BAKTERI DAN ANTIBIOTIK

DI BIDANG THT

Pembimbing
dr. Indra Setiawan, Sp.THT-KL

SMF Telinga Hidung dan Tenggorok Rumah Sakit Universitas Muhammadiyah Malang
Fakultas Kedokteran Universitas Muhammadiyah Malang
2018
Mutiara Sukma S. Umar Asadullah Aulia Devina R.
BAKTERI
Bakteri

Prokaryote

Unicelluler

DNA

1 to 20 μm or larger

Reproduce by asexual division

(Murray Medical Microbiology, 2016)

 Bakteri

Bentuk Pewarnaan gram

Batang/basil Kokus/bulat

Gram positif Gram negatif

Spiral/speris

(Murray Medical Microbiology, 2016)

BENTUK BAKTERI

Streproccus Lactoobacillus Spirocetae

Neiserria Vibrio
Staphylococcus

(Murray Medical Microbiology, 2016)

 Pewarnaan Gram

A B

(Murray Medical Microbiology, 2016)

Struktur Dinding Bakteri
Gram Negatif dan Positif

(Murray Medical Microbiology, 2016)

(Murray Medical Microbiology, 2016)
 Tahan asam

Mycobacterium tuberculosis
Mycobacterium leprae
Clostridium difficile

BAKTERI11GRAM POSITIF
BAKTERI GRAM NEGATIF
ANTIBIOTIK
Berdasarkan aktivitas dalam membunuh, antibiotik dibagai menjadi
• Bactericidal
• Bacteristatic

Bedasarkan mekanisme kerja, antibiotik dibagi menjadi 5 jenis, yaitu :

• Penghambatan sintetis dinding bakteri
• Penghambat membran sel
• Penghambatan sintetis protein di ribosom
• Penghambatan sintetis asam nukleat
• Penghambatan metabolik
(Yuniriadi,2009)
 Antibiotik
• B-Lactam  penghambat sintesis dinding sel
• Tetrasklin  penghambat sintesis proteis
• Aminoglikosida  penghambat sintesis proteis
• Macrolide  penghambat sintesis proteis
• Quinolone – Floroquinolon  menghambat replikasi dan transkri
psi DNA sel
• Sulfonamid  menghambat metabolisme sel
• Cloramfenikol  penghambat sintesis proteis
• Clindamycin  penghambat sintesis proteis
• Lipopeptide  mengganggu fungsi membrane sel
 B - Lactam

• Penicilin
• Cephalosporin
- Generasi 1  Gram positif
- Generasi 2  Gram negatif
- Generasi 3  Gram negatif
- Generasi 4  Gram positif dan negatif
• Carbapenem
• Monobactam
 Tetraskilin

• Doxycycline
• Tetracycline
• Minocycline
• Demelocycline

Bakteriostatik
Efek samping : fetal hepatotoksik, dizziness, nausea, vomit, irit
asi lambung, deposisi tulang dan gigi
KI : Gangguan ginjal
 Aminoglikosida
• Amikacin
• Gentamicin
• Neomycin
• Streptomycin
• Tobramycin

Bakterisidal
Efek Samping : Ototoksik
 Quinolone
• Ciprofloxacin
• Enoxacin
• Lomefloxacin
• Ofloxacin

Bakterisidal, Gram (-)

Efek Samping : nefrotoksik
KI : Ibu menyusui dan hamil
 Macrolide
• Eritromycin
• Azitromycin
• Clarythomycin

Lipopeptide
• Daptomycin
Bakteri dan Antibiotik di Bidang THT
 Bacteria Associated with ENT Infection

M.M Ahmad, et all. Nigerian Journal of Basic and Applied Science, 2016, 24(1): 15-18. Microbiological Assessment of Bacterial Isolates from Ear, Nose And
Throat (ENT) Among Patients Attending Aminu Kano Teaching Hospital.
International Journal of Basic & Clinical Pharmacology | August 2017 | Vol 6 | Issue 8 Page 1
International Journal of Basic & Clinical Pharmacology | August 2017 | Vol 6 | Issue 8 Page 1
International Journal of Basic & Clinical Pharmacology | August 2017 | Vol 6 | Issue 8 Page 1
Bakteri dan Antibiotik
di Telinga
 Bakteri dan Antibiotik pada Telinga
Diagnosis Antibiotik Bakteri

