Antibiotics

MACP 1213
 OBJEKTIF

• Menerangkan tindakan ubat

antibiotik.
• Menerangkan kesan
sampingan ubat.
• Menyatakan contoh, dos dan
cara pemberian ubat.
• Menyatakan indikasi dan
kontraindikasi ubat.
• Menyatakan nasihat yang
relevan semasa penggunaan/
pemberian ubat.
 Antibiotics

• Bahan kimia yang diperolehi

daripada mikroorganisma
yang mempunyai keupayaan
untuk menghalang pembiakan
atau membunuh bakteria.
 Jenis Antibiotics

• Broad Spectrum (berspektrum

luas)
– Antibiotics yang berupaya
bertindak ke atas species
bacteria yang banyak.
• Narrow Spectrum
(berspektrum terhad)
– Antibiotics yang berupaya
bertindak ke atas beberapa
species bacteria/ species yang
terhad sahaja.
 Tindakan
• Bactericidal – membunuh
bacteria
– Inhibit synthesis of bacterial cell
wall
– Inhibit synthesis of protein &
nucleic acid
– Disturbance in chemical activity
in bacteria
• Bacteriostatic – Menghalang
pembiakan bacteria
– Inhibit synthesis of protein
– Inhibit synthesis of folic acid
 General Indication

• Untuk merawat
jangkitan yang
disebabkan oleh
bacteria.
 General Dose
• Diambil dengan mengikut dos
dan jangka masa yang
ditentukan.
• Jangka masa: 7 – 10 hari
• Jangkitan sistem repiratory: 2
– 6 minggu
• Penyakit TB: 4 – 6 bulan
 Salah Guna Antibiotics
• Digunakan untuk merawat
jangkitan bukan disebabkan
oleh bacteria.
• ‘Self medication’ – pengubatan
sendiri dengan menggunakan
antibiotic.
• Pengambilan yang tidak
sempurna (tidak habiskan ubat)
• Penggunaan antibiotic dalam
dos dan jangka masa yang
salah.
• Penggunaan antibiotic dalam
dos dan jangka masa yang
tidak betul boleh
menyebabkan RESISTANT
(Antibiotic tidak berkesan
lagi).
Kesan Sampingan Umum
• Hypersensitivity
• Gangguan GI
• Hapuskan normal flora
(mulut, usus & genital)
• Kerosakkan hepar & ginjal
(dos berlebihan/ jangka
panjang)
Jenis-jenis Antibiotics
A. Penicillins
B. Cephalosporins
C. Tetracyclines
D. Macrolides
E. Aminoglycosides
F. Chloramphenicol
Penicillins
 Cara Tindakan

• Broad Spectrum (Gram +ve)

• Bactericidal & Bacteriostatic:
– Destroy bacterial cell wall
– Causes the bacteria to swell,
rupture, asume unusual shapes
& finally die.
 Indications (Penicillins)
• Urinary tract infections
• Respiratory tract infections
• Skin infections
• Meningitis
• Intra-abdominal infections
• Gonorrhea
• Syphilis
 Types of Penicillins

• Natural Penicillins
• Semisynthetic
Penicillins
 Natural Penicillins

• Benzylpenicillin (Penicillin G)
• Phenoxymethyl Penicillin
(Penicillin V)
• Procaine Penicillin
1. Benzylpenicillin
(Penicillin G)
Category: B
 Dose
• 1 mega unit = 600mg
• 5 mega unit = 3000mg/ 3g
• Adult:
• 600-1200mg IM qid
• Peads:
• 50-100mg/kg/d IV (2-4 divided
dose)
2. Phenoxymethyl
Penicillin
(Penicillin V)

Category: C
 Dose
• Adult:
– 500-750mg q 6 hr PO
• Peads up to 1 yr:
– 62.5 mg q 6 hr PO
• Peads up to 1-5 yr:
– 125 mg q 6 hr PO
• Peads up to 6-12 yr:
– 250 mg q 6 hr PO
 3. Procaine Penicillin
Category: B

