Typhoid Choices

Uncomplicated Typhoid Fever

Optimal Therapy Alternative Effective Drugs

Susceptibilit Daily dose Daily dose
Antibiotic Days Antibiotic Days
y mg/kg mg/kg
Fluoroquinolone Chloramphenicol 50-75 14-21
Fully
e.g., ofloxacin or 15 5-7 Amoxicillin 75-100 14
sensitive
ciprofloxacin TMP-SMX 8-40 14
Multidrug Fluoroquinolone 15 5-7 Azithromycin 8-10 7
Resistance or Cefixime 15-20 7-14 Cefixime 15-20 7-14
Azithromycin or 8-10 7
Quinolone Cefixime 20 7-14
Ceftriaxone 75 10-14
Severe Typhoid Fever

Optimal Therapy Alternative Effective Drugs

Susceptibilit Daily dose Daily dose
Antibiotic Days Antibiotic Days
y mg/kg mg/kg
Chloramphenicol 100 14-21
Fully Fluoroquinolone
15 10-14 Amoxicillin 100 14
sensitive e.g., ofloxacin
TMP-SMX 8-40 14
Multidrug Ceftriaxone 60
Fluoroquinolone 15 10-14 10-14
Resistance Cefotaxime 80
Ceftriaxone 60 7
Quinolone Fluoroquinolone 20 7-14
Cefotaxime 80 10-14

TMP/SMX 160/800 2x sehari atau pada anak-anak 4/20.

Untuk typhoid fever ada penilaian severity terutama melena (darah pada feses) menjadi penilaian
pengobatan dan gejala.

Monitoring typhoid fever:

1. Gejala keluar demam menurun

2. Tanda infeksi keluar
a. Lymphocytes ↑
b. Neutrophile ↑
3. Uji IgG; IgM
4. Uji windal negatif
 HIV

ARV Terminology

Drugs Terms
3TC Lamivudine
AZT Zidovudine
EFV Efavirenz
FTC Emtricitabine
NVP Nevirapine
TDF Tenofovir Disoproxil Fumarate

Adult (Including Pregnant and Breastfeeding Mother) ARV

Drugs Dosing
TDF 300 mg once daily
3TC 150 mg bid or
First line 300 mg once daily
Or FTC 200 mg once daily
EFV 400 mg / 600 mg once daily
150 mg bid
3TC
300 mg once daily
 AZT + 3TC + NVP
AZT 300 mg once daily
 AZT + 3TC + EFV
EFV 400 / 600 mg once daily
Alternative  TDF + 3TC (FTC) + NVP
FTC 200 mg once daily
 AZT + 3TC + NVP
200 mg once daily for 14 days
 TDF + 3TC (FTC) + EFV NVP
200 mg twice daily after 14 days
TDF 300 mg daily
Menyesuaikan First line
AZT TDF + 3TC (FTC) + LPV/r
TDF AZT + 3TC (FTC) + LPV/r
Second line Special Cases
HIV dan koinfeksi TB Second line dosis ganda
HIV dan koinfeksi HBV AZT + TDF + 3TC (FTC) + LPV/r
Medications
Isoniazid (INH) 5 mg/kg (range 4-6 mg/kg)
Rifampicin (RIF) 10 mg/kg (range 8-12 mg/kg)
Pirazinamin (PZA) 25 mg/kg (range 20-30 mg/kg)
Streptomycin (SM) 15 mg/kg (range 12-18 mg/kg)
Tuberculosis Ethambutol (EMB) 15 mg/kg (15-20 mg/kg)
Phases
Prophylaxis INH 6 months
Fase inisiatif (2 months) INH, RIF, PZA, SM, EMB dan Vit B6 25 mg 6 bulan
Fase Lanjutan (10 months) INH, RIF
Amfoterisin B (1 mg/kg/hari) IV + Fluconazole 1200
Cryptococcu Fase Induksi (2 weeks)
mg/hari po
s Meningitis Fase konsolidasi (8 weeks) Fluconazole 800 mg/hari po for 8 weeks
Infeksi
Bakteri Cotrimoxazole 960 mg/hari
Sekunder
Monitoring efektivitas:

 CD4 ↑
 Viral load ↓
 Lymphocytes and Neutrophiles ↑
 Hepatitis B
Categories:

