Thuốc kháng sinh, Tư vấn thuốc
Dùng thuốc kháng sinh đối với trẻ em
Th11
Câu hỏi: Dùng thuốc kháng sinh như thế nào đối với trẻ nhỏ?
Trả lời:
Kháng sinh là một vũ khí lợi hại để chữa các bệnh nhiễm khuẩn. Tuy nhiên, chúng ta cần thấy hết những phản ứng và tác phụ của nó đối với người bệnh nhất là đối với trẻ em.
Trẻ nhỏ dễ bị mắc các bệnh nhiễm khuẩn. Nhiều cháu được được cứu sống nhờ có các loại thuốc kháng sinh. Song không vì thế mà lạm dụng, ngược lại, phải hết sức thận trọng khi dùng thuốc kháng sinh cho trẻ nhỏ, bởi khi mới sinh ra, nhiều cơ quan trong cơ thể của trẻ chưa phát triển đầy đủ, chức năng hoạt động của các cơ quan cũng chưa hoàn chỉnh. Thuốc đưa vào cơ thể bất cứ đường nào như uống, tiêm, bôi ngoài da… đều được hấp thụ, chuyển hoá ở gan và đào thải qua thận trong khi chức năng của gan và thận ở trẻ sơ sinh và trẻ bú mẹ còn rất yếu, do đó khả năng thải trừ thuốc chậm hơn nhiều so với người lớn và trẻ lớn. Vì vậy thuốc dễ bị tích tụ trong cơ thể từ đó gây ra ngộ đốc nhất là khi trẻ dùng thuốc kéo dài. Thuốc vào cơ thể sẽ gắn với protêin trong huyết tương và đẩy bilirubin ra, làm tăng bilirubin trong máu gây nên hiện tượng vàng da. ở trẻ nhỏ, sự phân phối kháng sinh trong cơ thể cũng khác người lớn vì tỷ lệ nước trong cơ thể trẻ nhiều hơn, do đó liều lượng, cách dùng thuốc phải rất thận trọng.
Những thuốc kháng sinh cần đặc biệt thận trọng khi dùng cho trẻ nhỏ:
Chloramphenicol: có thể gây “hội chứng xanh xám” cho trẻ sơ sinh nhất là trẻ đẻ non. Ðứa trẻ bị xanh tái dần rồi truỵ tim mạch và chét. Cloramphenicol còn gây ngộ độc cho tuỷ xương, nếu dùng kéo dài có thể gây suy tuỷ, thiếu máu không hồi phục.
Tetracyclin: không nên dùng cho trẻ sơ sinh và trẻ dưới 8 tuổi vì thuốc này làm chậm phát triển của xương, làm cho răng vàng nâu vĩnh viễn. Tetraxyclin còn làm căng thóp ở trẻ sơ sinh.
Kháng sinh nhóm aminozit như streptomycin, gentamycin dùng cho trẻ sơ sinh dễ gây điếc. Các loại sulfonamid như bactrim, không nên dùng cho trẻ nhỏ vì dễ gây vàng da và độc với thận. Các thuốc kháng sinh: negram nitrofurantoin, rifamixin cũng không nên dùng cho trẻ nhỏ vì có thể gây vàng da, nhiễm độc cho gan.
Về cách đưa thuốc kháng sinh vào cơ thể cũng phải hết sức thận trọng: nên dùng đường uống, hoặc tiêm tĩnh mạch nếu có chỉ định của thầy thuốc. Ðối với trẻ nhỏ không nên tiêm bắp vì làm trẻ đau và đặc biệt là dễ gây xơ cứng cơ làm cho trẻ bị tàn tật.
Trẻ em không phải là người lớn thu nhỏ lại do đó không nên cho rằng người lớn dùng nhiều thì trẻ em dùng ít. Cơ thể trẻ chưa phát triển hoàn thiện nên có một số kháng sinh không được dùng cho trẻ em. Khi trẻ bị ốm, nhất thiết phải khám và chữa bệnh tại các cơ sở y tế, không tự ý cho trẻ uống thuốc kháng sinh hoặc điều trị theo sự mách bảo của những người không có chuyên môn.
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