Professional Documents
Culture Documents
Khie Chen
Rational Usage
Prudent Usage
Responsible Usage of AM
Increase Increase
mortality RESISTANCE
Prolonged Cost
hospital stay
Adequate Used of Antimicrobial
n Timely
n Appropriate
n Prompt discontinuation
Bagaimana Antibiotik dapat Meberikan
Respons Pengobatan?
Outcome
Microbiology
Clinical efficacy
Mechanism of action
Concentration Bacterial eradication
Antibacterial spectrum
at infection site Compliance with
Drug dosing regimen
Tolerability
Pathogen MIC
PK Rate of resolution
Prevention of resistance
Absorption PD
Distribution
Metabolism
Time vs. concentration
Excretion dependent killing
Optimal dosing Bactericidal vs. bacteriostatic
regimen activity
Tissue penetration
(Scaglione, 2002) Persistence of antibacterial effect
Penyakit dasar,
Komorbiditas
Status Imun
Derajat sepsis
Disfungsi organ
Penyakit dasar
Komorbiditas
Status Imun
Derajat sepsis
Disfungsi organ
Gram positif/negatif
Infeksi komunitas/
Rumah sakit HCAI/HAI
MDRO
Penyakit dasar
Komorbiditas
Status Imun
Derajat sepsis
Disfungsi organ
FOM Penicillins
Macrolides Aminoglycosides penicilin-G
(Fosfomycin)
erythromycin kanamycin ampicillin
midecamycin, dibekacin cloxacillin, etc.
amikacin Cephems
etc.
streptomycin cephalosporins
cephamycins
Chloramphenicol Tetracyclines
Inhibition of nucleic
acid synthesis
Cytoplasmic
membrane
DNA synthesis inhibition
inhibition
Quinolones
Polypeptides RNA synthesis inhibition
polymixin B, etc. rifampicin
Streptomisin Pengobatan TB
Aminoglycosides - spectrum of activity
Gram (+)ve Gram (-)ve
StaphyloStrepto Entero Pseudo
Drug cocci cocci cocci E.coli Klebsiella monas
Gentamicin + + + + + +
Amikacin + + + + + +
Streptomycin + + + + + +
Gram (+)ve wall
structure (stain with
difficulty)
Entero- Bacter-
M. tb MAI bacter Proteus oides
Gentamicin R + + + R
Amikacin + + + + R
Streptomycin + + + + R
Makrolida
n Aktif terhadap Mikobakteria, protozoa (T.
gondii, E. histolytica, P. falciparum ),
Campylobacter, Helicobacter, Borrelia,
Neisseria & other genital pathogens
n Efek samping salurun cerna, terutama
eritromisin
n Diberikan per-oral, bioavibilitas umumnya
baik dengan kadar dalam jaringan tinggi
Tetracyclines
n Aktif terhadap bakteri Gram (+)ve &
(-)ve, chlamydiae, rickettsiae, coxiellae,
spirochaetes, mycobacteria, E histolytica , &
plasmodia, leptospira
n Diberikan oral, absorbsi terpengaruh oleh
makanan
n Generasi terbaru Tygecycline sediaan iv
n Efek samping saluran ceran (mual)
3. Sintesis asam nukleat:
n Menghambat sintesis prekursor
Sulphonamides
Trimethoprim
n Menghambat replikasi DNA
Fluorokuinolon
n Menghambat RNA polymerase
Rifampisin
Sulfonamid
n Spektrum luas
n Gram positif dan Gram negatif
n Mencakup PCP, Nocardia, & Toxoplasma
gondii
n Penggunaan pada ISK, infeksi enterik dan
intraabdmominal, toksoplasmosis, profilaksis
PCP pada HIV
n Tdiak digunakan pada wanita hamil, alergi
sulfa.
Klasifikasi Fluorokuinolon
GEN. Nama Aktivitas antibakterial
Gen I Nalidixic acid terutama terhadap
Enterobacteriaceae
3rd-generation
cephalosporins
Tigecycline
Glycopeptides
Carbapenems
Quinolones
In Vitro Activity
No In Vitro Activity
Klasifikasi spektrum antibiotik
n H. influenzae Clindamycin+aztreonam *
Aztreonam
Imipenem, meropenem
Beta-lactam/beta-lactamase inhibitor
(piperacillin/tazobactam)
Lincosamides2
Lipopeptides1,2
Tetracyclines2
Macrolides2
MIC
Penicillins1
Cephalosporins1 T > MIC
Carbapenems1 Cmin = Trough
Macrolides1,2
Glycopeptides2
Lincosamides2
Time (hours)
n Definitif
Strategi Terapi Antimikroba Empirik
Pasien
Eskalasi Deeskalasi
perbaikan
- Terdapat pilihan antibiotik dengan spektrum yang lebih
sempit
- Terdapat pilihan antibiotik yang merupakan pilihan
Kolonisasi Patogen
Optimalisasi Kombinasi
Antibiotik yg PKPD Antibiotik
direkomendasikan
Prinsip Terapi Antibiotik Definitif
American Thoracic Society. Guidelines for the management of adults with hospital-acquired,
ventilator-associated and healthcare-associated pneumonia. Am J Respir Crit Care Med.
2005;171:388416
Pilihan Antimikroba untuk terapi MRSA
ARCP
REPORT
Hospital and Hospital Director
Department
Team
Nosocomial Infection
Clinical Pharmacist
Committe
Aktivitas Tim PPRA