Đã đến lúc cần đánh giá hiệu lực/hiệu quả của thuốc triclabendazole (TCBZ) trong điều trị ca bệnh tại bệnh viện và thử nghiệm tại thực địa cộng đồng

Thuốc triclabendazole (TCBZ) từ lâu được xem là thuốc lựa chọn đầu tay sử dụng trong điều trị bệnh sán lá gan lớn do Fasciola hepatica và Fasciola gigantica trong bệnh viện và cả qua các điều tra cộng đồng. Thuốc rất nhạy cảm với Fasciola spp., có hiệu lực và hiệu quả cao trong điều trị bệnh nhân mắc sán lá gan lớn hơn 30 năm qua trên các động vật và người nhiễm với hiệu quả điều trị cao, dung nạp tốt và ít tác dụng ngoại ý khi dùng liều dược lý khuyến cáo của các cơ quan chức năng về dược và y tế.

Tuy nhiên, trong thời gian gần đây, nhiều ca bệnh xác định mắc sán lá gan lớn đơn thuần biểu hiện giảm nhạy, kém đáp ứng với thuốc TCBZ (liều 10mg/kg), nhiều ca phải dùng lại liều thứ 2 và liều thứ 3 với liều gấp đôi (20mg/kg) tại Việt Nam, đồng thời trên thế giới như tại Peru, Hà Lan và Tây Ban Nha đã có các báo cáo ca bệnh kháng thuốc TCBZ rất rõ ràng và khẳng định bằng xét nghiệm trứng sau điều trị, khía cạnh kính hiển vi điển tử trên hình thái học của sán trước và sau điều trị TCBZ trên các phân lập nhạy và kháng thuốc. Bên cạnh đó, các dữ liệu về kháng thuốc TCBZ trên gia súc và vật nuôi đẫ được báo cáo trên y văn ngày một nhiều. Trong khi các thuốc mới vẫn còn đang trong giai đoạn nghiên cứu thử nghiệm giai đoạn thì việc duy trì thành quả của hiệu lực là cần thiết.

Hình 1

Tại Việt Nam, đến nay vẫn chưa có một nghiên cứu nào cụ thể và bài bản về tình trạng kháng thuốc thật sự hay không, cơ chế kháng thế nào và định loài và bộ gen của nó cũng như các chỉ điểm liên quan đến kháng TCBZ. Để có thể xây dựng một đề cương cụ thể và có thể chấp nhận và mang tính khoa học.

Xin chia sẻ với bạn đồng nghiệp một số nghiên cứu dưới đây:

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Relative activity of triclabendazole metabolites against the liver fluke, Fasciola hepatica.

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Serum antibody isotype responses of Fasciola-infected sheep and cattle to excretory and secretory products of Fasciola species.

Phiri IK, Phiri AM, Harrison LJ.

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Triclabendazole progress report, 2005-2009: an advancement of learning?

Fairweather I.

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Radfar MH, Nourollahi‐Fard SR, Mohammadyari N.

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Pleiotropic alterations in gene expression in Latin American Fasciola hepatica isolates with different susceptibility to drugs.

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