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KELOMPOK 2
JAJANG JAMALUDIN
KURNIA
WIWIN
MIKOSIS
Superficialis
Dermatofitosis
Non
Dermatofitos
is
Tinea capitis
Tinea barbae
Tinea corporis
( T. imbrikata &
T. favosa )
Tinea manum
Tinea pedis
Tinea kruris
Tinea unguium
Pitiriasis
versikolor
Piedra hitam
Piedra putih
Tinea nigra
palmaris
Otomikosis
Intermediate
Kandidiasis
Aspergillosis
Profunda
Subcutis
Sistemik
Misetoma
Kromomikosis
Sporotrikosis
Fikomikosis subkutan
Rinosporodiosis
Aktinomikosis
Nokardiosis
Histoplasmosis
Kriptokokosis
Koksidioidomikosis
Blastomikosis
Fikomikosis
-sistemik
ANTI JAMUR
INFEKSI SISTEMIK
Infeksi Yang
Disebabkan Oleh
Jamur Disebut
Mikosis.
Description of
the contents
INFEKSI TOPIKAL
ANTI
FUNGALS
Antifungal Agents
Polyene antibiotic
The polyene antibiotics bind with sterols in the fungal
cell membrane, principally ergosterol. This causes
the cell's contents to leak out and the cell dies.
Animal cells contain cholesterol instead of ergosterol
and so they are much less susceptible.
Nystatin
Amphotericin B (may be administered liposomally)
Natamycin
Rimocidin
Filipin
Pimaricin
Antifungal Agents
Imidazole and triazole
The imidazole and triazole groups of antifungal drugs
inhibit the enzyme cytochrome P450 14-demethylase.
This enzyme converts lanosterol to ergosterol, and is
required in fungal cell membrane synthesis. These drugs
also block steroid synthesis in humans.
Imidazoles:
Miconazole
Ketoconazole
Clotrimazole
Mebendazole
Isoconazole
Sertaconazole
Thiabendazole
Bifonazole
Butoconazole
Econazole
Fenticonazole
Oxiconazole
Sulconazole
Tiaconazole
Antifungal Agents
The triazoles are newer, and are
less toxic and more effective:
Fluconazole
Itraconazole
Ravuconazole
Posaconazole
Voriconazole
Antifungal Agents
Allylamines
Allylamines inhibit the enzyme squalene
epoxidase, another enzyme required for
ergosterol synthesis:
Terbinafine - marketed as Lamisil
Amorolfine
Naftifine
Butenafine
Antifungal Agents
Echinocandin
Echinocandins inhibit the synthesis of glucan
in the cell wall, probably via the enzyme 1,3-
glucan synthase:
Anidulafungin
Caspofungin
Micafungin
Antifungal Agents
Others:
Flucytosine is an antimetabolite.
Griseofulvin binds to polymerized microtubules
and inhibits fungal mitosis; It is derived from the
mold Penicillium griseofulvum.
Fluocinonide
Salicylic Acid (topical)
Tinactin or Tolnaftate
Potassium Iodide
Bersifat fungistatik
/fungisidal
tergantung dosis &
sensivitivitas jamur
Farmakokinetika
Absorpsi melalui saluran cerna
sedikit.
T 24 - 48 jam.
Kadar mantap dicapai setelah
beberapa bulan.
Dapat melewati plasenta,CSS &
vitreus.
Ekskresi melalui ginjal lambat sekali.
Efek samping
Infus kulit panas, keringatan, sakit
kepala, demam, flebitis ,penurunan
fungsi ginjal > 80% pasien ,dll.
Derajat kerusakan ginjal tergantung
dosis.
Efek toksik ginjal dapat ditekan
dengan pemberian bersama flusitosin.
Indikasi
1. Terapi awal infeksi jamur yang
mengancam kehidupan
2. Koksidiomikosis,Aspergilosis,
kandidiosis dll.
3. Obat terpilih (Drug of choice)
untuk Blastomikosis.
Perhatian
1. Selama pengobatan pasien harus
di rawat di rumah sakit
2. Monitoring ketat urinalisis, darah
dan kimia darah (K,Mg,ureum
dan kreatinin) menjelang tercapai
dosis optimal
3. Bila terjadi insuffisiensi
ginjal,terapi stop
2. FLUSITOSIN
Spektrum sempit
Efektif untuk kriptokokosis,
kandidiasis, Aspergilosis
Bila diberikan bersama
Amfoterisin B bersifat
supraaditif.
Efek samping
1. Griseofulvin
in vitro efektif terhadap berbagai jenis
jamur.
Absorpsi melalui sal cerna kurang baik
Efek samping : Leukopenia & granulo
sitopenia.
Sediaan tablet 125 mg & 500mg
Nistatin
Merupakan antibiotik polien.
Mekanisme kerja : berikatan dengan
ergosterol pada membran jamur,
permeabilitas meningkat, sel jamur mati.
Indikasi : kandidiasis kulit, selaput lendir,
dan saluran cerna.
