Prinsip Antibiotik

Ika Mustikaningtias, M.Sc., Apt.

Laboratorium Farmakologi dan Farmasi Klinik
Jurusan Farmasi FIKes
Universitas Jenderal Soedirman
Key facts
• Antibiotics are medicines used to treat infections caused by
bacteria
• Antibiotics work by killing bacteria and/or preventing their
growth
• Different types of antibiotics treat different kinds of infection
• Antibiotics are commonly prescribed for respiratory infections,
but most of these are caused by viruses, not bacteria
• Most patients are prescribed antibiotics without the doctor
knowing the cause of the infection
(NHS)
Key facts (con’t…)
• If you take antibiotics when you don’t need them, they
may lose their ability to kill bacteria
• Antibiotics resistance is growing. If the bacteria keep
‘overpowering’ the medicines we have, we may run out
of ways to kill these bacteria
• Antibiotic-resistant bacteria can cause serious infections
and can be spread to others in your family
(NHS)
 CHOICE OF A SUITABLE DRUG
CHOICE OF A SUITABLE DRUG
History of allergy
Age
The Patient
Renal, hepatic
function
Immunocompromise
d
Ability to tolerate drugs by
mouth
Severity of illness
The Taking other
causative medication
Female problem
organism
 Staphylococcus

Streptococcus

Enterococcus

Listeria
Gram
Bascillus
Positif
Clostridium

Mycobacterium

Mycoplasma
 Salmonella

Escherichia

Shigella

Gram Pseudomonas

Negatif Helicobacter

Haemophillus

Bordetella

Chlamydia
 Narrow Hanya memiliki satu
spectrum spectrum yg efektif

Spektrum
antibiotik Efektif utk melawan
Broad beberapa bakteri yg
spectrum bukan satu golongan
Gram
antibiotik
Terapi empiris
Terapi
Terapi definitif
Terapi
profilaksis
Terapi Empiris

Belum diketahui jenis bakteri penyebabnya

Erdikasi bakteri terduga, sblm ada hasil pmx

mikrobiologi
Peta pola kuman, kondisi klinis px, ketersediaan
antibiotik, kemampuan peneterasi

48-72 jam
 Contoh terapi antibiotik
CAP empiris
Pathoge S. Quinolone IV q24h x 1-2w
n Pneumoniae or combination therapy with
unknow H. Influenzae Ertapenem 1gr IV q24h x 1-2w
n M. or
Catarrhalis Ceftriaxone 1gr IV q24h x 1-2w
Mycoplasma plus either
pneumoniae Doxycycline IV x 1-2 w
Chlamydia or
pneumoniae Azitromycin 500 mg IV q24h x 1-2w
 Contoh terapi antibiotik
GI tract empiris
Acute E. Coli Preferred :
watery Campylobact Quinolone IV or PO x 5d
diarrhea er Alternate :
Yersinia Doxycycline 100 mg IV or PO q12h
Salmonella x 5d
Vibrio sp. Or
TMP-SMX 1 DS tab PO q12h x 5d
Typhoid Salmonella Preferred :
fever typhi/non- Quinolone IV or PO x 10-14d
typhi Or
TMP-SMX 5mg/kg IV or PO q6h x10-
14d
Terapi Definitif

Bakteri penyebab & pola resistensi diketahui

Erdikasi bakteri penyebab infeksi

Efikasi klinis, sensitivitas, biaya, kondisi px, lini

pertama, sesuai PDT, risiko resisten terkecil

Durasi sesuai diagnosis & indikasi

Terapi Profilaksis

Mencegah ILO

Sebelum, saat, hingga 24 jam post ope

Operasi bersih dan bersih kontaminasi

Rute : IV atau IV drip

Terapi Profilaksis

Dosis tunggal

Dapat diulang jika ope >3 jam atau ada indikasi

perdarahan >1500 mL
 Inhibit cell
wall
synthesis or
function
Inhibit
Antibiotic protein
synthesis
Inhibit
nucleic acid
synthesis or
function
 Penicillin

Cephalospori
Inhibit cell n
wall
synthesis or
function Carbapenem

Polypeptida
 Klasifikasi Sefalosporin Spektrum
GENERASI PERTAMA
• cefazolin Sama dengan penisilin, sensitif terhadap
• cefalexin penisilinase
• cefadroxil

GENERASI KEDUA
• cefaclor Aktivitas terhadap gram negatif meningkat,
• cefamandol dan lebih tahan terhadap enzim penisilinase
• cefotetam
• cefoxitin
• cefuroxim
GENERASI KETIGA
• cefotaxim Aktivitas terhadap gram negatif meningkat
• ceftazidim dan lebih tahan terhadap penisilinase
• ceftriaxon dibanding yang sebelumnya,
• cefoperazon Mampu menembus sawar darah-otak

GENERASI KEEMPAT Aktivitas gram negatif meningkat,

• cefepime khususnya untuk pseudomonas A. Termasuk
•cefpirome gram negatif yang mulai resisten
Ceftaroline
Memiliki aktivitas yang mirip dengan Ceftriaxone
akan tetapi memiliki aktivitas yang lebih baik
terhadap Gram positif

5 generation of Cephalosporin
th
 Macrolides

Inhibit 50s
Clindamycin
subunit

Inhibit Chloramphe
protein nicol
synthesis
aminoglycos
ides
Inhibit 30s
subunit
tetracyclines
 Inhibit DNA
Quinolones
gyrase

Sulfonamid
Inhibit folate
Inhibit synthesis
nucleic acid
synthesis or Trimethoprim
function

Metronidazol
e
Create free
radicals
Nitrofurantoi
n
Bakteriostatic vs Bactericidal
 Monotherapy vs Combination
Therapy ?

Examples of
antibiotics Carbenicillin + aminoglycoside
combinations
that prevent
resistance
Rifampin + other TB drug

5-flucytosine + amphotericin B
Failure antimicrobial
therapy

Drug
selection

Host factors

Microorganis
m
Antimicrobial Use
Management
Terimakasih