Dose
• 1 mega unit = 1000mg
• Adult:
– 300-900mg/day IM (divided
dose)
• Peads up to 1 yr:
– 150mg/d IM (divided dose)
• Peads up to 1-5 yr:
– 300mg/d IM (divided dose)
• Peads up to 6-12 yr:
– 600mg/d IM (divided dose)
 Semisynthetic Penicillins

• Amoxicillin (Amoxil, Trimox)

• Ampicillin (Penbritin)
• Bacampicillin (Penglobe)
• Cloxacillin sodium (Orbenin)
 1. Amoxycillin (Amoxil)
Category: B

Dose
• Adult:
• 250-500mg tds PO
• Peads:
• 20-40mg/kg/d PO (divided
dose)
 2. Ampicillin (Penbritin)
Category: B

Dose
• Adult:
• 250-500mg q 6 hr PO/ IM/ IV
• Max: 400mg/kg/day
• Peads:
• 1 yr: ¼ of adult dose
• 1-10 yrs: ½ of adult dose
3. Bacampicillin (Penglobe)
Category: B

Dose
• Adult:
• 400mg bd PO
• Severe infections: 800mg bd
PO
 4. Cloxacillin sodium
(Orbenin)
Category: B

Dose Oral
• Adult:
• 250-500mg q 6 hr PO
• Peads:
• < 2 yr: 125mg qid
• 2-10 yrs: 250mg qid
 Dose Parenteral
• Adult:
• 250-500mg q 6 hr
• Peads:
• < 20kg: 25-50mg/kg/day
(equally divided dose q 6 hr)
 Kesan Sampingan
• Hypersensitivity
• Nausea & Vomiting
• Diarrhea
• Glossitis & Gastritis
• Rash & Fever
• Pain at injection site
• Superinfection
 Contraindications

• Allergic to penicillins &

cephalosporins
 Cautious
• Renal disease
• Pregnancy
• Lactation
• Asthma
• Bleeding disorders
• GI disease
 Interactions

• Tetracycline
• Kurangkan tindakan dan
kesan penicillin
• Anticoagulants
• Meningkatkan risiko
pendarahan
• Beta adrenergic blocking
drugs
• Meningkatkan risiko reaksi
anafilaksis
• Birth control pills
(estrogen)
• Mengurangkan kesan ‘birth
control pills’

NOTE: penicillin should be given 1 hour

before or 2 hours after meals.
Identifying the Appropriate
Penicillins

• Culture & Sensitivity

test are performed to
determine if a
specific type of
bacteria is sensitive
to penicillin.
 Clear area indicates no
bacterial growth

This antibiotic is effective & retards

the growth of the bacteria
 Soalan
1. Beri definisi ubat Antibiotics?
2. Terangkan cara tindakan
penicillin?
3. Senaraikan contoh ubat
penicillin?
4. Nyatakan kesan sampingan dan
kontraindikasi penicillin?
Cephalosporins
 Cara Tindakan

• Broad Spectrum (Gram +ve

& some Gram –ve)
• Bactericidal:
–Destroy bacterial cell wall &
causes the bacteria to die.
Indications (Cephalosporins)

• Urinary tract infections

• Respiratory tract infections
– Pharyngitis, Tonsillitis, Otitis
media
• Gonorrhea
Generasi (Cephalosporins)

• First Generation
• Second Generation
• Third Generation
 First Generation

Contoh ubat

• Cephalexin (Keflex)
• Cephalexin (Ceporex syr)
 1. Cephalexin (Keflex)
Category: B

Dose
• Adult:
• 250-500mg q 6 hr PO
2. Cephalexin (Ceporex syr)
Category: B

Dose
• Peads (125mg/5ml syr):
• 25-100mg/kg/day (divided
dose)
• Max: 4g/day
 Second Generation

