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ANTIBIOTICS
dr. Siti Suparti
Medical School Padjadjaran University
Department of Pharmacology & Therapy
References :
1. Lippincotts Illustrated Reviews :
Pharmacology, 2nd ed
(Chapter 28)
2. Buku Pedoman Kuliah Farmakoklinik
Farmakologi III
Jilid 1 edisi 2
Prof. DR. Herri S. Sastramihardja, dr.,
SpFK
Resistance
Side effect
Definition
In vitro
Ideal antibiotics
AB
Classification
Spectra
Chemical structures
Mechanism of action
DEFINITION
AB are chemical substances obtained from
microbes/microorganisms (bacteria, fungi,
actinomycetes) that able to inhibit or
eradicate the growth of the other
microorganisms.
Antimicrobial
all antiinfections
semisynthetic
synthetic
nature antibiotics
In vitro
1. Primary bacteriostatic effect inhibit the
growth of m.o
Sulfonamide, tetrac, chlolamph,
erythromycin (low concentration),
lincomycin, clindamycin and fusidic acid
2. Primary Bactericidal Effects
Eradicate/kill
Pen, cef, aminoglic, erythromycin (high
concentration), cotrimazol. Rifampisin
and vankomycin.
Those classification is not absolute but
relative
SPECTRUM OF AB EFFECTS
1. Narrow spectrum antibiotics (NSAB)
Main effect : sensitive for gram positive
bacteria and bacil
e.g. : Pen. G, Pen. Resistent penicillinase
semisynthetics, bacitracin, macrolides,
lincomycin, vancomycin
2. Broad Spectrum Antibiotics (BSAB)
Main effect : sensitive for gram positive
and gram negative bacteriae
e.g. : Pen. (ampicillin and amoxycillin),
cefalosporins, tetracyclins,
chloramphenicol, trimetroprim and
sulfonamides
resistance
RESISTANCE and
MECHANISM OF ACTION
recall in
microbiology
SIDE EFFECTS
1. ALLERGIC REACTION
2. TOXIC REACTION
Direct effects in unproper dose e.g. :
aminoglycosides
3. SUPERINFECTION : new infection caused by
pathogen microbes or fungi during AB
therapy to primary infection.
SUPERINFECTION : frequent
potentially harmed risk
Causa : Enterobacter, Pseudomonas,
Candida and other fungi. Those agents are
difficult to be eradicated by to day available
antibiotics.
AVOIDING SUPERINFECTION
ANTIBIOTICS
HOST
PHARMACOKINETICS
PHARMACODINAMICS
CHARACTERISTIC
OF ANTIBIOTICS
HOST ASPECTS
BIOCHEMICAL &
PHYSIOLOGICAL &
PATHOLOGICAL
CONDITIONS
RATIONAL USE OF AB
Define the patient problems specify the
therapeutic objectives
PROCEDURES
STEPS TO PROCEDURES
THERAPY
M.O
ERADICATING
DEFINITIVE THERAPY
EMPIRIC THERAPY
PROPHYLAXIS
IN NON SURGICAL CONDITIONS
IN SURGICAL CONDITIONS
DEFINITIVE THERAPY
It is the most effective, least toxicity
and the narrowest selection
Based on :
* identification of bacteria
* sensitivity test
* interpretation in the content of the
overall clinical picture
* the AB of choice directed to M.O
EMPIRIC AB THERAPY
Giving AB directly without identification
and sensitivity test of bacteria, but
obtaining specimen for lab. analysis
before giving AB.
PATIENT HISTORY
Age baby, child, adult, old age !
Immune system immunocompromised!
Who?
Renal dysfunction accumulation! How ?
Hepatic dysfunction metabolism! How ?
Genetic factors G6-PD. Attention,
contraindication !
Pregnancy teratogenic, embryogenic
Lactation vulnerable AB for new born
if mixed
continue therapy
as initiated
If anaerobic only
PROPHYLAXIS
SURGICAL
1. Contaminated op.
2. Clean
contaminated op
3. Selected op may
suffer
post-op.infection
NON SURGICAL
PREVENT :
1. Streptococcal infection in
patient with a history of
RHD
2. In pre-dental extraction
who have implanted
prosthetic devices
3. TB/meningitis in close
contact individual
4. Protect fetus from
infection in HIV-infected
pregnant woman
DISANVANTAGES TO PROPHYLACTIC AB
1. Toxic/allergic reaction
2. Superinfection with more resistant
flora
3. The infection may be temporarily
masked
4. Ecology of the hospital flora may be
altered
Cont.
- Pathogen
drug resistence
superinfection
dual infection initially
- Laboratory :
erroneous report of susceptible
pathogen
AB COMBINATION
Synergisme (3) :
1) Blockade of sequential steps in
a metabolit sequence
- Trimethoprim - sulfamethoxazol
2) Inhibition of enzymatic inactivation
- Amoxycillin - clavulanat
3) Enhancement - Aminoglycosides
- Penicillins - Aminoglycosides
Antagonism (2) :
1. Inhibition of cidal activity by static
agent
- Tetracyclines Betalactam AB
2. Induction of enzymatic inactivation
- Ampicillin - Piperacillin
CLINICAL INDICATION OF AB
COMBINATION :
Mixed infection
Synergism effect
Risk of developing resistant
organism <
Increase AB coverage or
Infection of unknown origin
DISADVANTAGES OF AB COMBINATION
-