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Antimicrobial Dosage Forms and Its Application: Adisti Dwijayanti, Desak Gede BK Dr. Francisca Diana A, M.SC
Antimicrobial Dosage Forms and Its Application: Adisti Dwijayanti, Desak Gede BK Dr. Francisca Diana A, M.SC
Antimicrobial Dosage Forms and Its Application: Adisti Dwijayanti, Desak Gede BK Dr. Francisca Diana A, M.SC
• Introduction
• Dosage forms
• Route of administration
• Dosing
Steps in Prescribing
Pathophysiology/Pathogenesis
Route of administration
Dosage form
semisolid Gas
Prescribing errors involving
medication dosage forms
• Incident = 10%
• Outcome = fatal 0,7%, serious 12,2%
Powder/
gel injection
pulveres
ovule drops
•FAKTOR FAKTOR SEBAGAI
PERTIMBANGAN DALAM MEMILIH BSO
SIFAT OBAT
BIOAVAILABILITAS OBAT
PENDERITA
Dosage form
Systemic or Route of
Local effects Administration
Routes of Administration
Oral Injections
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Antimicrobial Dosage Forms
Antibacterial, Antifungal, Antiviral, Antiparasitic
ANTIBACTERIAL
Inhibitors of DNA
function
Inhibition of Cell Wall Inhibitors of • Gyrase inhibitors
• Nalidixic acid
Synthesis Tetrahydrofolate • Norfloxacin
• Penicillins Synthesis • Ofloxacin
• Cephalosporin • Sulfonamides (bacteriostatic) • Ciprofloxacin
• Bacitracin • Trimethoprim (bacteriostatic) • Lefofloxacin
• Vancomycin • Co-trimoxazole (bactericidal) • Nitroimidazole
• Sulfasalazine • Metronidazole
• Timidazole
• Rifampin
• Acid resistant
Penicillin V
• Tab 125 mg; tab 250 mg; tab 500 mg, dry syrup 250 mg/mL
(Phenoxyl penicillin)
Amoxicillin
Ampicillin • Acid resistant, Better absorbed than ampicillin
• Acid sensitive • Drops 125 mg/1,25 mL (Amoxyl ) (10 mL),
Aminopenicillin • Inj powder IM/IV 250 pipette calibration 125 mg; 62,5 mg
mg/vial & 500 mg/vial; Inj • tab 500 mg; tab 250 mg; inj 1g; dry syrup 125
powder IV 1 g/vial mg/5 mL
Oral Parenteral
Cefazolin - Inj 500 mg & 1 g
Cefadroxil Tab 500 mg; Caps 500 mg; Dry Syr 125 mg/5 mL -
& 250 mg/5 mL
Ceftriaxone - Inj 1 g
Cefotaxime - Inj 0,5 g; inj 1 g
Cefixime Caps 100 mg; Caps 200 mg; Dry syr 100 mg/5 -
mL
Cefepime - Inj 1 g
Ceftriaxone
Ceftriaxone sodium injection 1 g
• For intravenous use, maximum concentration 100 mg/mL
• For intramuscular use, maximum concentration 250 mg/mL
• Bacitracin
• Only for topical therapy
• Vancomycin
• Not absorbed via GI tract
• Pemberian IM menimbulkan nekrosis setempat
• Oral treatment of bowel inflammations occuring as a complication of antibiotic
therapy (pseudomembranous enterocolitis caused by Clostridium difficile)
• Sulfonamides
• Most are well absorbed via the enteral route
• Some are poorly absorbed from the gut suitable for the treatment of bacterial bowel
infections
• Metronidazole
• Well absorbed via enteral route
• Also given IV or topically (vaginal insert)
• Dosage forms
• Levofloxacin
• Tabl 250 mg; 500 mg
• Infusion 500 mg/100 mL; 750 mg/150 mL
• Tetracycline
• Low solubility
• More soluble in hydrochloride
• Absorption nearly complete for doxycycline and minocycline
• Form insoluble complexes with plurivalent cations (e.g. Ca2+, Mg2+, Al3+, Fe2+/3+) ><
concurrent ingestion of antacids and dairy products
• Dosage forms
• Tetracyclin: Caps 250 mg; caps 500 mg
• Dosage forms
• Caps 250 mg; Caps 500 mg; Susp 125 mg/5mL; Inj powder IV 100 mg; Inj powder IV 1 g
• Aminoglycosides
• Contain numerous hydroxyl groups and amino groups that can bind
