Anda di halaman 1dari 55

By:

dr. Aulia Chairani, MKK


Departemen Farmakologi
FK UPN Veteran JKT

Hampir separuh populasi dunia terinfeksi


gastrointestinal helmint prevalensi
Terutama di negara tropis dan subtropis
dengan pendapatan perkapita rendah
Anak-anak paling berisiko tertular
Untuk spesies tertentu bisa tanpa gejala
Morbiditas tinggi pada spesies yg lain
schistosomiasis, fascioliasis dan
hookworm
Infeksi cacing tidak hanya terjadi pada
manusia, tetapi jg menjadi masalah pada
hewan peliharaan dan ternak

Obat yang digunakan untuk membebaskan tubuh


dari infestasi cacing, baik dalam saluran cerna/
jaringan lain.
Beberapa obat cacing toksik diperlukan
identifikasi jenis cacing sebelum pengobatan.
Identifikasi (+) bila menemukan : salah satu bentuk
telur , larva dan cacing atau ketiganya
di dalam : - feses
- urin
- darah
- sputum
- jaringan

Cacing golongan cacing: Nematoda (bulat),


Trematoda (pipih) dan Cestoda (pita)

Infeksi campuran / tunggalBerikan Obat


Pilihan Utama

OPU Nematoda: Ivermektin, Pirantel pamoat,


Senyawa benzimidazol sintetik (Mebendazol,
Albendazol, Tiabendazol)

OPU Trematoda: Prazikuantel opisthorchiasis


Prazikuantel clonorchiasis
Triklabendazol fascioloasis

OPU Cestoda :Prazikuantel

(1) mempengaruhi motilitas cacing yaitu


menghambat depolarisasi neuromuskular
parasit
- befenium hidroksinaftoat : spastik paralisis
- pirantel pamoat
: spastik paralisis
- piperazin
: flaccid paralisis
(2) mengganggu pembentukan mikrotubulus
parasit dan menggangu pembentukan energi
cacing dengan menurunkan ambilan glukosa
- mebendazol/albendazol - tiabendazol
- pirvinium pamoat
- niklosamid

Farmakologi obat:
Spektrum luas
Efek :Vermicidal-Larvisidal-Ovisidal
Absorpsi kecil sekali (< 5%) bekerja pada usus
Ekskresi melalui urin warning ps. ggn ginjal dan
hepar
KI : wanita hamil dan menyusui, anak umur<2th
Kemasan dan Sediaan :
dus berisi 10 strip @ 4 tab, 400 mg/tab
botol berisi 10 ml suspensi
botol berisi 100 tab chewable

OPU untuk - S. stercoralis


- cacing tambang
- cutaneus larva migrans
ES : gangguan sal. cerna, kristaluria, mual,
muntah diare, kejang perut, sakit kepala,
lemah, pruritus di kulit, sindrom Steven
Johnsons (pernah dilaporkan kematian).
KI : payah ginjal

Triklabendazol : Dosis tunggal 10 mg/Kg BB


setelah sarapan

OPU untuk cacing kremi, gelang dan tambang

abs. oral <<

Dosis : 10 mg/kg BB, maksimum 1 g

eks. 15% urin

ES : ringan berupa gangguan saluran cerna,


sakit kepala
- Cacing kremi tunggal 10 mg/kg BB
- Cacing gelang tak perlu pencahar/laksan
Cacing tambang perlu ditambah pencahar
Terapi ulangan, ditunggu - Interval 2 mgg.

Indikasi

: N. americanus

Absorpsi

: sedikit dalam usus halus

Toksisitas

: rendah

Preparat & Dosis :


- Kaps. gelatin : 0.2, 0.5, 2.5, 5 ml
- Dosis Dewasa : 5 ml
- Dosis Anak
: 0.12 ml / kg BB
! ! Simpan di tempat dingin.
Bila terbentuk fosgen - toksik
Makanan harus bebas : lemak, minyak,
alkohol

Spektrum

luas - Untuk infeksi campuran

Toksisitas
Kerja

Dosis

: rendah - dapat digunakan u/ anak

: paralisis otot cacing - kurang poten

(+) pencahar MgSO4 30 g (diulang stlh 3 jam)


