dr. Ika KomalaBAGIAN FARMAKOLOGI UNIVERSITAS SWADAYA GUNUNG JATIANTIBIOTIK PADA SISTEM RESPIRASITera! a"#!m!kro$a %e&ara em!r!kIdeal ' em$er!a" a"#!m!kro$a $erda%arka" ada (a%!l k)l#)r k)ma" da" #e% keekaa"Ke"*a#aa" ' +. Pada %!#)a%! kl!"!k d!ma"a $a"*ak a"#!m!kro$a d!,)"aka"- k)ma" a#o,e" e"*e$a$ e"*ak!# #!dak d!ke#a()! ada %aa# #era! d!m)la!- a#a).. 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G7Penisilin G- er!#rom!%!"O#!#!% med!a da" %!")%!#!%7S.pneumoniae, H.infuenzae-S.aureus, kuman anaero7amoksisillin/amisillin-er!#rom!%!"- ko#r!mok%a9ol7amok%!%!ll!"7a%am kla6)la"a#Bro"k!#!% ak)# 7V!r)%7S.pneumoniae, H.infuenzae-!.pneumoniae77 77amoksisillin/amisillin- er!#rom!%!"7e!i"!omisinEk%a%er$a%! ak)# $ro"k!#!% kro"!k-S.pneumoniae, H.infuenzae !.pneumoniae-".#atarrha$is /4ara",07amoksisillin/amisillin- er!#rom!%!"- ko#r!mok%a9ol-dok%!%!kl!"7amoksisillin#asam kla$%lana"- ko#r!mok%a9ol- er!#rom!%!"I":)e"9a 76!r)% !":)e"9a A a#a) B7 7 7PILI8AN ANTIMIKROBA BERDASARKAN EDUCATED GUESSJENIS INFEKSIPENYEBAB TERSERINGPILIHAN ANTIMIKROBAP"e)mo"!a $ak#er!al7S.pneumoniae7H.infuenzae7!.pneumoniae7S.aureus7K)ma" e"#er!k Gram7"e,a#!17Pe"!%!l!" G roka!"- e"!%!l!" V- er!#rom!%!"- %e1alo%or!" ,e"era%! I7Amoksisillin/amisillin- ko#r!mok%a9ol- am!%!ll!"7%)l$ak#am-kloram1e"!kol- :)orok)!"olo"7E!i"!omisin, dok%!%!kl!"7Kloksasilin- %e1alo%or!" ,e"era%! I7Se&aloso!in 'ene!asi IIIde",a";#a"a am!"o,l!ko%!daT)$erk)lo%!% ar)7!.tuer#u$osis 7isonia(i)*!i&amisin*i!a(inami)/e"am+%"olTa$el !"! d!mak%)dka" )"#)k mem$a"#) me"e"#)ka" !l!(a" a"#!m!kro$a )"#)k %eme"#araB!la (a%!l emer!k%aa" m!kro$!olo,!k #ela( d!daa# maka !l!(a" a"#!m!kro$a (ar)% d!%e%)a!ka" la,!K)ma" e"*e$a$ da" keekaa""*a #er(ada a"#!m!kro$a daa# $er6ar!a%! ada RS;#ema# *a", $er$eda.Ya", #erma%)k am!"o,l!ko%!da ' ,e"#am!%!"- #o$ram!%!%"- "e#!lm!%!" da" am!ka%!" / %#re#om!%!" da" ka"am!&!" #!dak #erma%)k0Ya", #erma%)k %e1alo%or!" ,e"e I ' %e1a9ol!"- %e1rad!"- %e1alek%!"- %e1adrok%!l- dllSe1alo%or!" ,e" II ' %e1ama"dol- %e1ok%!#!"- %e1)rok%!m- dllSe1alo%or!" ,e" III ' %e1o#ak%!m- %e1oera9o"- %e1#r!ak%o"- %e1#a9!d!"- %e1%)9ol!"- mok%alak#am- dllYa", #erma%)k :)orok)!"olo" adala( ' %!ro:ok%a%!"- o:ok%a%!"- e:ok%a%!"- "or:ok%a%!"- dll / a%am "al!d!k%a#- a%am !em!da#- a%am !rom!da# #!dak #erma%)k0PENISILINJENIS PENISILIN TAHAN PENISILINASETAHAN ASAMSPEKTR,M ANTIMIKROBAPenisilin alam7Be"9!l e"!%!l!"/e"!%!l!" G07Fe"ok%!me#!l e"!%!l!"/Pe"!%!l!" V0777 kal! ? do%!% IM- d!a"4)rka" #!dak d!$er!ka" oralLar)#a" ,aram Na7e"!