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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 !