Acute Localised Otit Flucloxacillin oral 1g 6 hourly Staphylococ

is Externa cus aureus
Plus
(furuncle)
Topical steroids

Acute Diffuse Mild – Pseudomon

Otitis Externa moderate: as
Staphylococ
(swimmer’s ear) Topical cus aureus,
Antimicrobial Escherichia
coli
Severe (e.g cellulitis or blocked ear canal):

Ciprofloxacin oral 500mg 12 hourly

 Bakteri dan Antibiotik pada Telinga
Diagnosis Antibiotik Bakteri
Otitis externa – acut First choice : Clioquinol + flumethasone (Locorten Vioform)* Staphylococcu
e Adult and child > 2 years: 2 to 3 drops, twice daily, for 7 days s aureus, Stre
OR ptococcus pyo
genes, Pseudo
Dexamethasone + framycetin + gramicidin (Sofradex)* monas
Adult and child: 2 to 3 drops, three to four times daily, for 7 da aeruginosa, po
ys lymicrobial infe
Avoid excessive use, e.g. for longer than one week, as this m ctions
ay result in fungal infection which can be difficult to treat

Alternatives :Acetic acid 2% (Vosol)* may be sufficient in mild

cases.
Ciprofloxacin + hydrocortisone (Ciproxin HC)* if Pseudomona
s
suspected.
Flucloxacillin if there is spreading cellulitis or the patient is sys
temically unwell; also consider referral to hospital.
 Bakteri dan Antibiotik pada Telinga
Diagnosis Antibiotik Bakteri

Perichondritis 1st line - Pseudomonas

Staphylococcu
Ciprofloxacin oral 500mg – s aureus
750mg 12 hourly

2nd line – Add clindamycin oral 450mg 6 hourly

 Bakteri dan Antibiotik pada Telinga
Diagnosis Antibiotik Bakteri

Otitis media First choice : Amoxicillin Strepto

Child: 15 mg/kg/dose, three times daily, for five days (seven to ten days if coccus
age < two years, underlying medical condition or perforated ear drum) pneum
Use 30 mg/kg/dose, three times daily, for five to seven days in severe or r oniae,
ecurrent infection (maximum 500 mg/dose age three months to five years Haemo
, 1000 mg/dose age > five years) philus i
nfluenz
ae, Mor
Alternatives : Co-trimoxazole axella c
Child > 6 weeks: 0.5 mL/kg/dose oral liquid (40+200 mg/5 mL), twice dail atarrhal
y, for five to seven days (maximum 20 mL/dose) is
If a child can swallow tablets, co-trimoxazole 80+400 mg tablets can be u
sed (one tablet is equivalent to 10 mL of co-trimoxazole oral liquid)
N.B. Co-trimoxazole should be avoided in infants aged under six weeks,
due to the risk of hyperbilirubinaemia.
 Bakteri dan Antibiotik pada Telinga
Diagnosis Antibiotik Bakteri

Acute Co-Amoxiclav Staphyloc

Mastoiditis IV 1.2g occus aur
eus, H. infl
8 hourly uenzae

Oral Step down:

Co-amoxiclav
625mg 8 hourly
Bakteri dan Antibiotik
di Hidung
 Diagnosis / Penyakit Antibiotik Bakteri

Rhinitis Kronik First Choice: Klebsiella ozaenae, Bacillus

Atrofikan/Ozaena Gentamisin 80 mg + 1000 ml sa foetidur, Proteus mirabilis,
lin 12 hourly E.coli, S. aureus

Klebsiella :
Ciprofloxacin oral 500 mg 12 ho
urly
Rhinosinusitis First choice : Streptococcus pneumonia, Hae
Azithromycin oral 500 mg 24 ho mophilus influenza, Staphylococ
urly cus aureus