%!l!" G 3@@.@@@ IU /A+B@ m,0 IM &ea# d!a$%or%!- kadar )"&ak la%ma d!&aa! dalam 5ak#) +>73@ me"!#U"#)k memerlam$a# a$%or%!- e"!%!l!" G d!$er!ka" %e$a,a! %)%e"%! dalam a!r a#a) m!"*ak /Pe"!%!l!" G roka!"0Penisilin V 5ala))" rela#!1 #a(a" a%am 3@C me",alam! eme&a(a" d! %al &er"a a#a%.FARMAKOKINETIKAmisilin oral *a", d!a$%or%! d!e",ar)(! $e%ar"*a do%!% da" maka"a". Pe"*eraa" am!%!l!" #er(am$a#ole( ada"*a maka"a" d! lam$)",A$%or%! amoksisilin oral 4a)( le$!( $a!k dar! am!%!l!" . De",a" do%!% oral%ama- kadar dalam dara( #!",,!"*a k!ra7k!ra .D le$!( #!",,! dar! &aa!a" am!%!l!". Wak#) ar)( ked)a o$a# (am!r %ama. Pe"*eraa" amok%!%!l!" #!dak d!e",ar)(! maka"a"-ISTRIB,SIPe"!%!l!" G d!d!%#r!$)%! l)a% dalam #)$)(. Kadar o$a# *a", memada! daa# #er&aa! dalam (a#!- emed)- ,!"4al- )%)%- l!m1e da" %eme"- #e#a! ESS %)kar d!&aa!FARMAKOKINETIKAD!%#r!$)%! Pe"!%!l!" V- e"!%!l!" !%ok%a9ol!l )m)m"*a %ama de",a" e"!%!l!" G. de",a" do%!% %ama- kadar )"&ak %er)m #er#!",,! d!&aa! ole( d!klok%a%!l!".am!%!l!" 4),a d!d!%#r!$)%! l)a% dalam #)$)( da" e",!ka#a" ole( ro#e!" la%ma (a"*a .@C.am!%!l!" *a", ma%)k ke dalam emed) me",alam! %!kl)% e"#ero(ea#!k- #e#a! *a", d!ek%kre%! ke #!"4a &)k) #!",,!. Pada $ro"k!#!% a#a) "e)mo"!a- am!%!l!" d!%ekre%! ke dalam %)#)m %ek!#ar +@C kadar %er)m.d!%#r!$)%! amok%!%!l!" %e&ara ,ar!% $e%arAam!%!l!"FARMAKOKINETIKABIOTRANSFORMASI -AN EKSKRESIB!o#ra"%1orma%!e"!%!l!" )m)m"*a d!lak)ka" ole( m!kro$a $erda%ar e",ar)( e"9!m e"!%!l!"a%e da" am!da%e.8a"*a e"!%!l!" !%ok%a9ol!l da" me#!%!l!" *a", #a(a" e"!%!l!"a%eEk%kre%! )m)m"*a mll ro%e% %ekre%! d! #)$)l! ,!"4al- d!(am$a# ole( ro$e"e%!d /me"4ad! .73D le$!( lama0.O$a# la!" *a", $ere",ar)( ' 1e"!l$)#a9o"- %)l2"!ra9o"- a%e#o%al- !"dome#a%!".Keadaa" ,a,al ,!"4al memerlam$a# ek%kre%! e"!%!l!".e&ek samin'# Reak%! aler,!- #er%er!",- #) e"!%!l!" G. 7 Reak%! aler,! #er%er!", r)am k)l!#- #er$era#adala( reak%! a"a2lak#!k %*ok. Reak%! la!" ' a",!oedema- "e1roa#!- ,a",,)a" 1% (a#!.7 Reak%! #ok%!k ada %ara1 me"!m$)lka" ,e4ala epi$epsi grand ma$ ada em$er!a" e"!%!l!" V do%!% $e%arSed!aa" da" o%olo,!Jenis enisilin.a!a em+e!ian-osis )e/asa-osis anak Se)iaanPe"!%!l!" GIM- IV +7= mU;=7F 4.>.@@@7=@@.@@@ );k,;( =7F do%!%Pe"!%!l!" V Oral @-.>7@-> , G!d.>7>@ m,;k,;( dlm = do%!%Ta$ .>@- F.> m,. %*r +.>m,;> mlKlok%a%!l!"Oral @-.>7@-> , G!d.>7>@ m,;k,;( dalam = do%!%Ta$-&a +.>- .>@- >@@ m,S)% F.-> da" +.> m,;>mlAm!%!l!" Oral- IM- IVOral'.7= , G!dIV'=7B ,Oral'>@7+@@ m,;k,;( dlm = do%!%IM'+@@7.@@ m,;k, ;( dlm = do%!