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Cara kerja :
Menghambat DNA girase
( enzym supercoiling DNA )
Spektrum :
Quinolons Gram (-) ( trct UG )
Fluoroquinolons Gram (-) >>
GO / Chlamydia
Staphylococc
Pseudomonas A
Kinetik per oral
* 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
Trimethoprim + Sulfamethoxazole
( bacteriosatik ) ( bacteriostatik)
Pteridine precursor + PABA
Pteridine + PABA
+ glutamic acid
sulfonamid
Folic acid
Dihydrofolic acid
Dihydrofolic acid reductase
trimethoprim
Tetrahydrofolic acid
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
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
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