Antibiotik dan antiseptik saluran kemih

Dr. Rika Yuliwulandari, PhD

Infeksi Saluran Kemih

ISKB(Pada umumnya tidak ada symptoms Urethritis Cystitis Prostatitis ISKA(renal parenchyma, pelvis, ureters) ada symptom sistemik: menggigil, nyeri pinggang
belakang)

Pyelonephritis (infeksi ginjal)

- Mayoritas karena infeksi ascending, berasal dari organisme di daerah perineal dan menjalar ke daerah mucosa - Organisme terbanyak pada ISK: E. coli (flora normal intestin), sehingga kebanyakan infeksi berasal dari tractus digestivus

Terapi
Antibiotics
Berdasarkan data empiris atau tes sensitivitas Cistitis tanpa komplikasi Terapi jangka pendek Trimethoprim/sulfamethoxazole (TMP/SMX) 2 dd E. coli resistance to TMP-SMX Ex: Ciprofloxacin (Cipro)
Nitrofurantoin (Macrodantin)

3-4 dd Penggunaan jangka panjang Pulmonary fibrosis Neuropathies ISK dengan komplikasi Terapi jangka panjang (7 to 14 hari) Fluoroquinolones Ex: Ciprofloxacin (Cipro)

Terapi
Analgesik urinarium Pyridium Dikombinasikan dengan antibiotik Melegakan kandung kemih Urine berwarna orange kemerahan Mewarnai pakaian dalam dan dapat disalah artikan seperti darah OTC Urised Atropine , hyoscyamine , methenamine , methylene blue, phenyl salicylate , and benzoic acid Dikombinasikan dengan antibiotik Untuk meringankan gejala ISK ISK berulang Antibiotik Profilaksis atau supresive jangka pendetk Hati-hati resistensi

Antibiotik, antiseptik saluran kemih

QUINOLON

Pharmacokinetic of Fluoroquinolon

Therapeutic application of Ciprofloxacin

Drug interaction of Quinolon

INHIBITOR OF FOLATE SYNTHESIS

Pharmacokinetic

Drug interaction

INHIBITOR FOLATE REDUCTASE AND SYNTHESIS

Single and combined drug effect on E. coli

Therapeutic application of Cotrimoxazole

Pharmacology

UT antiseptic
UTI in women and elderly
Uncomplicated acute cystitis Pyelonephritis

80% due to E. coli, followed by staphylococcus and saprophyticus, Klebsiella pneumonieae, Proteus mirabilis Antiseptic can be used:
Nitrofurantoin Methenamin Nalidixic acid

These drugs do not achieve antibacterial levels in the circulation, but concentrated in the urine-----microorganisms at that site can be effectively eradicated.

Methenamin
Mechanism of action:
Decompose at an acidic pH of 5.5 or less in the urine ------ produce formaldehyde, which is toxic to most bacteria The reaction is slow ----- require 3 hours to reach 90 percent decomposition.

Should not be used in patients with indwelling catheters. Bacteria do not develop resistance to formaldehyde. [Note: Methenamine is frequently formulated with a weak acid, such as mandelic acid or hippuric acid.] Antibacterial spectrum:
Methenamine is primarily used for chronic suppressive therapy. Urea-splitting bacteria that alkalinize the urine, such as Proteus species, are usually resistant to the action of methenamine. Methenamine is used to treat lower UTIs but is not effective in upper UTIs.

 Pharmacokinetics:
Methenamine is administered orally. In addition to formaldehyde, ammonium ion is produced in the bladder, Because the liver rapidly metabolizes ammonia to form urea Methenamine is distributed throughout the body fluids, but no decomposition of the drug occurs at pH 7.4 ------Systemic toxicity does not occur. Elimination: in the urine.

Adverse effects:
Gastrointestinal distress Higher doses: albuminuria, hematuria, and rashes may develop.

Contra indication:
Renal insufficiency, because mandelic acid may precipitate. [Note: Sulfonamides react with formaldehyde and must not be used concomitantly with methenamine. patients with hepatic insufficiency, in which elevated levels of circulating ammonium ions would be toxic to the CNS.

Nitrofurantoin
Nitrofurantoin
Less commonly employed for treating UTIs because of its narrow antimicrobial spectrum and its toxicity.

Sensitive bacteria reduce the drug to an active agent that inhibits various enzymes and damages DNA. Antibiotic activity is greater in acidic urine. The drug is bacteriostatic. It is useful against E. coli, but other common urinary tract gram-negative bacteria may be resistant. Gram-positive cocci are susceptible. Adverse effects include gastrointestinal disturbances, acute pneumonitis, and neurologic problems.

Nalidixic Acid
Synthetic quinolone antibiotic

Effective against gram negative UTI (E. Coli, Enterobacter species, Klebsiella species, and Proteus species) Resistant to gram positive Pharmacokinetic:
Well absorbed >90% bound to protein --- inadequate for systemic tx Metabolism: Nalidixic acid is hydroxylated ---- 7-hydroxynalidixic acid (more potent bactericidal) Excretion: urine

Adverse effect: nausea, vomiting, abdominal pain, photosensitivity, urticaria, fever, CNS problem (headache --- malaise), liver toxicity (tx more than 2 weeks)