A. Biotik
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Transcript of A. Biotik
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Antibiotik
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Ant ib iot ik:
* Bahan / zat yg dihasilkan oleh mikroba
/ sintetiknya
* Membunuh /menghambat pertumbuhan
mikroba lainnya
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Gejala infeksi
hostKU
antibiotika
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Klasifikasi :
Struktur
kimia
spektrum Titik tangkap
kerja
* Penic i l l in
* Cephalospo rin
*Tetracyclin
*Chloramphenicol
* Macro l id
* Am inoglycos ide
* Quino lon
* Broad
* Narrow
* Dind ing sel
* Membran sel
* Sintesa pro tein
* Asam nukleat
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Titik tangkap kerja :
Dinding
sel
Membrane
sel
Sintesa
protein
Asam
nukeat
Penicilin
Cephalosporin
Monobactam
Carbapenam
Glycopeptide
Colistin
Polimixin .B
Tetracyclin
Chlorampheni
col
Aminoglycosid
Macrolid
LincomycinClindamycin
Rifampicin
Quinolon
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Hepatotoksik
>>> >
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Bacterosid Bacteriostatik
Penicilin
Streptomycin
Cephalosporin
Gentamycin
Quinolon
Polymycin
Bacitracin
Tetracycl in
Chloramphenicol
Erythromycin
L incomyc in
Sulfonamide
Dosis >>
Bac-sid
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Tx Ant ib io t ika kombinasi
Sinergis . Bac-sid + bac-sid
Aditifbac-statik + bac-statik
Antagonisbac-sid + bac-statik
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Resistensi
AB
Ku Ku
Ku resisten
Natural drug resisten
Aquired/ didapat
Silang
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Cross resisten:
Struktur kimia
sama : der Tetra
Polymyxin B ~ Colistin
tak sama : Erythromycin ~ Lincomycin
Reaks i yg merug ikan:
*Superinfeksi ( broad > narrow )
*Hipersensitifitas ( alergi )
*Toksisitas organ
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Penicillin
*Alami: jamur Penicilinum Notatum/ Chrysogenum
*Sem i sintet ik
*Sintet ik :rumus bangun :6-Am inopenic i l lanic acid
S
C C C
C N C
-lactamase / pen ici l in ase
amidase
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Penicillin
Farmakokinetik :
Abs : Pe cepat / Po bervariasi
Dist : seluruh jar tb ( serum ~ jar )
kadar (> ) : 90 % seks tubulus
10 % filtrasi glomerulus
sputum / asi
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Penicilin
Generic name spectrum PO Pen-ase Res
1.Pen-G2. Pen-V
3. Methicilin
4. Nafcillin5. Isoxazolyl -
Penicilin
Oxacillin
Cloxacillin
Dicloxacillin
Flucloxacillin
GR+>>GR-
Idem
Idem
Idemidem
+
+
-
+
-
--
-
-
-
-
-
--
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Kuman-kuman :
Staphylococcus
H. Influenzae
N. Gonococcus
E. colli
Beta-lactamase
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Beta-lactamase inhibitor:
Clavu lanic acid Sulbactam/ Tazobactam
( penicillinic acid sulfon )
Streptomyces semi sintetik
clavigerus ( inti pen )cara kerja
Meng ikat beta-lactamase
( anti bacteria >>>> )
+ amoxycillin + ampicillin
( Augmentin ) ( Unasyn )
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Penici l l in
Kl in is :
* First chioce drug bac meningitis,inf bone, joints, skin, soft tissue,
bronchi, tr UG.
* Gonorrhoea, syphilis
( banyak kuman yg sudah resistens
seperti juga pada Staphycc )
C h l i
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Cephalosporin
Jamur Cephalosporium acremonium semi sintetikCara kerja / struktur kimia ~ Pen
rumus bangun : 7 am inocephalospo ranicacid
S ( relatif tahan pen-ase )
C C C
C N C
C
- lactamase
amidase
Cross alergy ~ Pen
( Jarang 6-16 % )
Kinetik ~ Pen
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Cephalosporin G e n e r a s i
I II III IV
Spektrum ~ Pen > >>
Stabil Pen-ase > Pen > >> >>>
Potensi + ++ +++ ++++
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Cephalosporin
Generasi
I II III IV
Cefazolin
Cephalothin
Cephalexin
Cephadroxil
Cefuroxim
Cefaclor
Cefoxitin
Cefotetan
Cefotaxime
Ceftriaxone
Ceftazidime
Cefixim
Cefepim
Kl i i
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Kl in is :(cephalosporin)
*Bacteriemia ( + aminolgycosida )
*Surgical prophylaxis .. Pre / post OP*Mixed infection ( + anaerobes )
*Bacteri gram (- )
Reaksi yg m erug ikan:
*Pemberian Po.. N/V/D, IM iritasi/pain
IV thromboplebitis*Hipoprothrombinemia (ggn pembekuan darah)
*alergi
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Tetracyclin:
*Oxyteteracyclin
*Tetracyclin
*Doxycyclin
*Minocyclin
Basa sukar larut air ( bentuk garam mudah larut )
Stabil pH asam
Cara kerja : Sintesa protein
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F.Kinetik :
Abs : Po tak lengkap
Chelasi dg ion Ca , Mg , Al
membentuk ikatan komplek : - tak larut
- sukar di abs
Makanan mengurangi abs ( kec : Doxy / Mino )
Dist : seluruh jar
Doxy / Mino : lipid sol >>
Oxytetra : lipid sol
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Disimpan di tulang / gigi ( gigi coklat ) (< 8-9 th )
Eks : Ren (>>> )
Bile (>
( renal failure ..akumulasi (-) )
Klinis : - streptococc - staphylococc - pneumonia
- GO - Lues - LV - I nf trct UG
- ThyphusTrachoma - Acne
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ES : ( tetracyclin )
* Iritasi lambung ( > Oxytetra )
* Superinfeksi
* Hepatotoksik ( < Oxy / Tetra )
* Discoloration gigi / pertumbuhan tl ( < Oxy / Doxy )
