CURICULUM VITAE

Name : DR. Pratiwi Pujilestari Sudarmono, Sp.MK

Address : Department of Microbiology

Jln. Pegangsaan Timur 16 Jakarta 10320 – Indonesia
Phone : 62-21-3100828, 3100806, 322850
Fax : 62-21-3100810 E-mail : pratiwi@cbn.net.id,
Place and Date of Birth : Bandung, Indonesia, 31st July 1952

DEGREES HELD
MD., University of Indonesia, 1977
Specialist/Brevet in Microbiology, Medical Faculty, University of Indonesia,
1980
PhD. in Molecular Microbiology, Osaka University, Japan 1984
Specialist/Brevet in Clinical Microbiology 1987
Clinical Microbiologist, University of Indonesia 1992
Certificate Training Course on Hazard Assessment and Risk Management of
Genetically Modified Organism, Bangkok, Thailand 1997.
Certificate Molecular Biology, Smith College,
Massachussettes, 1999
BACTERIAL INFECTION
IN ACUTE
EXACERBATION OF
CHRONIC BRONCHITIS

PRATIWI SUDARMONO
MD,PhD
PDPI,Bandung,18 Maret 2005
 ACUTE EXACERBATION OF
CHRONIC BRONCHITIS
Chronic bronchitis is a condition in which
cough and excessive secretion of mucus
are present in the tracheo-bronchial tree
with no evidence of bronchiectasis,
asthma or TB.
Infection appears to be only one
component of the syndrome, beside
smoking, inhalation of dust or fumes
 Microbial isolates in AECB
Interpretation of the isolated bacteria from
sputum is very difficult to be directly
related as the cause of AECB
Bacterial isolates many times are the
contaminant of normal flora
But if chronic infections repeat many
times, causative bacteria can vary
Streptococcus pneumoniae,
H.influenzae,Staphylococcus aureus
and Mycoplasma pneumoniae are the
most common (?)
 BACTERIA ISOLATED FROM THE
SPUTUM AT MICRO-UI 2003 ( n:579 )
Klebsiella pneumoniae 28%
Pseudomonas aeruginosa 25%
Enterobacter aerogenes 15%
Staphylococcus aureus 9%
E.coli 6%
Moraxella catarrhalis 3%
Streptococcus pneumoniae 2%
Proteus mirabilis 2%
Acinetobacter anitratus 2%
Others 6%
AB resistant surveillance in
MICRO-UI in the year2003
Total bacteria isolated 2671
579 isolated from sputum, 459 from urine,
648 from pus, 224 from throat swab, 146
from blood
Antibiotic tested : 26 in y 2000, 35 in y
2002 , 39 in y 2003 (23 are beta lactams),
others are macrolide, fluoroquinolones(5)
,tetracyclines, chloramphenicol etc.
ANTIBIOTIC AVAILABLE IN
THE MARKET
At least 35 kinds of antibiotics
Beta lactams : penicillin,
amoxycillin,cephalosporin (15 tested at
Micro UI),carbapenem and monobactam
Macrolide
Aminoglycoside
Fluoroquinolone
 Sensitivity in Gram Positif
teico
2003
Amx Ceftr Levo Moxi

S.virid 77 89 23 78 89

S.aure 82 55 92 97 97
u
S.epid 87 74 76 86 94
ermidi
s
S.beta 76 97 82 78 73
Non A
S.pne 98 98 100 96 100
 Sensitive pattern Gram
negative 2003
AMX Ceftriax CIP Moxi
Haemop NA NA NA NA
hilus sp.
M.cattar 91 52 74 89
h
Kleb.pn 15 54 67 73
e
Pseud.a 4 29 60 58
e
E.coli 18 66 58 57
PROPERTIES OF THE QUINOLONES
ANTIBACTERIALS
The quinolones inhibit bacterial enzyme
topoisomerase IV produce by ParC and
ParE genes and DNA gyrase
(topoisomerase II) produce by GyrA and
GyrB genes
Resistance happen because of the
accumulation of chromosomal mutations
and the efflux mechanisms of bacteria
 Selected GROUP III
Quinolones
GATIFLOXACIN
MOXIFLOXACIN

Developmental compounds
GEMIFLOXACIN
GARENOXACIN,SITAFLOXACIN

Cover Gram positive and Gram negative,

aerobic and anaerobic, and
“atypical”pathogens, but never for
Pseudomonas sp
 MIC OF MOXIFLOXACIN
FEBRUARY 2004
Streptococcus pneumoniae
from sputum :0,0625-16
Staphylococcus aureus
from sputum : 0,008 – 0,125
Streptococcus viridans
from sputum : 0,125 - 1
 MIC OF MOXIFLOXACIN
FEBRUARY 2004
Klebsiella pneumoniae
from sputum :0, 008 - 0,5
Escherichia coli
from sputum : 0,008 – 0,125
Branhamella catarhalis
from sputum : 0,004 - 2
 Conclusion 1
AECB may caused by Gram negative
bacteria such as
K.pneumoniae,Enterobacter
aerogenes,E.coli,M.cattarhalis,Proteu
s mirabilis,A.anitratus and
Pseudomonas aeruginosa
Moxifloxacin is still proven to be a
potent AB against bacteria Gram
negative by looking into its low MIC 90
for above mentioned bacteria
 Conclusion 2

MOXIFLOXACIN is also proven to be a

potent antibiotic for respiratory
pathogens looking to its low MIC in
Gram positive bacteria ,such as
Streptococcus viridans,
Streptococcus pneumoniae, and
Staphylococcus aureus
 Conclusion 3
The resistance development for
ciprofloxacin and moxifloxacin are
relatively slow, since resistance
development will only happened if
there are cumulative mutation in
bacteria
The use of both antibiotics are prudent
and used with precaution approach
despite its broad marketing strategies
THANK YOU