumoniae pneumonia were low. These
results show that macrolides are clearly less
effective in patients with MR M. pneumoniae
pneumonia.