* Hypersensitivity
* Photosensitif ( Demeclocyclin )
Waktu perdarahan >>
Nefrotoksisitas (dosis tinggi dan bersama obat lain)
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Chloramphenicol
Sintetik
Sintesa protein
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Chloramphenicol
glucoronyl transferase ( hepar )Chloramphenicol
glucoronide
new borne (-) ( hepar >>
( gray sindrom )
t-tbh < , muntah
Kulit kelabu
Circulatory failure
Shock mati
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Klinis : * inf Salmonella
* inf H. influenzae ( meningitis )
* salep mata
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Thiamphenicol
~Chloramphenicol
( - NO2 digantiCH2So2 ( sulfomethyl ) )
Anti bac < ( kec :Bordetella pertusis /
Shigella sonnei )
Depresi bone marrow
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Aminoglycosida
StreptomycinNeomycin
Kanamycin :
( Amikasin / Dibikasin)
Tobramycin
Gentamycin
Sisomysin
Netilmycin
Abs : Po
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Streptomycin( dr streptomyces griseus )
Broard spect..terutama G (-) / ku TBC
Sintesa protein ..kadar max 1 -2 jam
Dist : seluruh jar
( CNS / CSF / Cairan sendi
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Klinis : TBC
Inf sal kemih
Meningitis
Bacteriemia / endocarditis ( + Pen )
ES : Hipersensitifitas
Ototoksik: pendengaran ( dihydro strep )
keseimbangan ( strep )
Nefrotoksik
Curare like . Kelemahan otot.
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Gentamycin ( Garamycin )
Abs : Po
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Lincomycin/Clindamycin
larut air
acid stable
bacterioside
toksisitas : liver damage / CV collaps
Digeser Clindamycin :
- Potensi >, Toksisitas
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Clindamycin
ES : iritasi GI N / V
superinfeksi
pseudomembrane colitis
bad-taste penetrasi saliva
Klinis :
- infeksi kulit ( G + )
- Inf- tract Resp ( H. influenzae )
- Acne
M lid
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Macrolide :
Erythromycin
Spiramycin
Roksitromycin
Claritomycin
Azithromycin
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Erythomycin
( dari streptomyces erythreus)
sintesa protein
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Resistensi antar Macrolide
Klinis :
*inf Upper resp *Diphteri carrier
*G (+) Pen-resisten *Acne
*lues Pen alergi
ES :
Po: N / V/ D /
lositis / stomatitis/ su er infeksi
Spiram cin
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Spiramycin
Cara kerja ~ Erythromycin
Spectrum : gram + / -
clamydia trachomatis
Toxoplasma gondii
Cryptosporidum muris ( AIDS )
F-kinetik :
Abs : po baik
Dist ..bronchus/saliva, prostat, muscle.
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Eks : urine
bile
t 4 -8 jam
ES : GI tract ..N / V / mulut kering
skin rash / asma / colitis
Klinis : Inf staphylococc / streptococc / pneumococc
GO ( resisten )
Toxoplasmosis
trachoma
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Roksitromycin ~ Erythromycin
iritasi lambung
t 10 jam ( 2dd )
Azithromycin t >> ( 1dd 500 mg )
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Rifampicin
Semi sintetik
Broad spct : gram (+) cocci
gram (-) bacilli
tuberculosaES : GI
Hepar ( terutama kel - hepar )
Enzym inducer
Use : TBC / Lepra
pseudomembrane colitis
Polymyxin A / B / C / D / E / M
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PolymyxinA / B / C / D / E / M
colistin
bacterioside.. G (-)
inf trct UG / telinga / kulit
use . Topikal ( aman ) , sistemik gg Ren / CNS
Potensiasi dg obat neuro-muscl paralysis
kelemahan ototLysis mast sel histamin
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Colistin
Spectrum / cara kerja ~ Polymyxin-B
Potensi >
GO / Chlamydia
Staphylococc
Pseudomonas A
F K i tik
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F. K inetik :
Abs : Po ( 50 90 % )
Dist : luas konst Ren / Pulmo > serum
CSF < serum
Sekrs : ren ( F-quinolon )
non renal : Quinolon + Pefloxacin
Hepatic failure : F-quinolon (+)
( kec. Pefloxacin )
Klinis :
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Klinis :
*Complicated urinary tract infection
* Gonorrhae
* Cervisitis
* Prostatitis
* Typhoid fever
* Septicemia ( thdp ku yg sensitive )
* Resp tract infection( bukan ok pneumococci )
Adversed reaction : ( f-quinolon )
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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 (-) )
Sulfonamides& Trimethoprim
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Sulfonamides& Trimethoprim
Sulfadiazine
Sulfisoxazole
Sulfamethoxazole +TrimethoprimCo-trimoxazole( Bactrim )
Sulfacetamide
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Co-trimoxazole:
( bacterioside )
Trimethoprim ( 1) + Sulfamethoxazole (5)( bacteriosatik ) ( bacteriostatik)
Klinis :
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s
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 immunosupresed )
Adverse effects
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Adverse effects ( co-trimoxazole )
Sulfonamide Trimethoprim
Alergy-rash, fever,
Stevens-johnson synd
Agranulocytosis
Kristal uria
Haemolysis
Inhibit metab- obat
Macrocytic anemia
Trombocytopenia
Aplastic anemia (elderly )
Fakto r kegagalan Tx Antib iot ika
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Fakto r kegagalan Tx. Antib iot ika
1. Indikasi kurang tepat
2. Dosis