Anti Biotika
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Transcript of Anti Biotika
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ANTI BIOTIKAHj Ramadhani RB, dr.,MKes
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Anti Biotika
Senyawa hasil sintesis mikroorganisme yg dapat membunuh atau menghambat pertumbuhan mikroorganisme lain, mis: Penosilin, streptomisin.
Bahan Kemoterapi : Senyawa yang disintesis in vitro (di luar
tubuh) untuk membunuh atau menghambat pertumbuhan mikroorganisme in vivo (di dlm tubuh). Mis: Sulfonamid.
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Bakterisid
A.Bacterisid , membunuh kuman (bakteri).
Penisilin Cephalosporin Aminoglikosida Kotrimoksazol Isoniazid
B.Bakteriostatik, menghambat pertumbuhan kuman kuman kemudian dihancurkan oleh daya tahan tubuh.
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Bakteriostatik
Bakteriostatik : menghambat pertumbuhan kuman kuman kemudian dihancurkan oleh daya tahan tubuh.*Sulfonamida *Trimethoprim*Chloramphenicol *Linkomisin *Tetrasiklin *Klindamisin*Eritromisin *Asam para amino salisilat
Kombinasi obat bakterisid + bakteriostatik dapat bersifat sinergistik, aditif atau antagonistik.
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Sulfonamida
Mekanisme kerja : menghambat sintesa asam folat
dengan mengikat pteridin menjadi suatu bentuk aktif.
Farmakokinetik:1. Diabsorbsi dengan baik mell usus halus.2. Penetrasinya baik ke dalam cairan otak
dan nasofaring.3. Ekskresi terutama dalam urin mell
filtrasi glomeruli dan sekresi tubuli.
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Toksisitas Sulfonamida:
Kemerahan (termasuk Stevens-Johnson sindrome)
Pusing, sakit kepala. Kristaluria (terutama Sulfadiazin) Anemia aplastik Kern icterus ( bila diberi 2mgg
terakhir kehamilan atau pd bayi baru lahir ) krn menggeser bilirubin dari ikatan proteinnya masuk dan merusak otak !!!
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Samb : Sulfonamid
SULFONAMID merupakan antibakteri spesifik krn : 1)tubuh/sel mamalia tidak mensintesa asam folat , sedangkan 2)kuman HARUS mensintesa asam folat tsb di dalam selnya agar bertahan hidup.
TRIMETOPRIM antibakteri selektif krn ia menghambat enzim kuman (dihidrofolat reduktase) 20.000-80.000 kali lebih kuat dari enzim mamalia.
“KOTRIMOKSAZOL” adalah campuran dari :
1 bgn Trimetoprim + 5 bgn Sulfametoksazol
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Sulfonamides & Trimethoprim
Sulfadiazine
Sulfisoxazole
Sulfamethoxazole +Trimethoprim Co-trimoxazole
( Bactrim )
Sulfacetamide
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Pteridine precursor + PABA
Pteridine + PABA
+ glutamic acid
Folic acid
Dihydrofolic acid
Dihydrofolic acid reductase
Tetrahydrofolic acid
DNA Bacterial growth
sulfonamid
trimethoprim
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Co-trimoxazole : ( bacterioside )
Trimethoprim ( 1) + Sulfamethoxazole (5) ( bacteriosatik ) ( bacteriostatik)
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PENICILLIN
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Toksisitas Penicillin :
A. HipersensitivitasReaksi tipe I (dini): Urtikaria, eritemaAnafilaksis (jarang)Reaksi tipe III (penyakit serum):demam,sakit sendi, eritema nodosa,dermatitis eksfoliatif ,
sindroma Steven- Johnson.B. Neurotoksisitas
Ensefalopati: Kejang, koma , kematian.
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Penicillin
Klinis:
* First choice drug bac meningitis,
inf bone, joints, skin, soft tisssue,
throat, bronchi, tr UG.
* Gonorrhoea, syphilis
( banyak kuman yg sudah resistens
al : Staphycc )13
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PenicillinGeneric name spectrum PO Pen-ase Res6. Ampicillin7. Amoxycillin8. Carbenicillin Carbenicillin- indanyl9. Ticarcillin10.Piperacillin
GR-/+ (BS)IdemGR- >
IdemIdemidem
++-
+--
---
---
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Alergy Penicillin
Skin test alergy ( + /- )
( pen G dosis <<<< IC )
( unreliable / berbahaya )
Penicilloyl polylysin
( PPL, Pre Pen )
+ (alergi) - ( ? )15
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SEFALOSPORIN
A. Sama seperti Penisilin : Mempunyai inti peptida Menghambat pembentukan dinding sel Dapat dihancurkan oleh enzim β – lactamase
dari kuman !!B. Generasi pertama :
Cefradine, cefadroxil , cefazolin.C. Generasi kedua :
Cefuroxim, cefachlor, cefoxitin. Efektif untuk E.coli, N.gonorrhoeae.Relatif tahan/resisten thdp enzim β – lactamase
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Generasi ketiga : (semuanya bentuk suntikan)
Cefotaxim Ceftriaxone Ceftazidime
Gambaran umum semua cefalosporin: Terutama diekskresi mell ginjal Penetrasi mell sputum buruk Untuk infeksi sal.kemih; sifilis; gonore Reaksi alergi/ kemerahan (=penisilin)
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Cephalosporin
Generasi I II III IVCefadroxil
Cefazolin
Cefradin
Cefalexin
Cefuroxim
Cefaclor
Cefoxitin
Cefotetan
Cefotaxime
Ceftriaxone
Ceftazidime
Cefipim
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ERITHROMYCINEritromisin
Termasuk gol. Makrolida
Mekanisme kerja : menghambat sintesa protein kuman.