%Ta$-&a +.>- .>@- >@@ da" +@@@m,S)% +.>;>@@m,;> mlAmok%!%!l!"Oral >@@ m,#!d.@7=@ m,;k,;( dlm 3 do%!%Ta$-&a +.>- .>@- >@@ m,S*r +.>;>mlAmok%!%!l!";a%. kla6)la"a#Oral >@@;+.>7BH>;+.> m, $!d7#!d.@7=@ m,;k,;( dlm 3 do%!%SEFALOSPORIND!$a,! me"4ad! = ,e"era%! /SG I7IV0SG I ' %e1alo#!"- %e1a!r!"- %e1a9ol!"- %e1alek%!"- %e1rad!"-%e1radok%!lSG III ' %e1o#ak%!m- mok%alak#am- %e1#!9ok%!m- %e1#r!ak%o"- %e1oera9o"- %e1#a9!d!mFarmakok!"e#!kd!$a,! . ,ol ' oral da" IM;IVek%kre%! ke$a"*aka" dalam $e"#)k )#)( melal)! ,!"4al- ke& %e1oera9o" ek%kre%! mll emed).kare"a"*a do )m)m"*a d!k)ra",! ada !"%)1. re" ro$e"e%!d me",)ra",! ek%kre%! %e1alo%or!".E1ek %am!",reak%! aler,! mer)aka" e%o #er%er!",- ,e4ala m!r! e%o kare"a e"!%!l!".reak%! %!la", daa# #er4ad! ada a%!e" d, aler,! e"!%!l!" $era#.%e1alo%or!" $er%!1a# "e1ro#ok%!k- me%k! le$!( r!",a" d!$a"d!", am!"o,l!ko%!da da" mok%alak#amd!are daa# #!m$)l ada em$er!a" %e1oera9o"- kr" ek%kre%!#) mll emed)Pa"d)a" do%!% %e1alo%or!"Jenis se&aloso!in.a!a em+e!ian-osis )e/asa-osis anakGene!asi e!"ama '%e1adrok%!l oral @->7+ ,;( I .D 3@ m,;k,;( dlm . do%!%%e1alek%!" oral @-.>7@-> ,;=D .>7>@ m,;k,;( dlm = do%!%%e1rad!" oral @-.>7@-> ,;=D .>7>@ m,;k,;( dlm = do%!%%e1a9ol!" IV @->7. ,;B 4am .>7+@@ m,;k,;( dlm 37= do%!%Gene!asi ke"i'a%e2k%!m oral .@@7=@@ m,;+7. do%!%B m,;k,;(%e1o#ak%!m IV +7. ,;F7+. 4am>@7.@@m,;k,;( dlm =7F do%!%%e1#a9!d!m IV +7. ,;B7+. 4amH>7+>@ m,;k,;( dlm .73 do%!%%e1#r!ak%o" IV +7= ,;.= 4am >@7+@@ m,;k,;( dlm . do%!%ERITROMISINMer)aka" ,ol makrol!dFarmakok!"e#!k d!%era $a!k ole( )%)% ke&!l $a,. A#a%m)da( d!r)%ak ole( a%am lam$)",- em$er!a" %ela)# #a(a" a%am a#a) e",,)"aa" dalam $e"#)k e%#er %#eara# a#a) %)k%!"a# me",)ra",! er)%aka".maka"a" me",(am$a# e"*eraa".(a"*a .7>C d!ek%kre%! dalam $e"#)k ak#!1 d! )r!"Pemeka#a" dalam 4ar!",a" (a#!- kadar o$a# ak#!1 dlm emed) +@@D kadar dalam dara(5ak#) ar)( %ek!#ar +-> 4am- er!#rom!%!" $erd!1)%! ke $er$a,a! 4ar!",a" #)$)( ke&)al! o#ak da" LES.ada !$) (am!l kadar %!k)la%! 1e#)% >7.@C dar! kadar o$a# !$)Ek%kre%! #er)#ama ole( (a#!- d!al!%!% er!#o"eal da" (emod!al!%!% #!dak daa# me",el)arka" er!#rom!%!" dar! #)$)(.EFEK SAMPINGE%o $era# 4ara", - reak%! m)",k!" #!m$)l dalam $e"#)k demam- eo%!"o2l!a da" ek%a"#em *a", &ea# (!la", 4k o$a# d!(e"#!ka".er!#rom!%!" oral %er!", #!m$)lka" !r!#a%! %al. &er"aSed!aa" da" o%olo,!!ea!a" kemasan osolo'i ke"e!an'aner!#rom!%!"Ea;#a$ .>@ da" >@@ m,d5%'+7. ,;(-d!$a,! dlm = do%!%A"ak'3@7>@ m,;k,;( d!$a,! dlm = do%!%Do%!% daa# d!