protons highly polar, poorly membrane permeable, not absorbed
enterally
• Injection
• E.g. Gentamicin, Tobramycin, Amikacin, Netilmicin, streptomycin
• Inhalation e.g. Tobramycin
• Dosage forms:
• Gentamycin: Inj 10 mg/mL; Inj 40 mg/mL; Inj 80 mg/mL
• Streptomycin: Inj powder 1 g/vial
• Erythromycin
• Poorly soluble in water, usually dispensed as a various esters and salts
• as a salt (Erythromycin stearate)
• as an ester (Erythromycin succinate)
• Erythromycin base is destroyed by stomach acid, must be administered with enteric coating
• Food interferes with absorption
• Stearates and esters are fairly acid-resistant better absorbed
• Erythromycin estolate best absorbed oral preparation
• Dosage forms
• Drops (Erythrocine) 100 mg/2,5 mL (30 mL); Dry syrup 200 mg/5mL; Film coated tablet 250 mg, tablet 500 mg, chewable tablet 200 mg;
• Clindamycin
• Orally, better absorbed than lincomycin
Anti Viral
• Acyclovir
• Enteral absorption incomplete (15-30%)
• Tablet 200 mg; 400 mg
• Cream 5% 5g; 10g
• Injection 250 mg vial,
• Gancyclovir
• Injection 500 mg vial
• Valacyclovir
• Absortion rate >2x acyclovir
• oral
Anti Viral
• Anti HIV regimens
• HAART: ≥ 3 anti-HIV • Nevirapine
combination, at least 2 • Tab 200 mg
different mechanism
• Efavirenz
• Zidovudine • Tab 600 mg
• Tab 300 mg
• Zidovudine & Lamivudine
• Lamivudine combination
• Tab 150 mg
ANTIFUNGAL
• Poorly absorbed, poorly tolerated systemically
• Most for topical uses clotrimazole, isoconazole, miconazole (Cream 2%)
Imidazole
• Ketoconazole is well absorbed (tablet 200 mg, cream, shampoo)
derivatives • Trizaole derivates : fluconazole (Caps 50 mg; Caps 150 mg; Inj 2 mg/mL),
itraconazole (Capsule 100 mgl
• Lindane
• Permethrin
RDT
ANTIMALARIALS
• Quinine-HCl
• Injection 250 mg/mL ampul 2 ml
• Tab 200 mg; Tab 222 mg; Tab 250 mg
• Chloroquine
• Syrup 80 mg/5 ml (50 ml)
• Artesunate
• Tablet 50 mg
• Injection 60 mg/mL ampul 1 mL
• Artemether
• Injection 40 mg/mL; 80 mg/mL ampul 1 mL
• Amodiaquine
• Tablet 153 (amodiakuin base)
• Primaquin
• Tab 15 mg
ANTIMALARIALS
• Combination
• Artemether-Lumefantrine
• tablet Artemeter 20 mg + lumefantrin 120 mg
• Sulfadoxine-Pirimethamine
• Tablet sulfadoksin 500 mg + pirimetamin 25 mg
• Artesunate- Amodiaquine
• Tab artesunate 50 mg + amodiaquin 200 mg
Prescribing
Pathophysiology/Pathogenesis
Diagnosis, Therapeutic objective
Drug of Choice
Mechanism of action, Indication,
Contraindication, side effect, interaction
Route of administration
Dosage form
SULFONAMID AMINOGLYCOSIDE
FLUROQUINOLONES ERYTHROMYCIN
•Kombinasi Obat-Obat Antibiotik
• Infeksicampuran.
• Ada risiko resistensi organisme, misalnya
pada TBC.
• Keadaan yang membutuhkan AB dengan
dosis besar, misalnya sepsis, dan
etiologi infeksi yang belum diketahui.
•Kombinasi Obat-Obat Antibiotik
• Harga terjangkau.
Gunakan sefalosporin generasi I – II untuk
profilaksis bedah.
Pada kasus tertentu yang dicurigai melibatkan
bakteri anaerob dapat ditambahkan metronidazol.
Cefixime Dose:
20 mg/kgBW/day (2 times a day)
Pro : XYZ
Umur : 3 tahun 3 bulan ; 14 kg
Dr. ABCD
SIP No. 123456/Yan-Kes/2000
Jl. Sehat Raya No. 6 Jakarta Timur
Jakarta, 1 Maret 2012
Pro : XYZ
Umur : 3 tahun 3 bulan ; 14 kg
RESEP LENGKAP 1. Tanggal penulisan resep
2. Mengisi kolom riwayat alergi obat pada bagian kanan atas lembar
resep manual atau secara elektronik dalam sistem informasi farmasi
untuk memastikan ada tidaknya riwayat alergi obat