Farmakokinetik : Basa eritromisin dirusak di lambung (tdk
bisa per-oral). Bentuk garamnya (garam estolat dan
garam palmitat bisa diberikan per-oral.
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Samb.Eritromisin
Aktivitas bakteri : Bakteriostatik thdp Step. β-haemolyticus ; Stap.aureus, Neisseria, H.influenzae.
Penggunaan:Alternatif untuk yg alergi Penisilin. (Px Infeksi streptokokus, pneumokokus dan gonokokus)
Toksisitas : Gangguan saluran cerna; alergi.
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CHLORAMPHENICOLKloramfenicol
Bersifat bakteriostatik Mekanisme kerja: Farmakokinetik: Aktivitas & Penggunaan: Toksisitas
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Chloramphenicol glucoronyl transferase ( hepar )
Chloramphenicol
glucoronide
new borne (-) ( hepar <<< )
Chloramphenicol >>>>
( Gray - sindrom )
t-tbh < , muntah
Kulit kelabu
Circulatory failure
Shock… mati22
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Thiamphenicol ~ Chloramphenicol
( - NO2 diganti –CH2So2 ( sulfomethyl ) )
Anti bac < ( kec :Bordetella pertusis /
Shigella sonnei )
Depresi bone marrow <<
Klinis : - Bronchitis - GO
- inf sal empedu
- salmonella ( Typh – ParaTyph )23
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TETRACYCLINTetrasiklin
Mekanismr Kerja: Kinetik: Toksisitas Sprktrum & Penggunaannya:
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Tetracyclin : * Oxyteteracyclin * Tetracyclin
* Doxycyclin * Minocyclin
* Tigecycline (iv)
Basa sukar larut air ( bentuk garam mudah larut )
Stabil pH asam
Cara kerja : Sintesa protein <<
Bacteriostatik
Broad spct : G +/- , Ricketsia, protozoa, Chlamydia
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Disimpan di tulang / gigi ( gigi coklat ) ( < 8-9 th )
Menembus sawar uri … discoloration gigi
Eks : Ren ( >>> )
Bile ( < )
Doxycyclin : eks bile >>>
( renal failure akumulasi (-) )
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ES : ( tetracyclin )
* Iritasi lambung ( > Oxytetra )
* Superinfeksi
* Hepatotoksik ( < Oxy / Tetra )
* Discoloration gigi / pertumbuhan tl ( < Oxy / Doxy )
* Antianabolik
* Photosensitif ( Demeclocyclin )
* Vistibular dizziness/vertigo(reversble): doxy/mono
* waktu perdarahan >>
* Renal tubular acidosis “Fanconi syndrom” ( tetra kadaluarsa )
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AMINOGLIKOSIDA
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AminoglycosidaStreptomycin
Neomycin
Kanamycin :
( Amikasin / Dibikasin)
Tobramycin
Gentamicin
Netilmicin
Spectinomycin
Abs : Po <<<
Ik-protein <
Eliminasi di glo
Tox: -Ototoksik
-Nephrotoksik
-Curare like
-Skin reaction29
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Clinical uses: ( Aminoglycoside )
* Terutama gram (-) ( garamicin, tobramycin, amikacin )
* Sering dikombinasi dg beta-lactam antibiotik (penicillin )
untuk inf ku gram (+ )
* Streptomycin + Penicillin entrococcal carditis
* Mycobac-tbc resisten Streptomycin ( penggantinya Amikacin )
* Neomycin, kanamycin topical dan oral
* Spectinomycin ( der – Aminocyclitol)
- Single dose
- intra muscular
- Gonorrhea ( alergi beta lactam )
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ERITHROMYCIN
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Erythromycin( dari streptomyces erythreus)
sintesa protein <<
Bacteriostatik…side (~ dosis )
Spectrum :
- Gram + cocci - Spirochetes- Neisseriae - Ent-histolityca- Coryn- diphteriae - Mycopl-pneumoniae
- H. influenzae - Virus besar32
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FLUORO QUINOLONE
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Quinolon Fluroquinolon
Nalidixic acid*
Pipemidic acid*
Cinoxin
NorfloxacinCiprofloxacinOfloxacinPefloxacinSparfloxacinLevofloxacinMoxifloxacinGemifloxacin
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