 Acute Hepatitis B, Hasil Lab IgM saja. Terapi antiviral dilakukan jika pasien memiliki gagal
ginjal akut atau sudah memiliki dengan berkepanjangan dengan tingkat severe. Ditandakan
dengan jumlah total bilirubin >3 mg/dL (atau direct bilirubin >1.5 mg/dL), INR (International
Normalized Ratio) >1.5 mg/dL, encephalopathy, atau ascites.
 Chronic Hepatitis B, Hasil Lab terdapat IgM. Terapi dilakukan jika HBsAg tidak habis setelah 6-
12 bulan dan mengikuti guideline CHB
Treatments:

 Acute Hepatitis B (IgM +)

Antiviral indicated only for those who have acute liver failure or who have protracted, severe
course as indicated by total bilirubin >3 mg/dL (or direct bilirubin >1,5 mg/dL), INR >1,5,
encephalopathy, ascites.

 Chronic Hepatitis B (IgM -)

For those who failed to clear HBsAg after 6 to 12 months, ongoing should follow guidance.

HBsAg Positive

HBeAg
HBeAg Positive
Negative

ALT > ULN & ALT > ULN &

ALT < ULN ALT > 2x ULN ALT < ULN ALT > 2x ULN
<2x ULN <2x ULN

HBV DNA HBV DNA HBV DNA HBV DNA HBV DNA HBV DNA
>20.000 IU/mL >20.000 IU/mL >20.000 IU/mL >2000 IU/mL >2000 IU/mL >2000 IU/mL

HBV DNA HBV DNA HBV DNA

<2000 IU/mL <2000 IU/mL <2000 IU/mL

Treat
Do Not Treat
Treat jika ada penyebab peningkatan ALT
 Drugs Dosing Side Effects Monitoring
Preffered
Flu-like symptoms, Complete blood count (monthly ever 3
PEG-IFN-α- fatigue, mood months)
2a 180 mcg weekly disturbances, TSH (every 3 months)
IFN-α-2a cyclopenia, Clinical monitoring for autoimmune ischemic,
autopenia neuropsychiatric and infection complication
Lactic acidosis
Lactic acidosis if there is clinical concern
Entecavir 0.5 mg daily (decompensated
Test for HIV before initiation
cirrhosis only)
Creatinine clearance for baseline.
If at risk for renal impairment, creatinine
Nephropathy, clearance, serum phosphate urine glucose,
Tenofovir Fanconi and protein atleast annually.
diprovoxil 300 mg daily syndrome, Consider bone density study baseline at
fumarate osteomalacia, baseline and during treatment in patients
lactic acidosis with history of fracture or risks for osteopenia
Lactic acid level if there is clinical concern
Test for HIV before treatment initiation
Lactic acid levels if there is clinical concern
Asses serum creatinine, serum phosphate
Tenofovir
25 mg daily Lactic acidosis urine glucose, and protein before and during
alafenamide
therapy in all patients as clinically appropriate
Test HIV before treatment initiation
Non preferred
Amylase if symptoms are present
Pancreatitis
Lamivudine 100 mg daily Lactic acid level if there is clinical concern
Lactic acidosis
Test for HIV treatment initiation
Creatinine clearance for baseline.
If at risk for renal impairment, creatinine
clearance, serum phosphate urine glucose,
Acute renal failure and protein atleast annually.
Adefovir 10 mg daily Fanconi syndrome Consider bone density study baseline at
Lactic acidosis baseline and during treatment in patients
with history of fracture or risks for osteopenia
Lactic acid level if there is clinical concern
Test for HIV before treatment initiation
Creatinine kinase
elevation and
Creatinine kinase if symptoms are present
myopathy
Telbivudine 600 mg daily Clinical evaluation if symptoms are present
Peripheral
Lactic acid level if there is clinical concern
neuropathy
Lactic acidosis

Monitoring:

