Antibiotik FK 10 Ppt

Farmakologi

Chloramphenicol Spiramycin

Ciprofloxacin

Garamycin Doxycyclin Amikacin Streptomycin

Tigecyclin Amoxicillin

Tetracyclin Cephalosporin Thiamphenicol

Co-trimoxazole

Cloxacillin Azithromycin Colistin

Rifampicin Clindamycin Ampicillin

Antibiotik

Hamzah.dr Sp.FK

Antibiotik :

* Bahan / zat yg dihasilkan oleh mikroba

/ sintetiknya

* Membunuh /menghambat pertumbuhan

mikroba lainnya

Obat anti infeksi

Khemoterapi

HostKU

Gejala infeksi

HostKU

Ku

Gejala infeksi

Host

Antibiotika

Antibiotik

Sawar darah otak Kapsul sendi Mata Dinding abses

Kuman

Antibiotik .... Absorpsi GI tract <<< Konsentrasi >>>>>>> (Tract UG )

kinetik

dinamik

manusia

farmakologi klinik

Antibiotik efekPenyakit infeksi

utama

samping

Hamil

Gg ren /hpr

Bayi/dws/tua

Pria/ wanita

Obat Sembuh

berjasa

berdosa

Prinsip pemberian antibiotik :

1. Pastikan diagnosa ok Infeksi ( panas blm tentu ok kuman )2. Infeksi serius ..pemeriksaan culture3. Bila dilakukan culture, sambil menunggu hasil , beri Antibiotik empirical4. pemilihan Antibiotik yg rasional - Kuman - Host 5. Monitoring keberhasilan terapi culture6. Kombinasi antibiotik - infeksi campuran - Synergis - Penyebab tidak tahu - Mencegah resistensi7. prophylactic ( Pre/post Op , Endocarditis )

Klasifikasi :

Struktur

kimia

Spektrum Titik tangkap

kerja

* Penicillin

* Cephalosporin

*Tetracyclin

*Chloramphenicol

* Macrolid

* Aminoglycoside

* Quinolon

* Broad

* Narrow

* Dinding sel

* Membran sel

* Sintesa protein

* Asam nukleat

Titik tangkap kerja :

Dinding

sel

Membrane

sel

Sintesa protein

Asam

nukeat

Peinicilin

Cephalosporin Carbapenam

Monobactam

Fosfomycin

Aztreonam

Meropenam

Ertapenam

Vancomycin

Bacitracin

Cycloserin

Colistin

Polimixin-B

Chloramphenicol

Tetracyclin

Macrolide

Ketolide

Lincomycin

Streptogramin

Oxazoladinone

Aminoglycosid

Rifampicin

Quinolon

Hepatotoksik >>> < t½ >>Tetracyclin

Erythromycin

Penicilin

CephalosporinChloramphenicol

Rifampicin

Lincomycin

As-Nalidixin

Sulfonamid

Nitrofurantoin

Nefrotoksik

>> <<<< / -Aminoglycoside

Polymixin

Colistin

Cephaloridin

Cephalotin

Chloramphenicol

Chlortetracyclin

Doxycyclin

Minocyclin

Rifampicin

Lincomycin

As-Nalidixin

Sulfonamide

Kadar di CSF

Inflamasi

Pen / Ceph - +

Tetracyclin -

Chloramphenicol +

Aminoglycoside << <

Macrolide -

Quinulon <

Clindamycin -

Rifampicin +

Bacterosid Bacteriostatik

Penicilin

Cephalosporin

Gentamicin

Rifampicin

Polymycin

Bacitracin

Streptomycin

Tetracyclin

Chloramphenicol

Erythromycin

Lincomycin

Sulfonamide

Dosis >>

Bac-sid

Tx Antibiotika kombinasi

SinergisSinergis ………Bac-sid + bac-sid

AditifAditif ………… bac-statik + bac-statik

AntagonisAntagonis…… bac-sid + bac-statik

Resistensi

AB

Ku Ku

Ku resisten

Natural drug resisten

Aquired

Transferred/ “infectious” *Transformation

*Transduction

*Conjugation

Cross resisten :

Struktur kimia

sama : der Tetracyclin

Polymyxin B ~ Colistin

Neomycin ~ Kanamycin

tak sama : Erythromycin ~ Lincomycin

Reaksi yg merugikan :

*Superinfeksi ( broad > narrow )

*Hipersensitifitas ( allergi )

Perlu diketahui pengobatan dengan Antibiotik

sama dengan obat lain

……………………………………………………………..