: Dewasa 1 g (pasien dipuasakan dulu),
Anak ? (tidak praktis)

ES

toksisitas : iritasi lokal, toksisitas sistemik (-)

Pemberian

dianjurkan)

Topikal perianal

korosif (tidak

Pyrvinium pamoat -

zat warna sianin

Indikasi : cacing kremi


Kerja

: Menghambat enzim respirasi cacing


Menghambat ambilan O2 dalam metab.
KH cacing

E.S. : muntahan dan feses merah


mual, muntah - kejang perut
Levamisol Dosis Tunggal 150 mg (efektif)

OPU - T. saginata dan T. Solium


Dosis tunggal : 10 mg/Kg BB (+ MgSO4, stlh 2 jam)
--Efektifitas mendekati 100% utk T.saginata

Befenium Hidroksinaftoat

N. americanus, A. duodenale, A. lumbricoides

abs - <

E.S. : yang serius tidak ada, sebab rasa pahit


muntah

eks : 0.5 % urin

Dosis : dewasa : 5 gr - 2 dd 1 hari


anak : 2.5 gr - 2 dd 1-3 hari

OPU

untuk askaris dan oxyuriasis


Dosis : BB>50 Kg = 3,5 g (sediaan: Tab 250 & 500 mg)

selama 2 hari berturut-turut


Otot cacing akan paralisis hidup keluar
dapat hidup (N) : suhu 35 C dalam garam faal
ES

: gangguan sal. Cerna ( mual, muntah, diare)


nyeri abdomen
alergi
sakit kepala
Abs. : Baik, metabolisme hati - variasi individu besar
Efek sistemik tidak ada
KI
: Insufisiensi ginjal, hepar
Epilepsi induksi serangan/kekambuhan

Indikasi Taeniasis , harus ditambahkan laksatif

Niklosamid

Dosis : 2 g (4 tab @ 500 mg), dikunyah+sedikit air


T. saginata : tidak membunuh telur
Sistiserkosis infeksi btk larva bs ke SSP,
dilaporkan kasus epilepsi
T. solium (+) laksan nekrosis skoleks,
mencegah autoinfeksi penyebab sistiserkosis
Tidak di absorpsi, tidak menimbulkan iritasi lokal,
gejala sal. cerna ringan
Dapat diberikan untuk ibu hamil dan anak.

untuk penderita kondisinya lemah atau gizi


buruk

cacing lepas dari mukosa dicerna

metabolit bersifat pencahar

E.S. : Relatif tidak ada

Schistosomiasis - OPU
disimpan lama toksik
terkena sinar UV rusak
pemberian IV lambat
S. japonicum intensif 14 hari
Stop terapi bila muntah, albuminuria, nyeri
sendi, demam
Indikasi : S. hematobium, S. mansoni,
Granuloma inguinal
KI : gangguan ginjal - jantung
ES : anemia hemolitik

OPU- W. bancrofti, B. malayi, Loa-loa


me mikrofilaria darah fagositosis
lenyap
nodul - hidrokel tidak efektif (operatif)

ES : alergi, takikardia, sakit kepala, mual,


muntah

KI : relatif tidak ada

Preparat & Dosis : Tab. 50 mg

Dosis anak : 3x sehari, 2 mg/Kg BB, 7-21 hr

Dosis dewasa (WHO) : 6 mg/Kg BB/hr, 12 hr

The elderly and people with an


impaired immune system, such as
HIV, cancer or those on
immunosuppressive medications,
are susceptible to crusted scabies,
called "Norwegian scabies
On those with a weaker immune
system, the host becomes a more
fertile breeding ground for the
mites, which spread over the host's
body, except the face
Sufferers of crusted scabies exhibit
scaly rashes, slight itching, and thick
crusts of skin that contain thousands
of mites
Such areas make eradication of
mites particularly difficult, as the
crusts protect the mites from topical
miticides, necessitating prolonged
treatment of these areas

Scabies (from Latin: scabere,


"to scratch"),known colloquially
as the seven-year itch
Contagious skin infection that
occurs among humans and other
animals
Caused by a tiny and usually not
directly visible parasite, the mite
Sarcoptes scabiei,
Burrows under the host's skin,
causing intense allergic itching
Infection in animals (caused by
different but related mite
species) is called
sarcoptic mange
Dogs and cats are infected by
different types of mites than
those which infect human
When canine or feline mites land
on human skin, they fail to thrive
and produce only a mild itch that
goes away on its own

Intense itching and superficial often linear burrows , to the point that a neat "line" of four
or more closely placed and equally developed mosquito-like "bites," is almost diagnostic
of the disease.

