ANTIMICROBIAL

THERAPYON SEPSIS
AND SEPTICSHOCK
Rizka Humardewayanti
Penyakit Tropik Infeksi Fakultas
Kedokteran UGM Yogyakarta
2018
BACKGROUND
BURDEN SEPSIS
DEFINITIONOF
SEPSIS-3
DEFINITION OFSEPSIS-3

“ Life-threatening organ dysfunction

caused by a dysregulated host
response to infection”
(Singer M et al.JAMA. 2016; 315[8]: 801- 810)
DIAGNOSIS
SEPSIS
DIAGNOSE SEPSIS
• Clinicallysometimesdifficultto diagnose
• Delay todiagnose and treatment  bad prognosis
 DIAGNOSE SEPSIS
• Criteria Inside ICU : Using SOFA score
or LODSscore

• Criteria Outside of the ICU:

• There is an increasing focus on
early recognition of sepsis.
• Using quick SOFA(qSOFA)
(Singer M et al. JAMA. 2016; 315[8]: 801- 810)
SEPSIS :QSOFA

(Singer M et al.JAMA. 2016; 315[8]: 801- 810)

SOFA SCORE
 LODS SCORE

JAMA 1996:276:802-10

Yogyakarta,
11/03/2018
From: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

JAMA.2016;315(8):801-810 doi:10.1001/jama.2016.0287
TREATING SEPSIS

Yogyakarta,
11/03/2018
 TREATING SEPSIS :
THE LATESTEVIDENCE
ANTIBIOTICS
Earlyadministration
(within1hour)
 Odds ratio for mortality from with each hourly
incremental delay in antibiotic administration
from severe sepsis/septicshockrecognition.

Abbreviations: OR – Odds ratio; Ref – reference value; CI – confidence interval.

 EFFECT OF TIMING ON SURVIVAL

Pooled odds ratios for mortality and time to antibiotics in less than or more than three hours from triagetime
Crit Care Med. 2015 September ; 43(9): 1907–191158.
Pooled odds ratios for mortality and time to antibiotics in less than or more than one
hour from severe sepsis/shock recognition
Crit Care Med. 2015 September ; 43(9): 1907–1915
Antibiotics
Appropriate
APPROPRIATEANTIBIOTICS
 Appropriate = in vitro activityagainst
pathogen
 Route ofadministration
 Dose andfrequency
 Penetration
 Cidality
 Pharmacodynamics and
Pharmacokinetics
Crit Care Clin2011;27:53-76
 EFFECTOF INAPPROPRIATE ANTIBIOTICS ON SURVIVAL

All numbers expressed as % unless otherwisespecified

* Immunosuppression = chemotherapy or chronic steroids (>10mg prednisone daily)
Chest 2009;136:1237-48
 Carbapenemen

Aminoglikosida
Betalactams
Antibiotics

How ToOpimize?
DOSE ANDROUTE
LOADINGDOSE
PHARMACODYNAMICS
AND
PHARMACOKINETICS
PHARMACOKINETICSAND
PHARMACODYNAMICS
T> MIC
AUC/M IC
Cmax/M IC
TIMEDEPENDENT

T > MIC
TIMEDEPENDENT

T > MIC
TIMEDEPENDENT
CONCENTRATIONDEPENDENT
CONCENTRATIONDEPENDENT
PENETRATION
PENETRATION

• Barrier Otak
Fluconazol Vs. Anidulafungin
ChlomafenicolVs. Beta Lactam
• Abses
Drainage --> Antibiotics Vs. Antibiotics
• Edema/Volume distribusiMeningkat
Lipofilik Vs.Hidrofilik
Cidality
CIDALITY
• Bacteriostatic?
• Bactericidal?

• Critically ill --> Bactericidal