Contoh ubat

• Cefaclor (Ceclor)
• Cefuroxime (Zinnat)
• Cefuroxime (Zinacef)
 1. Cefaclor (Ceclor)
Category: A

Dose
• Adult:
• 250mg q 8 hr PO
• Severe infection: double
dosage
• Max: 4g/day
 Dose

• Peads:
• 1 yr: 20mg/kg/day PO (divided
dose)
• Max: 1g/day
2. Cefuroxime (Zinnat)
Category: A

Dose
• Adult:
• 250-500mg bid PO
• Peads:
• 125mg bid PO
 3. Cefuroxime (Zinacef)
Category: A

Dose
• Adult:
• 750mg tid IM/ IV
• Sever infection: 1500mg tid-
qid IV
 Dose

• Peads:
• 30-100mg/kg/day IM/ IV
(divided dose)
 Third Generation

Contoh ubat

• Cefoperazone (Cefobid)
• Cefotaxime (Claforan)
• Ceftriaxone (Rocephin)
• Ceftazidime (Fortum)
1. Cefoperazone (Cefobid)
Category: A

Dose
• Adult:
• 1-2g bid IM/ IV (may be
doubled)
• Max: 9g/day (divided dose)
• Peads:
• 0.025-0.05g/kg bid-qid IM/ IV
2. Cefotaxime (Claforan)
Category: A

Dose
• Adult:
• 1g bid-tid IM
 Dose
• Peads:
• 50-150mg/kg/day IM (2-3
divided doses)
• Neonates/infant: 50mg/kg/day
IM (divided dose)
3. Ceftriaxone (Rocephin)
Category: A

Dose
• Adult:
• 1g/day IM/ IV (single dose)
• Severe infection: 1g bid-qid
 Dose

• Peads > 6 weeks:

• 20-50mg/kg/day IM/ IV (single
dose)
• Severe infection: up to
80mg/kg/day IM/ IV (single
dose)
4. Ceftazidime (Fortum)
Category: A

Dose
• Adult:
• 1g q 8 hr IM/ IV or 2g q 12 hr
IM/ IV
• Severe infection: 2g q 8 hr IM/
IV
 Dose

• Peads > 2 months:

• 30-100mg/kg/day IM/ IV (2-3
divided dose)
• Neonates & peads up to 2 mo:
• 25-60mg/kg/day IM/ IV (2
divided dose)
Kesan Sampingan
• Hypersensitivity
• Nausea
• Vomiting
• Diarrhea
• Nephrotoxicity
• Rashes
• Epidermal necrolysis
• Steven Johnson Syndrome
• Heartburn
• Fever
 Contraindication

• Allergic to cephalosporins &

penicillins
 Cautious

• Renal & hepatic disease

• Bleeding disorders
• Pregnancy
• Lactation
 Interactions

• Aminoglycosides
• Meningkatkan risiko
nephrotoxicity
• Oral Anticoagulants
• Meningkatkan risiko
pendarahan
• Alcohol
• Severe adverse reactions
(chest pain, arrhythmias,
unconsciousness)
 Soalan

1. Terangkan cara tindakan

cephalosporin?
2. Senaraikan contoh ubat
cephalosporin?
3. Nyatakan kesan sampingan dan
kontraindikasi cephalosporin?
Tetracyclines
 Cara Tindakan

• Broad Spectrum (Gram +ve &

Gram –ve)
• Bacteriostatic:
– Menghalang pertumbuhan
bacteria
– Menghalang synthesis protein
dalam bacteria.
 Indications (Tetracycline)

• Urinary tract infections

• Skin infections
• Respiratory tract infections
• Typhus fever
• Penicillin contraindicated
patient
 Contoh ubat

• Doxycycline (Vibramycin)
• Tetracycline (Achromycin)
• Oxytetracycline (Terramycin)
 1. Doxycycline
(Vibramycin)
Category: B