Ada istilah MIC

( Minimum Inhibitory Consentration )

Titik tangkap kerja :

Dinding

sel

Membrane

sel

Sintesa protein

Asam

nukeat

Penicilin

Cephalosporin Carbapenam

Monobactam

Fosfomycin

Aztreonam

Meropenam

Ertapenam

Vancomycin

Bacitracin

Cycloserin

Colistin

Polimixin-B

Chloramphenicol

Tetracyclin

Macrolid

Ketolid

Lincomycin

Streptogramin

Oxazoladinone

Aminoglycosid

Rifampicin

Quinolon

Antibiotik penghambat sintesa dinding sel

Penicillin Cephalosporin miscellaneous

Narrow spectrum Broad spect

Extended Spect

Narrow spectrum

Broad spectrum

Carbapenam - Imipenam

- Meropenam

Monobactam

- Aztreonam

Fosfomycin

Ertapenam

Vancomycin

Bacitracin

Cycloserin

Penicilinase suscep tible

Penicil G

Penicil V

Penicilinase resistant

( Anti-

Stapylococal )

?

Ampi

Amox

Carbeni cilin,

Piperacilin

Mezlocillin,

Azlocillin

1st gene 2nd , 3nd 4th

Gene

PenicillinNarrow spectum Broad

spectrumExtended Spectrum

Generasi- 1 :

Penicillin G ,

Penicillin V

Antistapylococal :

Methicillin, Nafcillin,

Isoxazolyl penicilin:

oxacillin,

cloxacillin,

dicloxacillin

Generasi- 2 :

Ampicillin ,

Amoxicillin,

Bacampicillin

Generasi- 3 :

Carbenicilin, Piperacillin( pseudomonas +proteus)

Generasi- 4 :

Mezlocillin, Azlocillin( pseudomonas +proteus)>>

(6)

Penicillin

Penicillin

*Alami : jamur Penicilinum Notatum/ Chrysogenum

*Semi sintetik

*Sintetik : rumus bangun : 6-Aminopenicillanic acid

S

C C C

C N C

-lactamase / penicilinase

amidase

Penicillin

Farmakokinetik :

Abs : Pe cepat / Po bervariasi

Dist : seluruh jar tb ( serum ~ jar )

kadar (<) mata, prostat, CNS

( kec. Inflamasi ….. Meningitis )

Eks : * urine ( >> ) : 90 % sekrs tubulus

10 % filtrasi glomerulus

* sputum / ASI

Penicillin

Farmakokinetik :

Probenicid dapat menghambat sekresi Penicillin

di tubulus

t½ Penicillin >>

PenicilinGeneric name spectrum PO Pen-ase Res

1.Pen-G

2. Pen-V

3. Methicilin

4. Nafcillin

5. Isoxazolyl –

Penicilin

Oxacillin

Cloxacillin

Dicloxacillin

Flucloxacillin

GR+>>

Idem+GR-<

Idem

idem

Idem

Idem

Idem

idem

-

+

-

-

+

+

+

+

-

-

+

+

+

+

+

+

Penicillin

Generic name spectrum PO Pen-ase Res

6. Ampicillin

7. Amoxycillin

8. Carbenicillin

Carbenicillin-

indanyl

9. Piperacillin

10.Mezlocillin

11.Azlocillin

GR-/+ (BS)

Idem

GR- >

Idem

Idem

Idem

Idem

+

+

-

+

-

-

-

-

-

-

-

-

-

-

-

-

PenicillinNarrow spectum Broad

spectrumExtended Spectrum

Generasi- 1 :

Penicillin G ,

Penicillin V

Antistapylococal :

Methicillin, Nafcillin,

Isoxazolyl penicilin:

oxacillin,

cloxacillin,

dicloxacillin

Generasi- 2 :

Ampicillin ,

Amoxicillin,

Bacampicillin

Generasi- 3 :

Carbenicilin, Piperacillin( pseudomonas +proteus)

Generasi- 4 :

Mezlocillin, Azlocillin( pseudomonas +proteus)>>

(6)

Kuman-kuman yg sudah membentuk -lactamase

Staphylococcus

H. Influenzae

N. Gonococcus

E. Colli

????????

