Pemilihan Regimen Antibiotika.pdf

8/11/2019 Pemilihan Regimen Antibiotika.pdf

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Pemilihan Regimen Antibiotika

Systematic Approach for Selection of

Antimicrobials


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Mengetahui adanya infeksi

1. Demam Suhu tubuh di atas rentang normal (36.7-37oC)

Manifestasi dari penyakit lain.

Drug-induced fever.

2. Tanda dan gejala WBC rentang normal 4000-10000/mm3 , pada kondisi

infeksi jumlah leukosit perifer bisa mencapai 30000-4000/mm.

infeksi bakteri peningktan jumlah granulosit, often withimmature forms (band neutrophils) seen in peripheral bloodsmears.

Leukositosis respon normal dari hostterhadap infeksi.

3. Tanda-tanda Lokal

Nyeri dan Inflamasi swelling, erythema,

tenderness, and purulent drainage

infection is superficial or in a bone or joint

deep-seated infectionsmeningitis,

pneumonia, endocarditis, and urinary tractinfection examining tissues or fluids.


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Identifikasi Patogen

Mengkultur bagian tubuh yg terinfeksi

sebelum diberikan terapi antimikroba

mengetahui mikroba yg menjadi penyebab.

Jika setelah tx dikultur false negative

Dalam pengambilan kultur, hati2 terhadap

kontaminasi.

Pemilihan terapi yang tepat

Select rational antimicrobial therapy for a given clinicalsituation, a variety of factors must be considered.

These include the severity and acuity of the disease, hostfactors, factors related to the drugs used, and thenecessity for using multiple agents

There are generally accepted drugs of choice for thetreatment of most pathogens

When selecting antimicrobial regimens, local susceptibilitydata should be considered whenever possible rather thaninformation published by other institutions or nationalcompilations


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Host Factor

When evaluating a patient for initial or empiric therapy, thefollowing factors should be considered:

Allergy or history of adverse drug reactions

Age of patient

Pregnancy

Metabolic abnormalities

Renal and hepatic function

Concomitant drug therapy

Patients with diminished renal and/or hepatic function willaccumulate certain drugs unless dosage is adjusted. Anyconcomitant therapy the patient is receiving may influencethe selection of drug therapy, the dose, and monitoring

Drug Factor Integration of both pharmacokinetic and

pharmacodynamic properties of an agent is importantwhen choosing antimicrobial therapy to ensure efficacy andprevent resistance

Antibiotics may demonstrate concentration-dependent(aminoglycosides and fluoroquinolones) or time-dependent (-lactams) bactericidal effects.

The importance of tissue penetration varies with the site of

infection

The most important pharmacodynamic relationship forantimicrobials that display time-dependent bactericidaleffects is the duration that drug concentrations exceed theMIC.


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COMBINATION ANTIMICROBIAL

THERAPY

Generally used to:

broaden the spectrum of coverage for empiric therapy

achieve synergistic activity against the infecting

organism

prevent the emergence of resistance

Increasing the coverage of antimicrobial therapy

is generally necessary in mixed infections wheremultiple organisms are likely to be present

Synergism

Traditionally, combinations of aminoglycosides and -lactams have been used since these drugs togethergenerally act synergistically against a wide variety ofbacteria.

Synergistic combinations may produce better results ininfections caused by Pseudomonas aeruginosa

The use of combinations to prevent the emergence of

resistance is widely applied but not often realized. Theonly circumstance where this has been clearly effectiveis in the treatment of tuberculosis


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Disadvantages of Combination

Therapy

increased cost

greater risk of drug toxicity

superinfection with even more resistant

bacteria

MONITORING THERAPEUTIC

RESPONSE

Culture and sensitivity reports from specimenscollected must be reviewed

Use of agents with the narrowest spectrum of activityagainst identified pathogens is recommended

Patient monitoring should include a variety ofparameters, including white blood cell count,

temperature, signs and symptoms of infection,appetite, radiologic studies as appropriate, anddetermination of antimicrobial concentrations inbody fluids


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As the patient improves the route of antibioticadministration should be reevaluated. Switch tooral therapy is an accepted practice for manyinfections. Criteria favoring switch to oral therapyinclude:

Overall clinical improvement

Lack of fever for 8 to 24 hours

Decreased WBC

A functioning GI tract

FAILURE OF ANTIMICROBIAL THERAPY

disease is not infectious or nonbacterial in

origin

undetected pathogen

Laboratory error in identification and/or

susceptibility testing errors are rare.

drug selection the host/pathogen.


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Failures Caused by Drug Selection

Inappropriate selection of drug, dosage, or

route of administration

Malabsorption of a drug product because of

GI disease or a drug interaction

Accelerated drug elimination

poor penetration into the site of infection

Failures Caused by Host Factors

Patients who are immunosuppressed (e.g.,granulocytopenia from chemotherapy, acquiredimmune deficiency syndrome) may respond poorly totherapy because their own defenses are inadequate toeradicate the infection despite seemingly adequatedrug regimens

Other host factors are related to the necessity for

surgical drainage of abscesses or removal of foreignbodies and/or necrotic tissue. If these situations arenot corrected, they result in persistent infection and,occasionally, bacteremia, despite adequateantimicrobial therapy..


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Failures Caused by Microorganisms

Development of drug resistance during therapy.

Primary resistance refers to the intrinsic resistance ofthe pathogens producing the infection. However,acquisition of resistance during treatment has becomea major problem as well.

Resistance overuse of antimicrobials in thecommunity, as well as in hospitals, and the increasingprevalence of immunosuppressed patients receivinglong-term suppressive antimicrobials for theprevention of infections

Pemilihan Regimen Antibiotika.pdf

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