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Antibiotics in Critically Ill E4ED Final
Antibiotics in Critically Ill E4ED Final
1928
Sir Alexander Fleming discovered
ANTIBIOTICS
Transformation of Life and Livelihoods
THE INTRODUCTION OF ANTIBIOTICS RAPIDLY
EXTENDED LIFE EXPECTANCY
1945 = 50 years
Today = 80 years
(developed countries)
Increase of 30 years
within 50 years
ADANYA ANTIBIOTIK DENGAN
MENINGKATKAN KESEJAHTERAAN
HIDUP...
Alexander Fleming
7
“It is anticipated to be only a
matter of time before
gonococci with full
resistance to the third-
generation extended
spectrum cephalosporins
emerge and spread
internationally.
Consequently, gonorrhoea
may become untreatable
unless new drugs become
available.”
WHO AMR surveillance report 2014
8
S e p s is in n e w b o rn s in five c o u n trie s in S o u th As ia
(India, Pakistan, Afghanistan, Nepal, Bangladesh)
On e c h ild d ie s e ve ry fiv e m in u te s b e c a u s e th e
a n tib io tic s g ive n a re n o t e ffe c tive d u e to
b a c te ria l re s is ta n c e
overuse
misuse
underuse
Mikroba Resisten
Indonesia bagaimana ??
MENGAPA RESISTENSI MENJADI MASALAH
GLOBAL ?
1. Kasus infeksi akibat bakteri resisten meluas di seluruh
negara
2. Kegagalan pengobatan infeksi akibat bekteri resisten
menimbulkan masalah : mortalitas, morbiditas dan
masalah sosial
3. Mengatasi infeksi bakteri resisten perlu biaya tinggi
4. Penemuan antibiotik baru sangat lambat
(WHO-2015)
12
Selective Pressure
15
Antibiotics Milestones
17
Kecepatan
penemuan
antibiotik
Timbulnya
resistensi
kuman
Restoring
balance
20
Kecepatan
Tujuan PRA
penemuan
antibiotik
Timbulnya
resistensi
kuman
prevalensi
AMR
Peran komunitas,
Bagan dokter, farmasi
Spekulatif
Waktu
21
Bagaimana
Menggunakan Antibiotik
Secara Bijak ?
The Principle of Antibiotic Use
Therapeutic Prophylaxis
Antibiotic use in the presence of
clinical manifestations with
suspected infection or infection
There are Preventing
infections in
Empiric Definitive no signs of
high risk
infection
patients or
occurrence of
postoperative
Burke A, Cunha. Antibiotic Essentials, 2010
infection
Dilemma in deciding on empirical antibiotic
therapy in critically ill patients
Using antibiotics may improve individual
patient outcome, but will induce selection
pressure and potential harm to future
patients or to the same patient in the future,
whereas withholding antibiotics will avoid
selection pressure but may put the individual
patient at increased risk of harm caused by an
untreated infection.
Reducing Antibiotic Use in the ICU: A Time-Based Approach to Rational Antimicrobial Use
P. O. Depuydt, L. De Bus, and J. J. De Waele
…Dilemma in deciding on empirical antibiotic therapy in critically ill patients
PK
PK/PD
Conc. Relationship
PD
Effect
Perubahan fisiologi pada pasien sakit kritis
Sistim kardiovaskuler Sistim pernafasan
• ↓ curah jantung • ↑ kapasitas penetrasi dari
• ↑ permeabilitas vaskuler beberapa antibiotik
• ↑ fungsi kardiovaskuler
Inisial phase
of sepsis or
septic shock
↑ Vd ↑ CL ↑CL & Vd
M.O. Cotta et al.
MEDIN-827;Pages 10
Pieralli F, Mancini A, Crociani A.
Appropriate Antibiotic Therapy in
Critically Ill Patients. Italian Journal of
Medicine 2016; 10:792