Dose
• Adult:
• 200mg PO on day 1
• Followed by 100mg/d PO
 Dose

• Peads > 9 yrs:

– 4.4mg/kg PO on day 1
– Followed by 2.2-4.4mg/kg/d PO
 2. Tetracycline
(Achromycin)
Category: B

Dose
• Adult:
• 250-500mg q 6 hr PO or
• 1-2g/day PO
 Dose

• Peads > 9 yrs:

– 25-50mg/kg/d PO (4 equally
divided dose)
 3. Oxytetracycline
(Terramycin)
Category: B

Dose
• Adult:
• 1-2g/day PO (divided dose)
• 250-500mg q 12 hr IV
 Dose

• Peads > 9 yrs:

– 15-25mg/kg/d IM (divided dose)
 Kesan Sampingan
• Nausea & vomiting
• Diarrhea
• Hypersensitivity
• Photosensitivity
• Discoloration (yellow-gray-
brown) of teeth (< 9 yrs)
 Contraindication

• Allergic to Tetracycline
• Pregnancy
• Lactation
• Children < 9 yrs
 Cautious

• Renal function impairment

 Interactions
• Antacids (aluminum, zinc,
magnesium/ bismuth salts)
& High calcium food
• Mengurangkan penyerapan
tetracycline
• Oral Anticoagulants
• Meningkatkan kesan
anticoagulant
• Oral contraceptives
• Mengurangkan kesan oral
contraceptives
• Digoxin
• Meningkatkan risiko digitalis
toxicity
Macrolides
 Cara Tindakan

• Narrow Spectrum (Gram +ve &

Gram –ve)
• Bacteriostatic & Bactericidal:
– Menghalang synthesis &
merosakkan protein dalam
bacteria.
 Indications (Macrolides)

• Respiratory tract infections

• Skin infections
• Acne
• Genital tract infections
 Contoh ubat

• Erythromycin stearate
(Erythrocin)
• Erythromycin Ethyl Succinate
(EES)
 1. Erythromycin stearate
(Erythrocin)
Category: B

Dose
• Adult:
– 250-500mg qid PO
• Peads:
– 30-50mg/kg/d PO (4 divided dose)
 2. Erythromycin Ethyl
Succinate (EES)
Category: B

Dose
• Adult:
• 400-800mg bd PO
• Peads > 9 yrs:
– 30-50mg/kg/d PO (2-4 divided
dose)
 Dose
(susp 200mg/5ml)
• Peads:
• Mild to moderate infection:
– 30-50mg/kg/day PO (equally
divided dose q 6 hr)
• Severe infection:
– Dose may be doubled
 Kesan Sampingan

• Nausea & vomiting

• Diarrhea
• Abdominal pain
• Hypersensitivity
 Contraindication
• Allergic to Macrolides
• Pre-existing liver disease

Cautious
• Pregnancy
• Lactation
 Interactions
• Digoxin
• Meningkatkan paras serum
digoxin
• Oral Anticoagulants
• Meningkatkan kesan
anticoagulant
• Antacids
• Mengurangkan penyerapan
macrolides
• Clindamycin, Lincomycin/
Chloramphenicol
• Mengurangkan aktiviti terapeutik
macrolides
• Theophylline
• Meningkatkan paras serum
theophylline
 Soalan

1. Terangkan cara tindakan

Tetracycline & Macrolides?
2. Senaraikan contoh ubat
Tetracycline & Macrolides?
3. Nyatakan kesan sampingan dan
kontraindikasi Tetracycline &
Macrolides?
Aminoglycosides
 Cara Tindakan
• Narrow Spectrum (some Gram
+ve & Gram –ve)
• Bactericidal:
– Membunuh bacteria
– Menghalang synthesis protein
dalam bacteria.
 Indications
(Aminoglycosides)

• Gastro-Intestinal infections
• Respiratory tract infections
• Skin infections
 Contoh ubat