Itching
The itch is made worse by warmth and is usually experienced as being worse at night,
possibly because there are fewer distractions
As a symptom it is less common in the elderly

Rash:
The superficial burrows of scabies usually occur in the area of the hands, feet, wrists,
elbows, back, buttocks, and external genitals The burrows are created by excavation of
the adult mite in the epidermis
In most people, the trails of the burrowing mites show as linear or s-shaped tracks in the
skin, often accompanied by what appear as rows of small pimple-like mosquito, or insect
bites. These signs are often found in crevices of the body, such as on the webs of fingers
and toes, around the genital area, and under the breasts of women
Symptoms typically appear 26weeks after infestation for individuals never before
exposed to scabies if previously exposed, the symptoms can appear within several days
after infestation But can also appear after several months or years
Acropustulosis, or blisters and pustules on the palms and soles of the feet, are
characteristic symptoms of scabies in infants

An individual who has scabies, but isn't exhibiting symptoms can still
spread them without knowing. Scabies Frequently Asked Questions,
2010.

Hospitals

Most common place to contract scabies is:


Nursing homes

Child care facilities

Prisons

FrotosGov/Ba, 2011.

Freeformkatia, 2008.
Miss_millions, 2010

Ulrichkarljoho, 2009.

Scabies may be diagnosed clinically in geographical areas where


it is common when diffuse itching presents along with either
lesions in two typical spots or there is itchiness of another
household member
The classical sign of scabies is the burrows made by the mites
within the skin
To detect the burrow the suspected area is rubbed with ink from a
fountain pen or a topical tetracycline solution, which glows under
a special light
The skin is then wiped with an alcohol pad. If the person is
infected with scabies, the characteristic zigzag or "S" pattern of
the burrow will appear across the skin; however, interpreting this
test may be difficult, as the burrows are scarce and may be
obscured by scratch marks
A definitive diagnosis is made by finding either the scabies mites
or their eggs and fecal pellets
Searches for these signs involve either scraping a suspected
area, mounting the sample in potassium hydroxide, and
examining it under a microscope, or using dermoscopy to
examine the skin directly

Symptoms of early scabies infestation


mirror other skin diseases, including
dermatitis, syphilis, various urticariarelated syndromes, allergic reactions, and
other ectoparasites such as lice and fleas

Intense scratching can cause a secondary


skin infection, such as impetigo.

Mass treatment programs that use topical


permethrin or oral ivermectin
There is no vaccine available for scabies
The simultaneous treatment of all close
contacts is recommended, even if they show
no symptoms of infection (asymptomatic), to
reduce rates of recurrence Asymptomatic
infection is relatively common
Objects in the environment pose little risk of
transmission except in the case of crusted
scabies, thus cleaning is of little importance
Rooms used by those with crusted scabies
require thorough cleaning

Permethrin
Permethrin :
Treatment of choice
Applied from the neck down usually before bedtime and left on for about 8 to
14hours, then showered off in the morning
One application is normally sufficient for mild infections
For moderate to severe cases, another dose is applied 714days later
May cause slight irritation of the skin, but the sensation is tolerable

Ivermectin
An oral medication, often used as a single dose
Treatment of choice for crusted scabies, and often used in combination with a
topical agent
Not tested on infants and not recommended for children under six years of age
Topical ivermectin preparations have been found to be effective for scabies in
adults, and are attractive due to their low cost, ease of preparation, and low
toxicity
Has also been useful for sarcoptic mange (the veterinary analog of human
scabies)

Others
Other treatments include lindane, benzyl benzoate, crotamiton, malathion, and
sulfur preparations