Alternative :
Clindamycin oral 450 mg 6 hour
ly
Rhinitis Akut First Choice : Haemophylus Influensa,
Clarithromycin oral 500mg 12 h Steptococcus, Pneumococcus
ourly
Bakteri dan Antibiotik
di Tenggorokan
 Penyakit Antibiotik Bakteri
Pharyngitis First choice : Streptococcus
Phenoxymethylpenicillin (Penicillin V) pyogenes
Child < 20 kg: 250 mg, 2-3x/day, for 10 days
Child ≥ 20 kg and Adults: 500 mg, 2-3x/day, for 10 days
OR
Amoxicillin
Child < 30 kg: 750 mg, once daily, OR 25 mg/kg, 2x/day (maximum 1000
mg/day), for 10 days
Child ≥ 30 kg and Adults: 1000 mg, once daily, for 10 days
OR
IM benzathine penicillin (stat)
Child < 30 kg: 450 mg (600 000 U)
Child ≥ 30 kg and Adults: 900 mg (1 200 000 U)

Alternatives :
Erythromycin
Child: 20 mg/kg/dose, 2x/day or 10 mg/kg/dose, 4x/day, for 10 days (maxi
mum 1 g/day)
Adult: 400 mg, 2x/day, for 10 days
N.B. Co-trimoxazole does not have reliable activity against S. pyogenes or
eradicate pharyngeal carriage and should not be used.
Penyakit Antibiotik Bakteri
Tonsilitis First choice : Streptococcus pyo
Phenoxymethyl penicillin oral 500mg 6 hourly genes, B hemolitic
Benzylpenicillin IV 1.2g 6 hourly AND Metronidazole IV 500mg 8 hourly us grup A

Oral Step down if no positive cultures: Mycoplasma pneu

Penicillin V oral 500mg 6 hourly AND metronidazole oral 400mg 8hrly for moniae
10 days
Neisseria Gono
rhoe
Alternatives :
Clarithromycin oral 500mg 12 hourly
Clindamycin IV 900mg 8 hourly

Oral Step down if no positive cultures:

Clindamycin oral 450mg 6 hourly
 Penyakit Antibiotik Bakteri
Tonsilitis Anti difteri serum (ADS) 20.000-10.000 unit Coryne bacterium
difteri Penisilin atau eritromisin 25-50 mg/kgBB dibagi 3 dosis, selama diphtariae
14 hari
Corticosteroid 1,2 mg/kgBB/hari
First choice : Streptococcus
Epiglotitis Ceftriaxone IV 2g OD pneumoniae
Oral step down:
Co-Amoxiclav 625mg 3x/day Staphylococcus
For 7 – 10 days pyogenes

Alternative: Haemophilus
Clindamycin IV 900mg 8 hourly AND Ciprofloxacin oral 500mg 1 influenzae,
2 hourly parainfluenzae
Oral Step down:
Clindamycin oral 450mg QDS AND Ciprofloxacin oral 500mg 12
hourly
 Penyakit Antibiotik Bakteri
Abses First choice : Streprococcus
peritonsillar Benzylpenicillin IV 1.2g 6 hourly AND sp.
Metronidazole IV 500mg 8 hourly Staphylococcus
For 10 days aureus
Oral Step down: Haemophilus
Penicillin V oral 500mg 6 hourly AND metronidazole oral 400mg Influenza
8hrly Neisseria sp.
Mycobacteria sp.
Above regimen may be insufficient for polymicrobial infection. Fusobacterium
If lack of clinical response and IM ruled out:
Co-amoxiclav IV 1.2g 8 hourly
Oral Step down
Co-amoxiclav oral 625mg 8 hourly

Alternative:
Clindamycin IV 900mg 8 hourly
Oral Step down:
Clindamycin oral 450mg 6 hourly
 DCSS & Tertiary Medicine, 2018, Ear Nose and Throat (ENT) Infectio
Sumber ns Antibiotic Guidelines, NHS Journal, pp.1-9

M.M Ahmad, et all., 2016, Microbiological Assessment of Bacterial Iso

lates from Ear, Nose And Throat (ENT) Among Patients Attendin
g Aminu Kano Teaching Hospital. Nigerian Journal of Basic and
Applied Science, 24(1): 15-18.

Murray, Patrick, 2016, Bacterial Classification, Structure, And Replica

tion, In Medical Microbiology, Elsevier, Philapelphia, pp. 106-11
1

Peraturan menteri kesehatan Republik Indonesia .2011.

Coates Anthony, Gerry Halls, dan Yanmin Hu. 2011. Novel Classe
s of antibiotics. British journal of pharmacology. 163(1) :
184 – 194

Kim Lewis. 2012. Recover the lost art of drug discovery. Internatio
nal journal of science. 485 : 439 - 440
Thank you