antibiotik fk 10 ppt
TRANSCRIPT
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