• Streptomycin
• Kanamycin (Kantrex)
• Gentamycin (Garamycin)
• Amikacin (Amikin)
 1. Streptomycin
Category: B

Dose
• Adult:
• 500mg-1g/d IM (divided dose)
 2. Kanamycin (Kantrex)
Category: A*

Dose
• Adult & Peads:
• 500mg-1g/d IM (divided dose)
3. Gentamycin (Garamycin)
Category: B

Dose
• Adult:
• 3mg/kg q 8 hr IM/ IV (divided
dose)
• Severe infection: up to 5mg/kg
q 8hr IM/ IV (divided dose)
 Dose
• Peads:
– 2.5-3.5mg/kg q 8 hr IM/ IV
(divided dose)
 4. Amikacin (Amikin)
Category: A

Dose
• Adult:
• 15mg/kg/day IM/ IV q 8-12 hr
(7-10 days)
• Max: 1.5g/day
 Dose
• Peads:
• 15mg/kg/day IM/ IV q 8-12 hr (7-
10 days)
• Max: 1.5g/day
• Neonates:
• Initial loading dose 10mg/kg/day
IM/ IV (2 divided dose)
• Followed by 15mg/kg/day IM/ IV
q 12 hr
 Kesan Sampingan
• Nausea & vomiting,
• Diarrhea
• Hypersensitivity
• Ototoxicity
• Nephrotoxocity
• Neurotoxicity
• Superinfection
 Contraindication

• Allergic to Aminoglycosides
• Pre-existing hearing loss
• Pregnancy
• Lactation
• Parkinsonism
 Cautious

• Renal Failure
• Elderly
• Nueromuscular disorders
 Interactions
• Cephalosporins
• Meningkatkan risiko
nephrotoxicity
• Loop diuretics
• Meningkatkan risiko
ototoxicity
• Shortly after general
anesthesia
• Neuromuscular blockage
(Paralysis of the respiratory
muscle)
Chloramphenicol
 Cara Tindakan
• Broad Spectrum (some Gram
+ve & Gram –ve)
• Bacteriostatic:
– Menghalang pertumbuhan
bacteria
– Menghalang replikasi bacteria.
• Digunakan jika antibiotic lain
tidak berkesan.
 Indications
(Chloramphenicol)

• Respiratory tract infections

• Skin infections
• Sensory organ infection
(eyes & ears)
 Contoh ubat

• Chloramphenicol
(Chloromycetin)
1. Chloramphenicol
(Chloromycetin)

Category: B
 Dose (oral)
• Adult:
• 500mg qid PO or
• 50mg/kg/day PO (4 divided
dose)
• Peads:
• 25-100mg/kg/day PO (4
divided dose)
 Dose (Parenteral)
• Adult:
• 1500-3000mg/day (divided
dose q 6 hr)
• Peads:
• 25-100mg/kg/day (divided
dose q 6 hr)
 Dose (Topikal)

• Ear:
– 2-3 drops bd - tds
• Eye:
– Drops: 1-2 drops q 3-4 hr
– Ointment: ½ inch q 3-4 hr
 Kesan Sampingan
• Fatal blood dyscrasias
• Superinfection
• Hypersensitivity
• Nausea
• Vomiting
• Diarrhea
 Contraindication
• Allergic to Chloramphenicol
 Cautious

• Liver & kidney disease

• G6PD deficiency
• Elderly
• Pregnancy
• Lactation
 Interactions
• Oral hypoglycemic agents,
oral anticoagulants &
phenytoin
• Kesan semua ubat di atas
meningkat
• Phenobarbital / Rifampicin
• Mengurangkan paras serum
chloramphenicol
 Soalan
1. Terangkan cara tindakan
Aminoglycosides &
Chloramphenicol?
2. Senaraikan contoh ubat
Aminoglycosides &
Chloramphenicol?
3. Nyatakan kesan sampingan dan
kontraindikasi Aminoglycosides
& Chloramphenicol?