PRINSIP PENGGUNAAN ANTIBIOTIKA

Yudi Purnomo Fakultas Kedokteran Universitas Islam Malang

INTRODUCTION
Peresepan Ab cukup tinggi saat ini Peresepan Ab yang rasional diperlukan Resistensi Ab Biaya pengobatan

PRINSIP PENGGUNAAN ANTIBIOTIK

Keperluan peresepan Apakah Ab diperlukan ? Pilihan Ab Ab yg paling sesuai terhadap kasus Penentuan dosis Dosis, rute, frekuensi, durasi Monitoring efikasi Apakah Tx Ab efektif ?

APAKAH ANTIBIOTIK DIPERLUKAN ?

Ab hanya berguna utk infeksi bakteri Tak semua demam e.c infeksi & tak semua infeksi e.c bakteri Tx Ab utk infeksi e.c virus hanya untuk mencegah infeksi bakteri sekunder Meskipun etiologi bakteri sdh jelas kadang tx Ab tak selalu diperlukan

APAKAH ANTIBIOTIK DIPERLUKAN ?

Bbrp infeksi bakteri hilang spontan Infeksi ringan di permukaan kulit lebih sesuai diberikan Antiseptik drpd Ab Bila kumpulan pus seharusnya di drainage dg baik, jika drainage sdh cukup, Ab kadang tak diperlukan lagi

PILIHAN ANTIBIOTIK

Ada 3 faktor yang harus diperhatikan : - Etiologi - Pasien - Antibiotika

ETIOLOGI

Dx Klinik Gejala klinik Data empirik

Dx Laboratorium Kultur bakteri Hasil test sensitivitas penting untuk pedoman terapi

PASIEN

Usia Neonatus : pertumbuhan Lansia : Clerance Px gangguan hepar & ginjal Px hamil Px alergi skin test Px infeksi serius sepsis, meningitis

ANTIBIOTIK

Farmakokinetik Ab Farmakodinamik Ab Toksisitas Ab Interaksi Obat Ab Rute pemberian Kepatuhan Px Harga

DOSIS REGIMEN

Rute pemberian oral, topikal or parenteral Lama Tx Akut : 5-7 hari, kronik : tgt kasus

MONITORING EFIKASI

Lakukan evaluasi setelah 3 hari tx Dilanjutkan dg dosis yg sama Level treatment oral parentral, dosis, broad spektrum Level treatment parenteral oral, dosis, narrow spektr Stop tx

PENYEBAB AB TAK BERESPON

Etiologi agent resisten dg Ab Dx incorrect Pilihan Ab benar tapi dosis & rute salah Ab tak mencapai tempat infeksi Pus or jaringan rusak efek Ab Infeksi sekunder

ANTON VAN LEEUWENHOEKS MICROSCOPIC OBSERVATIONS.

SIZES OF MICROBES

BACTERIA

Basil

Coccus

Basil
Spiral

Basil

Diplococcus

BACTERIAL CELL-WALL

Madigan et al, 2012

Tortora, Funke and Case, 2013

Discovery of Penicillin in 1928

Sir Alexander Flemming (1881-1955)

Tortora, Funke and Case, 2013

ACTION MECHANISM OF ANTIMICROBES

MECHANISM OF ACTION ANTIMICROBES

Cowan, 2012

ANTIBIOTICS EFFECT ON BACTERIA

Kayser, Medical Microbiology 2005 Thieme

Efficacy of Selected AntI-Infective Agents

Kayser, Medical Microbiology 2005 Thieme

Campaign to Prevent Antimicrobial Resistance in Healthcare Settings

KEMUNCULAN RESISTENSI ANTIMIKROBA

Bakteri Sensitif

Bakteri Resisten

Resistance Gene Transfer Bakteri Resisten Baru

Tortora, Funke and Case, 2013

Campaign to Prevent Antimicrobial Resistance in Healthcare Settings

SELEKSI STRAIN RESISTEN ANTIMIKROBA

Strain Resisten Jarang

Terpapar Antimikroba
Strain Resisten Dominan

Tortora, Funke and Case, 2013

Campaign to Prevent Antimicrobial Resistance in Healthcare Settings

12 Langkah Pencegahan Resistensi Antimikroba: Penderita MRS Dewasa

12 Break the chain Cegah Transmisi 11 Isolate the pathogen 10 Stop treatment when cured 9 Know when to say no to vanco Gunakan Antimikroba scr Bijak 8 Treat infection, not colonization 7 Treat infection, not contamination 6 Use local data 5 Practice antimicrobial control 4 Access the experts Diagnosa & Terapi yg Efektif 3 Target the pathogen 2 Get the catheters out 1 Vaccinate Cegah Infeksi

THE PENICILLIN

Hauser, 2013

GUIDELINES FOR DOSING OF SOME COMMONLY USED PENICILLINS.

Katzung et al, 2012

SPECTRUM OF ACITIVITY AND COMMON USE OF CO AMOX-CLAVULANATE

Spectrum of Activity
Gram positive ( not Enterococcus) Gram negative Bacteria particularly Haemophilus influenzae Beta-lactamase producing Pathogens Anaerobes

Common use in Clinical

Otitis Media Upper and Lower Respiratory Tract Cholangitis Septic Arthritis Animal or Human Bite wounds
Finberg, 2012; Hauser, 2012

SPECTRUM OF COAMOXICILLIN/CLAVULANAT

Hauser, 2013

EMPIRIC ANTIMICROBIAL THERAPY FOR COMMUNITY- ACQUIRED PNEUMONIAE

Hauser, 2013

ACTIVITIES OF AGENTS USED TO TREAT OTITIS MEDIA

Hauser, 2013

EMPIRIC ANTIMICROBIAL THERAPY FOR ACUTE OTITIS MEDIA

Hauser, 2013

ANTIBIOTICS IN CLINICAL USE

Gillespie and Bamford, 2012

JA SAPHIRO (2007)

Bacteria are Small, not Stupid !