Beta-lactamase

(Penicillinase)

Beta-lactamase inhibitor:

Clavulanic acid Sulbactam / Tazobactam

( penicillinic acid sulfon )

Streptomyces semi sintetik

clavigerus ( inti pen )

cara kerja

Mengikat beta-lactamase

( anti bacteria <<< )

+ Amoxycillin + Ampicillin

( Augmentin ) ( Unasyn )

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 )

Alergy Penicillin

Skin test alergy ( + /- )

( pen G dosis <<<< IC )

( unreliable / berbahaya )

Penicilloyl polylysin

( PPL, Pre Pen )

+ (alergi) - ( ? )

Cephalosporine

Cephalosporin

Jamur Cephalosporium acremonium semi sintetik

Cara kerja / struktur kimia ~ Pen

rumus bangun : 7 aminocephalosporanic acid

S ( relatif tahan pen-ase )

C C C

C N C

C

-lactamase

amidase

Cross alergy ~ Pen

( Jarang 5-10 % )

Kinetik ~ Pen

Cephalosporin G e n e r a s i

I II III IV

Spektrum ~ Pen > >>

Stabil Pen-ase > Pen > >> >>>

Potensi + ++ +++ ++++

Cephalosporin

Genersi

I II III IV

Cefadroxil

Cefazolin

Cefradin

Cefalexin

Cefuroxim

Cefaclor

Cefoxitin

Cefotetan

Cefotaxime

Ceftriaxone

Ceftazidime

Cefipim

Klinis : (cephalosporin)

* Bacteriemia ( + aminolgycosida )

* Surgical prophylaxis ( Pre / post OP )

* Mixed infection ( + anaerobes )

* Pen-ase producing N.gonorrhae

* Bac- gram (- )

Reaksi yg merugukan :

* Pemberian Po.. N / V / D , IM …iritasi/pain

IV… thromboplibitis *Allergy

* Hipoprothrombinemia

Antibiotik

penghambat sintesa protein

Bacterial protein synthesis inhibitors

( A-B menghambat sintesa protein ) Broad spectrum

Moderate spectrum

Narrow

spectrum

Chlor

amphe

nicol

Tera

cyclin

Macro

lide

Ketolid Linco

samide

Strepto

gramin

Oxazoladinone

(Line

zolid)

Amino

glycocide

Subclass Prototype Other agents

Chloramphenicol Chloramphenicol

Tetracyclin Tetracyclin Demeclocyclin, Doxycyclin,

Minocyclin, Tigecyclin

Macrolid Erythromycin Clarithromycin, Azithromycin

Ketolid Telithromycin

Lincosamide Lincomycin Clindamycin

Streptogramin Quinupristin-Dalfopristin

Oxazoladinone Linezolid

Aminoglycosides - Systemic

- Local

- Aminocyclitol

Gentamicin

Neomycin

Spectinomycin

Amikacin,Netilmicin,

Tobramycin,Streptomycin

Gentamicin,Kanamycin

Chloramphenicol

Chloramphenicol

Sintetik

Sintesa protein <<

Broad spct ~ Tetra

( Gram +/- , Ricketsia, Salmonella, H.influenzae )

Penggunaan jarang ?

Depressi bone marrow

Agranulocytosis

Chloramphenicol

glucoronyl transferase ( hepar )

Chloramphenicol

glucoronide

new borne (-) ( hepar <<< )

Chloramphenicol >>>>

( Gray - sindrom )

t-tbh < , muntah

Kulit kelabu

Circulatory failure

Shock… mati

Klinis : * inf Salmonella

* inf pneumococc / meningococc ( meningitis )

* inf H. influenzae

* salep mata

Drug interaction :

* Menghambat metb obat lain

( phenytoin, tolbutamid, warfarin )

* Pemberian bersama Phenobarbital, Rifampicin

memperpendek waktu paruh Chloramphenicol.

