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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