Tiêu chảy là tình trạng phổ biến ở người lớn, trẻ em, người già, đặc biệt là vào mùa hè. Tình trạng này nếu kéo dài sẽ gây ra rất nhiều ảnh hưởng nghiêm trọng đến sức khỏe. Vì vậy, tiếp nhận bệnh và phân biệt điều trị tiêu chảy chính xác tại nhà thuốc là vô cùng quan trọng.

1. Tiếp nhận bệnh nhân và hỏi bệnh

1.1 Trường hợp 1:

  • Tính chất phân: Phân toàn nước, không có máu, không nhầy nhớt, không sốt.
  • Nhận định: Tiêu chảy do tả, hoặc nội độc tố vi khuẩn tụ cầu (trong thức ăn)
    Hỏi thêm: Đi bao nhiêu lần/ngày (Đi > 3 lần/ngày).
  • Lưu ý: Đối với trường hợp tiêu chảy cấp do độc tố tụ cầu hay tả thì thường đi nhiều lần/ngày. Phân lỏng như nước vo gạo.

1.2 Trường hợp 2:

  • Tính chất phân: Phân nhầy nhớt, có lẫn ít máu. Hầm hầm hoặc sốt nhẹ.
  • Nhận định: Tiêu chảy do lỵ trực khuẩn amib
    Tiêu chảy do Salmonella: tiêu chảy, sốt cao, nôn và đau bụng
  • Lưu ý: Bệnh nhân sẽ có triệu chứng mót rặn, khó đi tiêu. Mót rặn, phân nhầy máu là triệu chứng đặc trưng của lỵ.
Phương pháp điều trị tiêu chảy

2. Nguyên nhân và triệu chứng

Giải quyết nguyên nhân gây bệnh: kháng sinh được xem là chủ lực trong bệnh tiêu chảy do vi khuẩn

Điều trị triệu chứng:

  • Tiêu chảy do vi khuẩn: không cắt cơn tiêu chảy (không dùng thuốc cầm tiêu chảy)
  • Tiêu chảy do tả hoặc nội độc tố vi khuẩn: do số lượng đi cầu nhiều lần/ngày. Cần ngưng tiêu chảy để tránh mất nước.

Bù nước và điện giải

Phương pháp điều trị tiêu chảy

3. Phác đồ điều trị tiêu chảy

3.1 Tiêu chảy do E.coli, Campylobacter, Yersinia, Salmonella, Vibriospp

Thuốc ưu tiên:  Kháng sinh nhóm quinolon (uống hoặc truyền) x 5 ngày (người > 12 tuổi): 

+ Ciprofloxacin 0,5g x 2 lần/ngày 

+ Hoặc norfloxacin 0,4g x 2 lần/ngày 

Thuốc thay thế:

+ Ceftriaxon đường tĩnh mạch (TM) 50-100mg/kg/ngày x 5 ngày 

+ TMP-SMX 0,96g x 2 lần/ngày x 5 ngày 

+ Doxycyclin 100mg x 2 lần/ngày x 5 ngày 

3.2 Tiêu chảy do Shigella 

Thuốc ưu tiên: Quinolon (uống hoặc truyền TM) x 5 ngày (người > 12 tuổi): 

+ Ciprofloxacin 0,5g x 2 lần/ngày 

+ Hoặc norfloxacin 0,4g x 2 lần/ngày 

Thuốc thay thế:

+ Ceftriaxon đường tĩnh mạch (TM) 50-100mg/kg/ngày x 5 ngày 

+ Hoặc azithromycin (uống) 0,5g/ngày x 3 ngày (ưu tiên cho phụ nữ có thai) hoặc azithromycin (uống) 10mg/kg/ngày x 3 ngày x 3 ngày (cho trẻ em <12 tuổi)

Phương pháp điều trị tiêu chảy

3.3 Tiêu chảy do thương hàn (Salmonella typhi, paratyphi) 

Thuốc ưu tiên: Quinolon (uống hoặc truyền) x 10-14 ngày (người lớn >12 tuổi):

+ Ciprofloxacin 0,5g x 2 lần/ngày 

+ Hoặc norfloxacin 0,4g x 2 lần/ngày 

Thuốc thay thế: Ceftriaxon (TM) 50-100 mg/kg/lần x 1 lần/ngày x 10-14 ngày 

3.4 Tiêu chảy do vi khuẩn tả (vi khuẩn tả hiện nay đã kháng lại các kháng sinh thông thường)

Thuốc ưu tiên: Nhóm Quinolon (uống hoặc truyền TM) x 3 ngày (người > 12 tuổi):

  • Ciprofloxacin 0,5g x 2 lần/ngày
  • Hoặc norfloxacin 0,4g x 2 lần/ngày

Hoặc azithromycin (uống) 0,5g/ngày x 3 ngày (ưu tiên cho phụ nữ có thai) hoặc azythromycin (uống) 10mg/kg/ngày x 3 ngày (cho trẻ em <12 tuổi)

Thuốc thay thế:

+ Erythromycin 1g/ngày uống chia 4 lần/ngày (trẻ em 40mg/kg/ngày), dùng trong 3 ngày 

+ Hoặc doxycylin 300mg liều duy nhất (dùng trong trường hợp vi khuẩn còn nhạy cảm) 

3.5 Đánh giá và xử lý tình trạng mất nước:

Phải đánh giá ngay và kịp thời xử lý tình trạng mất nước khi người bệnh đến viện và song song với việc tìm căn nguyên gây bệnh:

  • Người bệnh mất nước độ I, uống được: bù dịch bằng đường uống, dùng dung dịch Oresol
  • Người bệnh mất nước từ độ II trở lên, không uống được: bù dịch bằng đường tĩnh mạch. Dung dịch lựa chọn: Ringer Lactat hoặc Ringer Acetat. Ngoài ra: Nacl 0,9%, Glucose 5% với tỷ lệ 1:1.

3.6 Điều trị hỗ trợ

+ Giảm co thắt: Spasmaverin 

+ Làm săn niêm mạc ruôt: Diosmectit 

+ Không lạm dụng các thuốc cầm tiêu chảy như loperamid 

Xem thêm điều trị viêm âm đạo tại đây

Bài viết dựa trên kinh nghiệm đứng quầy, dược sĩ chỉ nên tham khảo. Tùy vào từng bệnh nhân và trường hợp cụ thể thì chúng ta mới có thể cắt liều chính xác nhất.

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