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    Pengantar Farmakoterapi Penyakit Infeksi

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    Alunaficha Melody Kirania
    This document discusses signs and symptoms of infection, identification of pathogens, and selection of antimicrobials. It describes how leukocytosis, neutrophil counts, lymphocytes and other markers indicate infection. Gram staining and blood cultures help identify normal flora versus pathogens. Minimum inhibitory concentration and disk diffusion tests determine antibiotic susceptibility. Host factors, site of infection, and drug properties like toxicity and tissue penetration influence empirical antibiotic selection. Response to treatment and side effects require monitoring.

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    Pengantar Farmakoterapi Penyakit Infeksi

    Uploaded by

    Alunaficha Melody Kirania
    117 views27 pages
    This document discusses signs and symptoms of infection, identification of pathogens, and selection of antimicrobials. It describes how leukocytosis, neutrophil counts, lymphocytes and other markers indicate infection. Gram staining and blood cultures help identify normal flora versus pathogens. Minimum inhibitory concentration and disk diffusion tests determine antibiotic susceptibility. Host factors, site of infection, and drug properties like toxicity and tissue penetration influence empirical antibiotic selection. Response to treatment and side effects require monitoring.

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    Penyakit Infeksi Farmakoterapi

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    This document discusses signs and symptoms of infection, identification of pathogens, and selection of antimicrobials. It describes how leukocytosis, neutrophil counts, lymphocytes and other markers indicate infection. Gram staining and blood cultures help identify normal flora versus pathogens. Minimum inhibitory concentration and disk diffusion tests determine antibiotic susceptibility. Host factors, site of infection, and drug properties like toxicity and tissue penetration influence empirical antibiotic selection. Response to treatment and side effects require monitoring.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    117 views27 pages

    Pengantar Farmakoterapi Penyakit Infeksi

    Uploaded by

    Alunaficha Melody Kirania
    This document discusses signs and symptoms of infection, identification of pathogens, and selection of antimicrobials. It describes how leukocytosis, neutrophil counts, lymphocytes and other markers indicate infection. Gram staining and blood cultures help identify normal flora versus pathogens. Minimum inhibitory concentration and disk diffusion tests determine antibiotic susceptibility. Host factors, site of infection, and drug properties like toxicity and tissue penetration influence empirical antibiotic selection. Response to treatment and side effects require monitoring.

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    1

    Learning objective
    - Mahasiswa mampu menjelaskan tanda dan
    gejala infeksi
    - Mahasiswa mampu menjelaskan pemilihan
    antimikroba utk mengatasi penyakit
    infeksi

    2
    Pendahuluan
    - Tanda dan gejala infeksi :
    * Leukositosis (WBC > 10.000/mm3)(N:4.000-10.000)
    atau leukopeni ( WBC < 4000/mm3)
    * increased production & mobilization of granulocytes
    (neutrophils, basophils, and eosinophils), lymphocytes
    *Infeksi akutshift to the left (adanya immature
    neutrophils )
    *Neutropenia : penurunan jumlah neutrofil dlm darah
    * demam dgn suhu > 37C (N:36-37C) atau < 36oC

    3
    The explanation :
    - WBCs are divided into two groups: granulocytes &
    agranulocytes
    - Polymorphonuclear (PMN) granulocytes are made up of
    neutrophils, basophils, and eosinophils.
    - Neutrophils In response to infection leave the
    bloodstream and enter the tissue to interact with and
    phagocytize offending pathogens.
    -Neutrophil :

    * Mature neutrophils segmen


    * Immature neutrophils bands.
    - an acute infection immature neutrophils ( bands )

    increased rate and the percentage of bands (usually 5%)


    can increase in relationship to mature cells shift to the
    left
    4
    Demam, menggigil,hipotermi
    Extreme fatigue yg bisa berlangsung > 23 bln
    Weight loss berkelanjutan
    Nyeri dan sakit seluruh tbh
    *Nyeri dan inflamasi : bengkak, eritema, kesakitan, purulent
    drainage
    Symptoms referable to an organ system :

