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Elly Nurus Sakinah

LO
 Mengetahui Antibakteri yang digunakan pada ISK
 Menjelaskan mekanisme kerja antibakteri tersebut
 Menjelaskan efek samping antibakteri tersebut
 Mampu mengaplikasikan penggunaan antibakteri
pada ISK
Farmakoterapi pada ISK
 Tujuan :
 mencegah infeksi sistemik,
 eradikasi kuman, dan
 mencegah infeksi rekuren
 Prinsip Umum :
 Evaluasi awal : gejala, lokasi infeksi, komplikasi
 Pemilihan antibakterial
 Folow up
Quinolon
Quinolon / Fluroquinolon
Generasi I Generasi II Generasi III
Nalidixic acid* Norfloxacin . Moxifloxacin .
Gemifloxacin
Pipemidic acid* Ciprofloxacin
Ofloxacin .
Cinoxin Pefloxacin .
Sparfloxacin.
Levofloxacin .
quinolon

Cara kerja :

Menghambat DNA girase


( enzym supercoiling DNA )
Spektrum :

Quinolons  Gram (-) ( trct UG )


Fluoroquinolons  Gram (-) >>
GO / Chlamydia
Staphylococc
Pseudomonas A
Kinetik per oral

* Nalidixic acid + ( t ½ = 6 jam )

* Norfloxacin ++ ( t ½ = 3 jam )

* Ciprofloxacin ++ ( t ½ = 3 jam )

* Ofloxacin ++ ( t ½ = 4 jam )

* Sparfloxacin ++
* Levofloxacin ++ ( t ½ = 7 jam )

* Pefloxacin +++
* Moxifloxacin ++ / enteral ( t ½ = 10 jam )

* Gemifloxacin ++ / enteral
Quinolon
(Asam Nalidiksat ) Abs per oral ( cepat )
Ekskresi ( cepat ) → ren

( jadi tak manfaat utk infeksi sistemik )

Norfloxacin ~ asam Nalidiksat


- kadar urin tinggi ,
- kadar serum rendah
( tidak berguna utk infeksi diluar sal kemih )
Klinis :( f-quinolon )-
• Infeksi : * saluran kemih ( cipro / nor / of )
* saluran cerna ( cipro / of / pe )
* saluran napas ( ciporo / of / levo / moxi

* tulang- sendi ( cipro )


* kulit - jar lunak ( cipro ? )
* ok sexual ( cipro / levo )
Klinis Cipr Of levo Nor Pe Moxi Gemi
( itis )
UG + + +

GI + + +

Resp + + + + +

Tl-snd +

Sk- st +
Sexual + +
Klinis :( f-quinolon )

*Complicated urinary tract infection


* Gonorrhae
* Cervisitis
* Prostatitis
* Typhoid fever
* Septicemia ( thdp kuman yg sensitive )
* Resp tract infection( bukan ok pneumococci )
Adversed reaction : ( f-quinolon )
- Gangg GI tarct
- Skin rashes
- Joint pains
- Allergy
- Menghambat ikatan GABA dg reseptornya
 convulsi
- Gangg pertumbuhan tulang / cartilage
( ibu hamil / anak masa pertumbuhan (-) )
Co-trimoxazole
Sulfonamides & Trimethoprim

Sulfadiazine
Sulfisoxazole
Sulfamethoxazole +Trimethoprim Co-trimoxazole
( Bactrim )
Sulfacetamide
Co-trimoxazole :
( bacterioside )

Trimethoprim + Sulfamethoxazole
( bacteriosatik ) ( bacteriostatik)
Pteridine precursor + PABA

Pteridine + PABA
+ glutamic acid
sulfonamid
Folic acid

Dihydrofolic acid

trimethoprim Dihydrofolic acid reductase

Tetrahydrofolic acid 

DNA  Bacterial growth


Klinis : (Co-trimoxazole )
* Inf-systemic
* Inf chronis - trct UG
* Inf-ku gram (-) bacilus
* Inf-trct Resp ( bronchitis ok S.pneumoniae, H.influenzae )
* Otitis media ( S.pneumoniae, H.influenzae )
* Typhoid fever ( resisten Chloramphenicol, Ampicilin )

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

Aplastic anemia (elderly)


Teratogenic ( folate antagonist)
Penicillin
Penicillin
*Alami : jamur Penicilinum Notatum/ Chrysogenum
*Semi sintetik
*Sintetik : rumus bangun : 6-Aminopenicillanic acid

amidase S

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 )
Penicillin

Klinis:
* First choice drug  bac meningitis,
inf bone, joints, skin, soft tisssue,
throat, bronchi, tr UG.
* Gonorrhoea, syphilis
( banyak kuman yg sudah resistens
al : Staphycc )
Cephalosporine
Cephalosporin
Jamur Cephalosporium acremonium semi sintetik
Cara kerja / struktur kimia ~ Pen
rumus bangun : 7 aminocephalosporanic acid

amidase S ( relatif tahan pen-ase )

Cross alergy ~ Pen


C C C
( Jarang 10-20 % )
 Kinetik ~ Pen
C N C
-lactamase
C
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

Cefazolin Cefaclor Ceftriaxone

Cefradin Cefoxitin Ceftazidime

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