ANTIBIOTICS USED IN

PREGNANCY

Erna Kristin
Department of Pharmacology
Faculty of Medicine
Gadjah Mada University
 DRUG USED IN PREGNANCY

%
 DRUG USED IN PREGNANCY

%
 Physiologic changes in pregnancy

Phmacokinetics

Changes

plasma volume increased

Albumin
decreased
Aliran darah berubah
 Kadar
albumin

g/dl

Robson Sc, et al. Brit J Obstet Gynecol 1990;

 Perubahan fisiologi pada kehamilan

FARMAKOKINETIKA

Perubahan

Enzim GFR
Cmax

AU
C
T0.
5

Tma
x
 Antibiotika

Bakteris Bakteriosta
id tik

membunu menghambat
h

Fagositosis dan antibodi

 Cell
Cell wall
wall synthesis
synthesis DNA
DNA replication
replication
Cycloserine Quinolones
Bacitracin Nitroimidazoles
Beta lactams
Glycopeptides DNA

Folic
Folic acid
acid
Asam Folat
mRNA Rifampicin
metabolism
metabolism Asam Folat
50 50 50
Trimetoprim 30 30 30
Sulfonamid
Ribosomes

Cell
Cell Protein
Protein synthesi
synthes
membrane
membrane
Polymixins Aminoglycosides
PABA
Macrolides
Lincosamides
Amphenicols (50S
Tetracyclines (30S
 TETRACYCLINE

Short acting Intermediate acting Long acting

Oxytetracycline Doxyciclin
Demeclosilin
Tetracycline Minosiklin
 GOLONGAN TETRASIKLIN (D)

Melewati Kadar terapi pada

plasenta sirkulasi fetal
Trimester 1 Gangguan
pertumbuhan tulang
Trimester 2 Perubahan warna gigi
&3
 GOLONGAN SULFONAMIDA (C)

Melewati Kadar lebih rendah

plasenta pada sirkulasi fetal
Trimester 3 Mendesak bilirubin
dari ikatannya
dengan protein
Hemolisis neonatal
Dihindari
 TRIMETOPRIM (B3)

Melewati Kadar fetal tidak >

plasenta ibu
Dosis besar Teratogen (binatang)
antagonis asam
folat
Dihindari
 Neonatal Grey
KLORAMFENIK syndrome
OL

Karsinogenik
METRONIDAZOL (B2)
Dosis tinggi tidak
boleh
GOLONGAN AMINOGLIKOSIDA (D)

Amikasin Hindari
Gentamisin
Kanamisin
Neomisin
Netilmisin
Tobramisin
Nefrotoksik-
Aminoglikosida
Ototoksisitas-Aminoglikosida
 GOLONGAN PENICILLIN
(A)

Spektrum AB Contoh

Spektrum sempit,
Sensitive thd beta-
lactamase
Benzil penisilin,
penisilin V

Spektrum
luas
Ampicilin,
amoksisilin
 Farmakokinetika ampisilin oral
pada kehamilan

Parameter Hamil Tidak hamil

AUC 8.2+4.1 12.6+4.3*
Cmax (ug/ml) 2.2+1.0 3.7+1.5*
Bioavailability (%) 45.6+20.2
48.1+19.3**
*p<0.001
**NS
Phillipson J Inf Dis 1977; 136:370.
GOLONGAN
SEFALOSPORIN

Sefaleksin
(A)
Sefalotin (A
Lain (B2)