 HBV DNA ↓
 HBsAg ↓
 IgM (-)
COVID-19
 Kategori COVID 19:
Medication Form Dosing Duration
Tablet 500 mg/6-8 jam 2 minggu
Vitamin C Tablet hisap 500 mg/12 jam 30 hari
Asymptomatic
Multivitamin 1-2 tablet/24 jam 30 hari
Vitamin D PO 1000-5000 IU/hari 14 hari
Tablet 500 mg/6-8 jam 2 minggu
Vitamin C Tablet hisap 500 mg/12 jam 30 hari
Ringan
Multivitamin 1-2 tablet/24 jam 30 hari
Vitamin D PO 1000-5000 IU/hari 14 hari
Loading dose 1600 mg/12 jam Hari 1
Favipiravir 200 mg PO
600 mg/12 jam Hari 2-5
Antivirus Molnupiravir 200 mg PO 800 mg/12 jam 5 Hari
Nirmatrelvir 150 mg PO 2 tablet /12 jam
5 Hari
RItonavir 100 mg PO 1 tablet/12 jam
Vitamin C 100 cc IV Drip 200-400 mg/4 jam NaCl 0.9% ~
Sedang 1000 IU Tablet/hari
Vitamin D PO
5000 IU Tablet Kunyah/hari
Loading dose 200 mg Hari 1
Remdesivir IV drip
1x 100 mg Hari 2-5/10
Loading dose 1600 mg/12 jam Hari 1
Favipiravir 200 mg PO
Antivirus 600 mg/12 jam Hari 2-5
Molnupiravir 200 mg PO 800 mg/12 jam 5 Hari
Nirmatrelvir 150 mg PO 2 tablet /12 jam
5 Hari
RItonavir 100 mg PO 1 tablet/12 jam
Heparin
Enoxaparin Subkutan 1x0,4 cc
Anticoagulant
Rivaroxaban PO 10; 15; 20 mg
Fondaparinux Injeksi 2.5 mg/0,5 mL
Vitamin B1 IV 1 ampul/24 jam
Vitamin C 100 cc IV Drip 200-400 mg/4 jam NaCl 0.9% ~
Berat/Kritis
1000 IU Tablet/hari
Vitamin D PO
5000 IU Tablet Kunyah/hari
Loading dose 200 mg Hari 1
Remdesivir IV drip
1x 100 mg Hari 2-5/10
Loading dose 1600 mg/12 jam Hari 1
Favipiravir 200 mg PO
Antivirus 600 mg/12 jam Hari 2-5
Molnupiravir 200 mg PO 800 mg/12 jam 5 Hari
Nirmatrelvir 150 mg PO 2 tablet /12 jam
5 Hari
RItonavir 100 mg PO 1 tablet/12 jam
Heparin
Enoxaparin Subkutan 1x0,4 cc
Anticoagulant
Rivaroxaban PO 10; 15; 20 mg
Fondaparinux Injeksi 2.5 mg/0,5 mL
Anti inflamasi Dexamethasone Injeksi 6 mg/24 jam
Metilprednisolon PO 32 mg/24 jam
 Hydrocortisone PO/IV 160 mg/24 jam
Tocilizumab Injeksi Bolus 8 mg/kg / 12 jam
Anti IL-6
Sarilumab

Monitoring:

 Gejala hilang
 Hasil PCR negatif
 Neutrophiles & Lymphocytes ↑
 MALARIA
Kategori Malaria:

 Uncomplicated
 Severe
First line Uncomplicated
Durasi pengobatan Dosage
Medication Falciparum Vivax Berat badan
Knowlesi Ovale 40 – 60 kg 60 – 80 kg >80 kg
DHP 1 – 3 hari 3 4 5
Primaquine 1 1-14 1 1 1

Second line
Falciparum/Knowlesi
Doxycycline
Dosage
Medication Durasi pengobatan Berat badan
40 – 45 kg 45 – 60 kg >60 kg
Kina 1 – 7 hari 3x2 3x2½ 3x2½
Primaquine 1 hari 1 1 1
44 – 59 kg >59 kg
Doxycycline 1 – 7 hari 2 x 75 mg 2 x 100 mg

Tetracycline
Dosage
Medication Durasi pengobatan Berat badan
40 – 45 kg 45 – 60 kg >60 kg
Tetracycline 1 – 7 hari 4 x 125 mg 4 x 250 mg 4 x 250 mg
Kina 1 – 7 hari 3 x 2½ 3 x 2½ 3x3
Primaquine 1 hari 1 1 1

Vivaks/Ovale
Dosage
Medication Durasi pengobatan Berat badan
40 – 45 kg 45 – 60 kg >60 kg
Kina 1 – 7 hari 3 x 2½ 3 x 2½ 3x3
Primaquine 1 hari 1 1 1
Monitoring:
Infeksi Saluran Kemih