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 )

Tetracyclin

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

F.Kinetik :

Abs : Po tak lengkap

Chelasi dg ion Ca , Mg , Al

membentuk ikatan komplek : - tak larut

- sukar di abs

Makanan mengurangi Abs ( kec : Doxy / Mino )

Dist : seluruh jar

Doxy / Mino : lipid sol >>

Oxytetra : lipid sol <<

Disimpan di tulang / gigi ( gigi coklat ) ( < 8-9 th )

Menembus sawar uri … discoloration gigi

Eks : Ren ( >>> )

Bile ( < )

Doxycyclin : eks bile >>>

( renal failure akumulasi (-) )

Use:

1. Inf Mycoplasmapneumoniae, Chlamydia,

Rikettsia, Vibro species

2. Alternative drug Syphilis, inf tract resp,

prophylaxis inf chronis bronchitis, Eptospirosis, Acne.

3. Selective ulcus ok Helibacter pylori (tetracyclin ),

prevensi Malaria (Doxycyclin ), pengobatan amebiasis

4. Tigecyclin ( der Minocyclin ) broad spectrum (iv)

efektif pd ku yg sudah resisten Tetra,Methicillin,

Vancomycin, ku yg produksi betalactamase,

ku anaerobe, Chlamydia dan Mycobacteria.

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 )

Macrolide

Macrolide :

* Erythromycin

* Spiramycin

*Roksitromycin

*Claritomycin

*Azithromycin

Erythomycin

( dari streptomyces erythreus)

sintesa protein <<

Bacteriostatik…side (~ dosis )

Spectrum :

- Gram + cocci - Spirochetes

- Neisseriae - Ent-histolityca

- Coryn- diphteriae - Mycopl-pneumoniae

- H. influenzae - Virus besar

Resistensi antar Macrolide

Klinis :

*inf Upper resp *Diphteri carrier

*G (+) Pen-resisten

*lues Pen allargy *Acne

ES :

Po: N / V/ D /

Glositis / Stomatitis / super infeksi

SpiramycinCara kerja ~ Erythromycin

Spectrum : gram + / -

clamydia trachomatis

Toxoplasma gondii

Cryptosporidum muris ( AIDS )

F-kinetik :

Abs : po baik

Dist bronchus/saliva, prostat, muscle.

Eks : - urine

- bile

t ½ : 4 -8 jam

ES : GI tract N / V / mulut kering

skin rash / asma / colitis

Klinis : Inf staphylococc / streptococc / pneumococc

GO ( resisten )

Toxoplasmosis

Trachoma

Roksitromycin ~ Erythromycin

* iritasi lambung <<

* kadar jar >

* t½ 10 jam ( 2dd )

Azithromycin t½ >> ( 1dd 500 mg )

Ketolid

Telithromycin ( stuktur ketolid ~ Macrolid )

- Cara kerja / specrtum ~ Erythromycin

( sensitif pada kuman yg sudah resisten thdp Macrolid

ok terikat kuat pada ribosome )

- Pemberian oral once daily

- Eliminasi bile dan urine

- Penggunaan terbatas ok efek sampingnya

Hepatotoksik, gangg penglihatan

Lincosamide

( Lincomycin / Clindamycin )

Lincomycin / Clindamycin

larut air

acid stable

bacterioside

toksisitas : liver damage / CV collaps

Digeser Clindamycin :

- Potensi >, Toksisitas << , cross resistensi +

Clindamycin

ES : iritasi GI… N / V

superinfeksi

pseudomembrane colitis

bad-taste … penetrasi saliva

Klinis :

- infeksi kulit ( G + )

- Inf- tract Resp ( H. influenzae )

- Acne

Streptogramin

Quinopristin-dalfopristin

* Kombinasi dari 2- Streptogramin

* Bacteriocid

* Efektif thdp kuman yg sudah resisten penicillin,

methicillin, vancomycin

* Pemberian iv

* ( menyebabkan arthralgia-myalgia sindrom )

* Streptogramin adalah inhibitor CYP3A4

Menyebabkan kadar bbp obat meningkat

( Astemizole, Cisaprid, ciclosporin, diazepam, warfarin )

Oxazoladinone

Linezolid ( Zyvox )

- Antibiotik pertama dari oxazolidinone

- Menghambat sintesa protein

- Efektif thdp ku yg sudah resisten (gram +) cocci

( penicillin, vancomycin)

- Pemberian peroral / parentral

- Metabolisme mel hepar

- Eliminasi half life 4 -6 jam

- Efek samping throbositopenia , neutropenia

Aminoglycosida

Subclass Prototype Other agents

Aminoglycosides

- Systemic

- Local

Gentamicin

Neomycin

Amikacin,

Netilmicin,

Tobramycin

Streptomycin

Gentamicin, Kanamycin

Aminocyclitol Spectinomycin

- Spectinomycin ( im,single dose ) GO ( yg allergi betalactam )

