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ANTIBIOTIK PADA ISK

Elly Nurus Sakinah


LO
Mengetahui Antibakteri yang digunakan pada ISK
Menjelaskan mekanisme kerja antibakteri tersebut
Menjelaskan efek samping antibakteri tersebut
Mampu mengaplikasikan penggunaan antibakteri
pada ISK
Farmakoterapi pada ISK
Tujuan :
mencegah infeksi sistemik,
eradikasi kuman, dan
mencegah infeksi rekuren
Prinsip Umum :
Evaluasi awal : gejala, lokasi infeksi, komplikasi
Pemilihan antibakterial
Folow up
Quinolon / Fluroquinolon
Generasi I Generasi II Generasi III
Nalidixic acid* Norfloxacin . Moxifloxacin .
Gemifloxacin
Pipemidic acid* Ciprofloxacin
Ofloxacin .
Cinoxin Pefloxacin .
Sparfloxacin.
Levofloxacin .
quinolon

Cara kerja :
Menghambat DNA girase
( enzym supercoiling DNA )
Spektrum :
Quinolons Gram (-) ( trct UG )
Fluoroquinolons Gram (-) >>
GO / Chlamydia
Staphylococc
Pseudomonas A
Kinetik per oral

* Nalidixic acid + ( t = 6 jam )

* Norfloxacin ++ ( t = 3 jam )

* Ciprofloxacin ++ ( t = 3 jam )

* Ofloxacin ++ ( t = 4 jam )

* Sparfloxacin ++
* Levofloxacin ++ ( t = 7 jam )

* Pefloxacin +++
* Moxifloxacin ++ / enteral ( t = 10 jam )

* Gemifloxacin ++ / enteral
Quinolon
(Asam Nalidiksat ) Abs per oral ( cepat )
Ekskresi ( cepat ) ren

( jadi tak manfaat utk infeksi sistemik )

Norfloxacin ~ asam Nalidiksat


- kadar urin tinggi ,
- kadar serum rendah
( tidak berguna utk infeksi diluar sal kemih )
Klinis :( f-quinolon )

*Complicated urinary tract infection


* Gonorrhae
* Cervisitis
* Prostatitis
* Typhoid fever
* Septicemia ( thdp kuman yg sensitive )
* Resp tract infection( bukan ok pneumococci )
Adversed reaction : ( f-quinolon )
- Gangg GI tarct
- Skin rashes
- Joint pains
- Allergy
- Menghambat ikatan GABA dg reseptornya
convulsi
- Gangg pertumbuhan tulang / cartilage
( ibu hamil / anak masa pertumbuhan (-) )
Co-trimoxazole
Co-trimoxazole :
( bacterioside )

Trimethoprim + Sulfamethoxazole
( bacteriosatik ) ( bacteriostatik)
Pteridine precursor + PABA

Pteridine + PABA
+ glutamic acid
sulfonamid
Folic acid

Dihydrofolic acid
Dihydrofolic acid reductase
trimethoprim
Tetrahydrofolic acid

DNA Bacterial growth


Klinis : (Co-trimoxazole )
* Inf-systemic
* Inf chronis - trct UG
* Inf-ku gram (-) bacilus
* Inf-trct Resp ( bronchitis ok S.pneumoniae, H.influenzae )
* Otitis media ( S.pneumoniae, H.influenzae )
* Typhoid fever ( resisten Chloramphenicol, Ampicilin )

Drug of choice Tx / Px :
Pneumonia ( ok. Pneumocytsis carinii )
( terutama pend dengan immunosppressed )
Adverse effects ( co-trimoxazole )
Sulfonamide Trimethoprim
Alergy-rash, fever, Macrocytic anemia
Stevens-johnson synd Trombocytopenia
Agranulocytosis
Kristal uria
Haemolysis
Inhibit metab- obat

Aplastic anemia (elderly)


Teratogenic ( folate antagonist)
Penicillin
Penicillin
*Alami : jamur Penicilinum Notatum/ Chrysogenum
*Semi sintetik
*Sintetik : rumus bangun : 6-Aminopenicillanic acid
S
amidase

C C C


C N C

-lactamase / penicilinase
Kuman-kuman yg sudah membentuk -lactamase

Staphylococcus

H. Influenzae

N. Gonococcus Beta-lactamase

E. Colli (Penicillinase)

????????
Penicillin

Farmakokinetik :
Abs : Pe cepat / Po bervariasi
Dist : seluruh jar tb ( serum ~ jar )
kadar (<) mata, prostat, CNS
( kec. Inflamasi .. Meningitis )
Eks : * urine ( >> ) : 90 % sekrs tubulus
10 % filtrasi glomerulus
* sputum / ASI
Beta-lactamase inhibitor:
Clavulanic acid Sulbactam / Tazobactam
( penicillinic acid sulfon )
Streptomyces semi sintetik
clavigerus
cara kerja
Mengikat beta-lactamase
( anti bacteria <<< )
+ Amoxycillin + Ampicillin
( Augmentin ) ( Unasyn )
Cephalosporine
Kuman Cephalosporin

Generasi
I II III IV
Terutama pd Plus > Kuman >>
Kuman Kuman Gram (- ) Kuman
gram (+) gram ( - ) Gram (- )
< Kuman
Gram ( + )
Cephalosporin

Generasi
I II III IV
Cefadroxil Cefuroxim Cefotaxime Cefipim

Cefazolin Cefaclor Ceftriaxone

Cefradin Cefoxitin Ceftazidime

Cefalexin Cefotetan
use Cephalosporin

Generasi
I II III IV
-Streptococc = gen I -Streptococc -Inf trct
-Staphylococc Plus / Peumococc urinary
-Inf urinary trct - H.Influenza, ( << ) -inf trct
-Inf bone / joint - N Gonorrhae Resp
-inf upper Resp -Gram ( - )
trct GI / UG ( Infeksi
( >>> ) serius )
Klinis : (cephalosporin)
* Bacteriemia ( + aminolgycosida )
* Surgical prophylaxis ( Pre / post OP )
* Mixed infection ( + anaerobes )
* Pen-ase producing N.gonorrhae
* Bac- gram (- )
Reaksi yg merugikan :
* Pemberian Po.. N / V / D , IM iritasi/pain
IV thromboplibitis
*Allergy
* Hipoprothrombinemia
Terima Kasih
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Wassalamualaikum Wr.Wb