Efek samping : jarang ditemukan, mual,
muntah, diare ringan
PERTIMBANGAN TERAPI
Infeksi berat gol imidazol
Lesi hiperkeratosis kuku anti
jamur topikal + zat keratolitik
Infeksi jamur dgn tanda
radanghebat anti jamur +
kortikosteroid
Tinea versikolor selenium
sulfid
ANTELMENTIK
Obat untuk memberantas atau mengurangi
infestasi cacing dalam lumen usus atau
jaringan tubuh
Antelmentik lama kurang aman
kurang efektif
Antelmentik baru lebih aman & efektif
rasa tidak mengganggu, sebagian
dapat diberikan oral, dosis tunggal.
1. Dietilkarbamazin
Obat pilihan pertama untuk
filariasis
Dapat menghilangkan
mikrofilaria
W bacrofti, B malayi, loa loa dari
peredaran darah.
Dietilkarbamazin
Mekanisme kerja :
1.Menurunkan aktivitas otot cacing
paralisis
2.Menyebabkan perubahan pada
permukaan membran mikrofilaria
sehingga mudah dihancurkan.
Efek samping
Relatif aman pada dosis terapi
Pusing,gangguan sal cerna, sakit kepala
dll.
Reaksi alergi karena matinya parasit
dan substansi yang dilepaskan oleh
mikrofilaria yang hancur.
2. Piperazin
Efektif terhadap A. lumbricoides &
E vermicularis
Mekanisme kerja :
Blokade respon otot cacing
terhadap asetil kolin paralisis
Cacing mudah dikeluarkan oleh
peristaltik usus,cacing keluar 1-3
hari setelah pengobatan.
3. Pirantel Pamoat
Untuk : caing kremi, gelang,
tambang.
Mekanisme kerja : depolarisasi otot
cacing dan meningkatkan frekuensi
impuls
Cacing mati dalam keadaan
spastis
Pirantel Pamoat
Absorpsi kurang baik, ekskresi
sebagian besar melalui tinja
Efek non terapi: keluhan saluran cerna,
demam & sakit kepala
Kontra indikasi :
wanita hamil,Usia < 2 tahun
Pemberian bersama piperazin
Pirantel Pamoat
Obat terpilih untuk : askariasis,
ankilostomiasis, enterobiasis &
strongiloidiasis
Sediaan : tablet 125mg, 250 mg
Dosis 10 mg/kgBB, dosis tunggal
Antelmentik
4. Mebendazol
Spektrum paling luas, obat terpilih
untuk enterobiasis & trichuriasis.
Mekanisme kerja :
menyebabkan kerusakan struktur
subseluler & menghambat sekresi
asetilkolinesterase cacing.
Menghambat ambilan glukosa secara
irreversibel.
Antelmentik lain
Levamisol
Niklosamid
Niridazol
Prazikuantel
Ivermektin, dll.
TERAPI PILIHAN
Helminth
Ascaris
lumbricoides
Treatment of Choice
Albendazole, Mebendazole P
pamoat
E. vermicularis
Hookworms
Trichuris trichiura
Filaria
Albendazole, Mebendazole, P
pamoat
Albendazole Mebendazole, P
pamoat
Mebendazole, albendazole
Dietilcarbamazine
Cutaneus larva
migrans
S. stercoralis
ect
Ivermectin, Thiabendazole
2.
Combination therapy:
Drug Classification
Anti-amebiasis Drugs
Amebiasis is infection with Entamoeba histolytic.
Amebiasis is transmitted through gastrointestinal
tract.
Ameba has two stages of development: cyst(
) and trophozoite( ).
Cysts small intestine little trophozoites (ileocecum)
CHLOROQUINE
A synthetic 4-aminoquinoline formulated as the
phosphate salt for oral use.
Pharmacokinetics
Rapidly and almost completely absorbed from the
gastrointestinal tract.
Very large apparent volume of distribution of 1001000 L/kg.
Necessitate the use of a loading dose to rapidly
achieve effective serum concentrations.
Slowly released from tissues and metabolized.
Principally excreted in the urine.
Pharmacological Effects
1.
2.
3.
Clinical Uses
1. Treatment: nonfalciparum and sensitive
falciparum malaria. Primaquine( )
must be added for the radical cure of P vivax
and P ovale, because chloroquine does not
eliminate dormant liver forms of these
species.
2. Chemoprophylaxis: for without resistant
falciparum malaria in malarious regions.
3. Amebic liver abscess( ): not
effective in the treatment of intestinal or
other extrahepatic amebiasis.
Metronidazole
A nitroimidazole( ). The nitro group of
metronidazole is chemically reduced in
anaerobic( ) bacteria and sensitive
protozoans. Reactive reduction products appear
to be responsible for antimicrobial activity.
Pharmacokinetics
Oral metronidazole is readily absorbed and
permeates all tissues by simple diffusion.
Protein binding is low (<20%)
Through blood brain barrier
Metabolizing in liver.
Excreted mainly in the urine.
GOOD
BYE