Aminoglycosida

Streptomycin

Neomycin

Kanamycin :

( Amikasin / Dibikasin)

Tobramycin

Gentamicin

Netilmicin

Spectinomycin

Abs : Po <<<

Ik-protein <

Eliminasi di glo

Tox: -Ototoksik

-Nephrotoksik

-Curare like

-Skin reaction

Farmakokinetik :

* Poorly lipid soluble ( parentral )

* Unable to enter the CNS

* Not metabolised

* Excreted unchanged by the kidney

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 )

Gentamicin ( Garamicin )Abs : Po <<

Eks : …glo ( bentuk tak berubah )

renal failure .. Akumulasi obat

ES : gg keseimbangan / pendengaran

* keseimbangan garamcin, tobramycin

* pendengaran amikacin, kanamycin

Tak dianjurkan ibu hamil / neonatus ( ? )

Klinis : sistemik ( Gram - )

topikal : kulit ( luka bakar) , salep mata

Resistensi Aminoglycosida

- Terutama pada ku gram negatif

- gram postif streptococc ( s-pneumoniae ), entrococci

resisten thdp garamicin dan aminogylosida lain

Ok enzym transferases

Inactivasi Amikacin, garamicin, tobramycin

( tidak pada streptomycin )

Netilmicin kurang sensitif thdp transferase

Rifampicin

Rifampicin

* Semi sintetik

* Broad spct : gram (+) cocci

gram (-) bacilli

Tuberculosa / lepra

* ES : GI Nausea / vomiting

Hepar ( terutama kel - hepar )

* Enzym inducer

* Use : TBC / Lepra

pseudomembrane colitis

Polymyxin

Polymyxin A / B / C / D / E / M

colistin

Bacterioside G (-)

Inf trct UG / telinga / kulit

Use Topikal ( aman ) , sistemik (gg Ren / CNS)

Potensiasi dg obat neuro-muscl paralysis

kelemahan otot

Lysis mast sel histamin

Colistin

Spectrum / cara kerja ~ Polymyxin-B

Potensi <

Abs Po : < 5 th (+) , dewasa (-)

Menembus placenta barrier

ES ~ Polymyxin-B

CI : myasthenia gravis

Use : topikal ( + neomycin + corticostroid )

GI tract ( E.colli yg resisten neomycin )

Quinolon

Quinolon / FluroquinolonGenerasi I Generasi II Generasi III

Nalidixic acid*

Pipemidic acid*

Cinoxin

Norfloxacin .

Ciprofloxacin

Ofloxacin .

Pefloxacin .

Sparfloxacin.

Levofloxacin .

Moxifloxacin .

Gemifloxacin

Getifloxacin

( ? )

quinolon

Cara kerja :

Menghambat DNA girase

( enzym supercoiling DNA )

Spektrum :

Quinolons Gram (-) ( trct UG )

Fluoroquinolons Gram (-) >>

GO / Chlamydia

Staphylococc

Pseudomonas A

F. Kinetik :

Abs : Po ( 50 – 90 % )

Dist : luas const Ren / Pulmo > serum

CSF < serum

Sekrs : ren : F-quinolon

non renal : Quinolon + Pefloxacin

Hepatic failure : F-quinolon (+)

( kec. Pefloxacin )

F. Kinetik :

Abs : peroral

Peroral : Nalidixic acid +

Norfloxacin . ++

Ciprofloxacin . ++

Ofloxacin . ++

Sparfloxacin. ++

Levofloxacin . ++

Pefloxacin . +++

Moxifloxacin . ++ / entral

Gemifloxacin ++ / entral

Getifloxacin. ( ? ) ++ / entral

Quinolon(Asam Nalidiksat ) Abs per oral ( cepat ) ...... Ekskresi ( cepat )…….ren ( jadi kurang manfaat utk infeksi sistemik )

Norfloxacin ~ asam Nalidiksat - kadar urin tinggi , - kadar serum rendah ( tidak berguna utk infeksi diluar sal kemih )

Klinis :( f-quinolon )-

• Infeksi : * saluran kemih ( cipro / nor / of )

