Antibiotik dan antiseptik saluran kemih

Dr. Rika Yuliwulandari, PhD

Infeksi Saluran Kemih

ISKB(Pada umumnya tidak ada symptoms

Urethritis

Cystitis

Prostatitis

ISKA(renal parenchyma, pelvis, ureters) ada symptom sistemik: menggigil, nyeri pinggang belakang)

Pyelonephritis (infeksi ginjal) - Mayoritas karena infeksi ascending, berasal dari organisme di

daerah perineal dan menjalar ke daerah mucosa

- Organisme terbanyak pada ISK: E. coli (flora normal intestin), sehingga kebanyakan infeksi berasal dari tractus digestivus

Terapi

Antibiotics Berdasarkan data empiris atau tes sensitivitas

Cistitis tanpa komplikasi

Terapi jangka pendek

Trimethoprim/sulfamethoxazole (TMP/SMX)

2 dd

E. coli resistance to TMP-SMX

Ex: Ciprofloxacin (Cipro) Nitrofurantoin (Macrodantin)

3-4 dd

Penggunaan jangka panjang

Pulmonary fibrosis

Neuropathies

ISK dengan komplikasi

Terapi jangka panjang (7 to 14 hari)

Fluoroquinolones

Ex: Ciprofloxacin (Cipro)

Terapi Analgesik urinarium

Pyridium Dikombinasikan

dengan antibiotik Melegakan

kandung kemih Urine berwarna

orange kemerahan Mewarnai

pakaian dalam dan dapat disalah artikan seperti darah

OTC

Urised Atropine ,

hyoscyamine , methenamine , methylene blue, phenyl salicylate , and benzoic acid

Dikombinasikan dengan antibiotik

Untuk meringankan gejala ISK

ISK berulang Antibiotik Profilaksis atau

supresive jangka pendetk Hati-hati resistensi

Antibiotik, antiseptik saluran kemih

QUINOLON

Pharmacokinetic of Fluoroquinolon

Therapeutic application of Ciprofloxacin

Drug interaction of Quinolon

INHIBITOR OF FOLATE SYNTHESIS

Pharmacokinetic

Drug interaction

INHIBITOR FOLATE REDUCTASE AND SYNTHESIS

Single and combined drug effect on E. coli

Therapeutic application of Cotrimoxazole

Pharmacology

UT antiseptic

UTI in women and elderly Uncomplicated acute cystitis Pyelonephritis

80% due to E. coli, followed by staphylococcus and saprophyticus, Klebsiella pneumonieae, Proteus mirabilis

Antiseptic can be used: Nitrofurantoin Methenamin Nalidixic acid

These drugs do not achieve antibacterial levels in the circulation, but concentrated in the urine------ microorganisms at that site can be effectively eradicated.

Methenamin

Mechanism of action: Decompose at an acidic pH of 5.5 or less in the urine ------ produce

formaldehyde, which is toxic to most bacteria The reaction is slow ----- require 3 hours to reach 90 percent

decomposition.

Should not be used in patients with indwelling catheters. Bacteria do not develop resistance to formaldehyde. [Note:

Methenamine is frequently formulated with a weak acid, such as mandelic acid or hippuric acid.]

Antibacterial spectrum: Methenamine is primarily used for chronic suppressive therapy. Urea-splitting bacteria that alkalinize the urine, such as Proteus

species, are usually resistant to the action of methenamine. Methenamine is used to treat lower UTIs but is not effective in upper

UTIs.

Pharmacokinetics: Methenamine is administered orally. In addition to formaldehyde, ammonium ion is produced in the

bladder, Because the liver rapidly metabolizes ammonia to form urea Methenamine is distributed throughout the body fluids, but no

decomposition of the drug occurs at pH 7.4 ------Systemic toxicity does not occur.

Elimination: in the urine.

Adverse effects: Gastrointestinal distress Higher doses: albuminuria, hematuria, and rashes may develop.

Contra indication: Renal insufficiency, because mandelic acid may precipitate. [Note:

Sulfonamides react with formaldehyde and must not be used concomitantly with methenamine.

patients with hepatic insufficiency, in which elevated levels of circulating ammonium ions would be toxic to the CNS.

Nitrofurantoin

Nitrofurantoin Less commonly employed for treating UTIs because of its

narrow antimicrobial spectrum and its toxicity.

Sensitive bacteria reduce the drug to an active agent that inhibits various enzymes and damages DNA.

Antibiotic activity is greater in acidic urine. The drug is bacteriostatic. It is useful against E. coli, but other common urinary tract

gram-negative bacteria may be resistant. Gram-positive cocci are susceptible.

Adverse effects include gastrointestinal disturbances, acute pneumonitis, and neurologic problems.

Nalidixic Acid

Synthetic quinolone antibiotic

Effective against gram negative UTI (E. Coli, Enterobacter species, Klebsiella species, and Proteus species)

Resistant to gram positive Pharmacokinetic:

Well absorbed >90% bound to protein --- inadequate for systemic tx Metabolism: Nalidixic acid is hydroxylated ---- 7-hydroxynalidixic acid (more potent

bactericidal) Excretion: urine

Adverse effect: nausea, vomiting, abdominal pain, photosensitivity, urticaria, fever, CNS problem (headache --- malaise), liver toxicity (tx more than 2 weeks)