    * Febrile patient with complaints of flank pain and dysuria


    pyelonephritis ok E.coli
    * Febrile individual with cough and sputum production
    pulmonary infection
    Catatan :
    leukositosis stres, inflamasi ( mis.RA,keganasan),
    respon dr obat (mis. korticosteroid)

    5
    - Leukocytosis normal host defense to infection and is an
    important adjunct to antimicrobial therapy.
    - Neutropenia cancer chemotherapy neutrophil
    counts < 500 cells/mm3 high risk for bacterial or fungal
    infections
    - Lymphocytes (T cell ( immunity) & B cell ( humoral ) the

    immune system lymphocytosis acute viral


    infections
    - ESR) / LED &CRP concentration endocarditis,

    osteomyelitis, intraabdominal infections

    6
    Identification Of The Pathogen
    - the human body contains microorganisms that colonize
    body systems normal flora
    * organisms occur naturally in the tissues of the host and
    provide some benefits (defense by occupying space,
    competing for essential nutrients, stimulating cross-
    protective antibodies suppressing the growth of
    pathogenic bacteria and fungi )
    - Organisms that comprise the normal florapathogenic
    when host defenses become impaired or translocated to
    other body sites during trauma

    7
    FLORAL NORMAL TUBUH

    8
    Identifikasi kuman itu flora normal or patogen
    - Staphylococcus epidermidis (ditemukan di darah pasien
    RS )
    * normal skin flora & colonizes intravenous catheters.

    -kondisi pasien (signs and symptoms, laboratory data )


    -kemungkinan m.o penyebab infeksi

    If removal of the catheter can eliminate the organism from


    the bloodstream

    unnecessary application of antimicrobials

    9
    Pewarnaan kuman ( gram staining )
    - Menggunakan pewarna crystal violet+ iodium kompleks
    crystal violetiodine + alkohol + safranin

    -Bakteri gram (+) : warna ungu


    -Bakter gram (-) : warna merah
    Blood cultures
    - the most definitive method available for the diagnosis and
    eventual treatment of infection
    - A clinical specimen inoculated in a variety of artificial media
    bakteri (+) identifikasi

    true pathogen, contaminant, normal flora

    10
    GRAM STAIN

    11
    Kuantitatif
    MIC ( minimal Inhibitory concentrations )
    - the lowest antimicrobial concentration that prevents visible growth of
    an organism after approximately 24 hours of incubation in a specified
    growth medium.
    - in-vitro antibacterial activity
    - It is determined through the macrotube dilution method
    - It uses liquid growth medium (broth), doubling serial dilutions of
    antimicrobials in test tubes, and a standard inoculum of bacteria (
    105 CFU/ mL).
    - The tubes (up to 10 mL) were incubated at approximately 35C for18
    to 24 hours and then examined for visible bacterial growth

    12
    Kualitatif
    - It uses selected antibiotic-impregnated disks are placed on
    an agar plate previously streaked with a standard suspen-
    sion of bacteria (12 108 CFU/mL)
    The drug contained in the disk diffuses in a concentration
    gradient out into the agar.
    - The plate is incubated (18 to 24 hours at 35C)visual

    bacterial growth occurs only in areas in which the drug


    concentrations are below those required for growth
    inhibition.
    - The diameters of the zones of inhibition are measured and

    are compared with standard zone size ranges determine


    susceptibility (S), intermediate susceptibility (I), or
    resistance (R)
    -

    13
    PENGUKURAN
    DIAMETER HAMBAT AB

    14
    Pemilihan AB
    Empiris antibiogram RS setempat,patients history,

    physical examination,gram stains, performed tests on


    specimens from the infected site
    - Culture and sensitivity
    Host factor :