* saluran cerna ( cipro / of / pe )

* saluran napas ( ciporo / of / levo / moxi /

gemi / gati ? )

* tulang- sendi ( cipro )

* kulit - jar lunak ( cipro ? )

* ok sexual ( cipro / levo )

Klinis :( f-quinolon )

*Complicated urinary tract infection

* Gonorrhae

* Cervisitis

* Prostatitis

* Typhoid fever

* Septicemia ( thdp ku yg sensitive )

* Resp tract infection( bukan ok pneumococci )

Adversed reaction : ( f-quinolon )

- Gangg GI tarct

- Skin rashes

- Joint pains

- Allergy

- Menghambat ikatan GABA dg reseptornya

convulsi

- Gangg pertumbuhan tulang / cartilage

( ibu hamil / anak masa pertumbuhan (-) )

Co-trimoxazole

Sulfonamides & Trimethoprim

Sulfadiazine

Sulfisoxazole

Sulfamethoxazole +Trimethoprim Co-trimoxazole

( Bactrim )

Sulfacetamide

Co-trimoxazole :

( bacterioside )

Trimethoprim ( 1) + Sulfamethoxazole (5) ( bacteriosatik ) ( bacteriostatik)

Pteridine precursor + PABA

Pteridine + PABA

+ glutamic acid

Folic acid

Dihydrofolic acid

Dihydrofolic acid reductase

Tetrahydrofolic acid

DNA Bacterial growth

sulfonamid

trimethoprim

Klinis : (Co-trimoxazole )

* Inf-systemic

* Inf chronis - trct UG

* Inf-ku gram (-) bacilus

* Inf-trct Resp ( bronchitis ok S.pneumoniae, H.influenzae )

* Otitis media ( S.pneumoniae, H.influenzae )

* Typhoid fever ( resisten Chloramphenicol, Ampicilin )

Drug of choice Tx / Px : Pneumonia ( ok. Pneumocytsis carinii ) ( terutama pend dengan immunosppressed )

Adverse effects ( co-trimoxazole )

Sulfonamide Trimethoprim

Alergy-rash, fever,

Stevens-johnson synd

Agranulocytosis

Kristal uria

Haemolysis

Inhibit metab- obat

Macrocytic anemia

Trombocytopenia

Aplastic anemia (elderly)

Teratogenic ( folate antagonist)

Faktor kegagalan

tx. Antibiotik

Faktor kegagalan Tx. Antibiotik01 Indikasi kurang tepat 02 Dosis <

03 Daya tahan tubuh <

04 Resistensi

05 Superinfeksi06 Infeksi campuran 07 Tindakan bedah

08 R. hipersensitif

09 Interaksi obat

10 Farmakokinetik

Buku acuhan

1.The farmacological basis of therapeutics (Goodman & Gilmans)

2. Basic clinical pharmacology ( Bertram G Katzung)

3. Pharmacology -Examination & broad review

Katzung & Trevor’s (2008 )

4 Medical Pharmacology ( Peter winstanley & Tom Walley (2002 )

5.WHO Model Formulary (2002 )

6.Pharmacology Principles and applications ( 2009 )

Eugenia M.Fulcher, Robert M.Fulcher,Cathy Dubeansky S

7. Farmakologi dan terapi ( UI -2008 )

Pertanyaan : 1. Gray sindrom ? Mengapa ?

2. Mengapa balita tidak boleh diberi Tetracyclin ? ( Ibu hamil ? Ibu menyusui ? )

3. Mengapa Tetracyclin tak boleh diberikan bersama antasida ?4. Apa Clavulanic acid ? ( cara kerjanya ? )

5. Mengapa ibu hamil tak boleh diberi Aminoglycosida ? ( kalau ibu menyusui )

6. Pend dengan kelainan ginjal bila diberi

antibiotika gol Tetracyclin,

Gol Tetracyclin apa yg boleh diberikan

mengapa ?

7. Apa tujuan pemberian Probenicid bersama

Penicillin ?

8. Mengapa fluroquinolon tak dianjurkan pemberiannya pada balita ?

9. Apa Adverse effects dari co-trimoxazole ?

10. Mengapa Tetracyclin tak dianjurkan diberikan pada balita ?

11. Mengapa Rifampicin tidak dianjurkan pem berianya bersama oral contrasepsi steroid ?

selamat belajar