Applied

Pharmacotherapy
By:
First group
Fifth case:

A young mother (30 y.o) presented to a pharmacy bringing following prescription for her son :
R/FDC No XXX
    S1 Dd 1
R/ Cefixime 100 Mg III
    Mf Pulv No X
    S4 Dd 1 Pulv
R/ Paracetamol Syr Fl I
     S 3 Dd 5 Ml
Pro: D (3 Y.O, 12kg)
The Kid Was Diagnosed With TB For A Month With Symptoms Of Cough, Fever And Difficulty In
Gaining Weight Since 3 Months Ago And The Mantoux Test And BTA Were Both Positive.  In
Addition, He Experienced A Red Stool After Taking The Medicine And Pain While Urinating,
Fever, Nausea As Well As Vomiting Which Was Later Diagnosed With Urinary Tract Infection.
TUBERCULOSIS  Socio-economic factors:

Risk Poverty, malnutrition, wars

Factor  Immunosuppression:
A communicable infectious HIV/AIDS, chronic
disease caused by immunosuppressive therapy
Mycobacterium tuberculosis. It (steroids, monoclonal
can produce silent, latent antibodies against tumor
infection, as well as progressive, necrotic factor), a poorly
Definition
active disease developed immune system
(children, primary
immunodeficiency disorders)
 Occupational: Mining,
Mycobacterium
Etiology construction workers,
tuberculosis
pneumoconiosis (silicosis)
Pathophysiology of TB
URINARY TRACT INFECTION (UTI)

Definition Etiology Risk Factor

The presence of  Most: E. coli (80% to 90%)  Age

microorganisms in the  Additional causative  Gender
urine that cannot be organisms: Staphylococcus  Malnutrition
accounted for by saprophyticus, Klebsiella  Personal hygiene
contamination. pneumoniae, Proteus spp.,  Urinary emptying
(DiPiro, 2017) Pseudomonas aeruginosa dysfunction
and Enterococcus spp.  Genitourinary tract
(DiPiro, 2017) abnormalities
 Pathophysiology of UTI
Microorganisms reach
the urinary tract
by ascending,
hematologic, or
lymphatic spread The risk of bacteremia is
increased in UTIs such
as pyelonephritis and
acute bacterial prostatitis,
Urosepsis exacerbated by urinary
(when microorganisms tract obstruction
reach the bloodstream)

Mostly caused by E. Coli.

Currently there are markers of sepsis.
Cytokines are involved in the inflammatory
process, with the function regulates the
magnitude and duration of the host
response to inflammation. Cytokines present
in microorganisms can reach the urinary tract
by ascending spread, hematology, or lymphatic
 TB
1. Prompt resolution of signs and
symptoms of disease
2. Achievement of a noninfectious
state, thus ending isolation
3. Adherence to the treatment
regimen by the patient
4. Cure as quickly as possible
(generally with at least 6 months
of treatment)
UTI
1. To eradicate the invading
organisms
2. Prevent or treat systemic
consequences of infection
3. Prevent recurrence of infection
4. To decrease the potential for
collateral damage with too broad
of antimicrobial therapy.
Standard Therapy of TB
Daily doses
Drug name Max. Doses Mechanism Side effect
(mg/kgBB/day)
Isoniazid (H) 10 (7-15) 300 INH is a bactericidal agent whose Hepatitis
mechanism of action includes Neuritis
inhibiting mycolic acid synthesis Peripheral
in mycobacterium tuberculosis Hypersensitivity

Rifampisin (R) 15 (10-20) 600 It acts by inhibiting bacterial Reddish orange body
protein synthesis. RIF binds with fluids
the DNA dependent RNA Increased liver
polymerase enzyme of the bacteria enzymes
thus preventing transcription to Skin reactions
RNA and subsequent protein
synthesis

Pirazinamid 35 (30-40) - Inhibits fatty acid synthesis in Liver toxicity

(Z) the bacteria Arthralgia
Gastrointestinal
Ethambutol (E) 20 (15-25) - Inhibits the synthesis of Optic neuritis
arabinogalactan (an important Reduced eye acuity
component of the mycobacterial Red green color
cell wall) blindness
TB in
Chindren
 Standard Therapy of UTI In Children
Antibiotics Daily Doses Mechanism Adverse Effects
Amoxicillin/clavulanate 20 to 40 mg/kg, Amoxicillin binds to penicillin-binding Diarrhea
divided every 8 hours proteins within the bacterial cell wall and Nausea
inhibits bacterial cell wall synthesis. Vomiting
Clavulanic acid is a beta-lactamase inhibitor Rash
often used in conjunction with amoxicillin to
broaden its spectrum further and combat
resistance
Cefixime 8 mg/kg once or Like all beta-lactam antibiotics, cefixime binds Abdominal pain
divided every 12 hours to specific penicillin-binding proteins Diarrhea
(pbps) located inside the bacterial cell wall, Flatulence
causing the inhibition of the third and last Rash
stage of bacterial cell wall synthesis
Cefpodoxime 10 mg/kg, divided The bactericidal activity of cefpodoxime results Abdominal pain
every 12 hours from its inhibition of cell wall synthesis. The Diarrhea
active metabolite of cefpodoxime binds Nausea
preferentially to penicillin-binding protein 3, Rash
which inhibits production of peptydoglican, the
primary constituent of bacterial cell walls
 Cont..
Cephalexin 50 to 100 mg/kg, divided Cephalexin inhibits bacterial cell wall Diarrhea
every 6 hours synthesis, leading breakdown and Headache
eventually cell death Nausea
Vomiting
Rash
Trimethoprim/ 8 to 10 mg/kg, divided Sulfamethoxazole achieves this directly as a Diarrhea
sulfamethoxazole every 12 hours competitor of p-aminobenzoic acid (PABA) Nausea
during the synthesis of dihydrofolate. Vomiting
Trimethoprim is a direct competitor of the Photosensitivity
enzyme dihydrofolate reductase, causing its Rash
inhibition, which halts the production of
tetrahydrofolate to its active form of folate
Non Pharmacology Therapy

1. TB

 Routine sunbathing every morning

 Maintain environmental sanitation and hygiene

 Maintain the proper diet/healthy food

2. UTI

 Drink lots of mineral water

 Maintain sanitation and hygiene

Literature Search Result

NNT= 50 NNT= 17