    * alergi obat : alergi AB cephalosporin, cross sensitivity dll


    * usia : > 65 thn penurunan fgs nephron penurunaan
    fgs renal
    * kehamilan : risiko drug teratogenicity, perubahan
    farmakokinetik obat penicillins, cephalosporins, and
    aminoglycosides
    are cleared from the peripheral circulation more rapidly

    15
    * genetic or metabolic abnormalities
    - Patients with G6P4 dehydrogenase + sulfonamides,
    nitrofurantoin, nalidixic acid, antimalarials, dapsone, and
    perhaps, chloramphenicol hemolysis
    * Renal and hepatic function
    - penyesuaian dosis
    - site of infection
    - concomitant drug therapy
    * INH + phenytoin metab phenytoin dihambat INH
    toksisitas fenitoin

    16
    Underlying disease states
    Patients with immunosuppressive diseases (malignancy,

    HIV-AIDS dll ) highly predisposed to infections


    Concomitant Disease States

    Trauma, burns, iatrogenic wounds induced in surgery

    predisposing to infection (disruption of the hosts inte-


    gumentary barriers )
    Drug factors

    * PK & PD considerations
    # concentration-dependent bactericidal effects : aminogly-
    coside, fluoroquinolone
    - maximize peak:MIC ratio
    # time-dependent bactericidal effects : lactam AB (ce-
    phalosporin, carbapenem )
    - (T > MIC) duration that drug concentrations >the MIC
    17
    Tissue Penetration
    * Kadar obat yg rendah pada cairan bilier utk terapi
    kolesistitis dan kolangitis dan sedikitnya obat yg rute
    eliminasi primer di bilier sbg btk aktif
    * Abses
    # Penetrasi ke jaringan sulit krn dipengaruhi o/ acid
    pH,WBC products,various enzymes can inactivate even
    high concentrations of certain drugs

    *CNS antimicrobial penetration is relatively well defined


    - cth.AB utk penyakit meningitis bakterial

    18
    Drug Toxicity
    - Antibiotics associated with CNS toxicities (not dose-

    adjusted for renal function


    * Penicillins, cephalosporins, quinolones, and imipenem.
    - Hematologic toxicities ( prolonged use)
    * chloramphenicol bone marrow suppression
    * trimethoprim megaloblastic anemia
    * aminoglycoside nephrotoxicity,ototoxicity

    19
    MONITOR
    Efektivitas terapi
    1.Kondisi klinis
    tampilan fisik pasien, daerah sekitar infeksi lokal
    ( inflamasi, sekresi pus atau sekret),nyeri berkurang,
    SOB berkirang,batuk or produksi sputum berkurang,
    nafsu makan meningkat )
    tanda vital suhu, nadi, TD sistemik ( infeksi disertai
    syok),kesadaran (infeksi disertai penurunan kesadaran)
    2.Data laboratoris
    - hasil lab :kdr leukosit dlm drh,leukosuria (ISK),LED
    (infeksi kronik TBC), CRP ( TBC, pneumonia)
    - gambar radiologis membaik

    20
    Efek samping obat
    - Gangguan fgs ginjal:
    acute kidney injury : aminoglikosida
    Acute interstitial nephritis : kotrimoksazol, ciprofloksasin
    - Monitor kadar kreatinin
    - Gangguan fgs liver
    hepatitis : kloksasillin, amoksiklav, ceftriaxone
    - monitor kdr SGPT, SGOT, bilirubin total
    - Skin rash, urtikuria : gol penisillin, ciprofloxacine, kotri-

    moksazple
    - Steven Johnson syndrome : kotrimoksazol, ciprofloxa-

    cine
    - Bone marrow supression : chloramphenicol

    21
    Lampiran
    Klasifikasi organisma infeksius

    Rods (bacilli)
    Clostridia (Clostridium perfringens, Clostridium tetani, Clostridium difficile)
    Propionibacterium acnes
    22
    23
    24
    25
    Golongan
    KlasifikasiAntibiotika
    Antibiotika

    26
    Folate
    Inhibitors

    27

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