#!",ka#ka" .D l!a# ada !"1ek%! $era#O$a# d!$er!ka" %e$el)m maka"Er!#rom!%!" %#eara#Ea .>@ m,Ta$ >@@ m,S)% oral'.>@ m,;> mlD5%'.>@7>@@ m, #!a F 4am;>@@ m, #!a +. 4amA"ak'3@7>@ m,;k,;( d!$a,! dlm $e$eraa do%!%IdemEr!#rom!%!" e#!l%)k%!"a#Ta$ k)"*a( .@@ m,S)% oral'.@@ m,;> mlT#% oral'+@@ m,;.-> mlD5%'=@@7F@@ m, #!a F 4amA"ak'3@7>@ m,;k,;( d!$a,! dlm $e$eraa do%!%O$a# #!dak erl) d!$er!ka" %e$el)m maka"KOTRIMOKSAJOLFARMAKOKINETIK#r!me#or!m &ea# d!d!%#r!$)%! dalam 4ar!",a"- k!ra7k!ra =@C #er!ka# ada ro#e!" la%ma de",a" ada"*a %)l1ame#ok%a9ol.6ol)me d!%#r!$)%! #r!me#or!m (am!r KD?%)l1ame#ok%a9olF@C #r!me#or!m da" .>7>@C %)l1ame#ok%a9ol d!ek%kre%! melal)! )r!" dalam .= 4amSEDIAAN DAN POSOLOGI#er%ed!a dalam $e"#)k #a$le# oral me",a"d)", =@@ SEDIAAN DAN POSOLOGI#er%ed!a dalam $e"#)k #a$le# oral me",a"d)", =@@ m, %)l1ame#ok%a9ol da" B@ m, #r!me#or!m a#a) B@@ m, %)l1ame#ok%a9ol da" +F@ m, #r!me#or!ma"ak #er%ed!a %)%e"%! oral *a", me",a"d)", .@@ m, %)l1ame#ok%a9ol da" .@ m, #r!me#ro!m.do%!% d5% 'B@@ m, %)l1ame#ok%a9ol da" +F@ m, #r!me#ro!m %e#!a +. 4amdo%!% a"ak ' #r!me#or!m B m,;k, ;( da" %)l1ame#ok%a9ol =@ m,;k,;( d!$er!ka" dlm . do%!%em$er!a" ada a"ak $er)%!a d! $5( . #( da" $)m!l- $)%)! #!dak d!a"4)rka"FLUOROKUINOLONFl)orok)!"olo" lama ' %!ro:ok%a%!"-o:ok%a%!"-"or:ok%a%!"- dll0Fl)orok)!"olo" $ar)'mok%!:ok%a%!"-le6o:ok%a%!"A$%or%! $a!k- 5ak#) ar)( a"4a",B!oa6a!la$!l!#a% oralAare"#eralPe"*eraa" #er(am$a# 4!ka d!$er!ka" $er%ama a"#a%!daSed!k!# #er!ka# ro#e!"D!%#r!$)%! $a!k ada $er$a,a! or,a" #)$)(Me#a$ol!%me d! (a#! da" d!ek%kre%!ka" mll ,!"4al%e$a,!a" ke&!l o$a# d!kel)arka" mll emed)E1ek#!6!#a% :)orok)!"olo" ,e"era%! er#ama )"#)k ISPB $a!k- "am)" #!dak eka #(d S.aureus da" S.pneumoniaeS!ro:ok%a%!" da" o:ok%a%!" daa# d!,)"aka" )"#)k e",o$a#a" TBE *a", #ela( re%!%#e" #(d $a"*ak o$a# /MDR0E1ek %am!", ' #er%er!", ada %al &er"a /m)al- m)"#a(- ra%a #!dak e"ak d! er)#0E1ek %am!", ada SSP $er)a %ak!# keala da" )%!",I"#erak%! de",a" a"#a%!d- Fe- #eo2l!"- da" o$a# a"#!ar!#m!aT!dak d!!"d!ka%!ka" )"#)k a"ak/%ama! +B #(0da" 5a"!#a (am!lDOSIS DAN SEDIAANOBAT SE-IAAN ORAL -OSIS PARENTERALS!ro:ok%a%!" Ta$ .>@->@@-H>@ m,.D.>@ 7>@@ m, .D.@@7=@@ m, IVPe:ok%a%!" Ta$ =@@ m,I"1'=@@ m,;> ml=@@ m,;+.> ml.D=@@ m, .D=@@ m, IVO:ok%a%!" Ta$ .@@ da" =@@ m,S)"#!ka" .@@ m,;.@@ ml+73D +@@7.@@ m,+73D +@@7.@@ m, IVNor:ok%a%!" Ta$ =@@ m, .73D .@@7=@@ m,Le6o:ok%a%!" Ta$ .>@ da" >@@ m,I"1'>@@ m,;+@@ ml+D.>@7>@@ m, +D>@@ m, IV #!a .= 4ammok%!:ok%a%!" Ta$ =@@ m,I"1'=@@ m,;l#+D=@@ m, +D=@@ m, IV #!a .= 4am