View
32
Download
3
Category
Preview:
DESCRIPTION
bahan SIMPOSIUM ANTIBIOTIK
Citation preview
ANTIBIOTIK PADA KEADAAN IMUNODEFISIENSI
RaveinalSub Bagian Alergi Imunologi Klinik
FK UNAND / RS M Jamil Padang
Sistem Imun
mekanisme utama yang melindungi tubuh terhadap invasi dari organisma terhadap ketahanan sel atau tubuh dari benda asing seperti mikroorganisme, toksin, bahan kimia, obat obatan atau sel kanker.
Imunitas nonspesifik dan spesifik
Makrofag yang teraktifasi akan memicu sel T spesifik dari sistem imun spesifik / di dapat untuk memproduksi berbagai antibodi
Cellular components of the immune system
The cellular component
develops from the pluripotent hematopoietic stem cell. The cellular components of
the immune system are :1. Lymphocytes2. Monocytes/Macrophages3. Dendritic cells4. Granulocytes5. Mast cells
PhagocytosisIs the uptake of particulate material by engulfment.
Three steps in the process of phagocytosis :- Recognition and attachment- Engulfment- Killing and degradation
GAMBARAN DEFISIENSI IMUN
• Ditemukan tanda peningkatan kerentanan thdp infeksi rekuren, kronis, oportunistik & respon buruk thdp antibiotik
• Primer relatif jarang• Sekunder timbul oleh berbagai faktor
sesudah lahir• Defisiensi imun sering mengenai limfosit,
komplemen dan fagositosis
Defisiensi sistem imun
• Defisiensi sel B limfosit : Infeksi berulang spt otitis media, pnemonia
• Defisiensi sel T limfosit : rentan terhadap virus, jamur dan protozoa
• Defisiensi fagositosis : infeksi sistemk kuman dgn virulensi rendah, infeksi piogenik
• Defisiensi komplemen : infeksi bakteri, autoimunitas
Cellular targets of pathogenic bacteria
Figure 2-45
Tumor necrosis factor-α has important local protective effects but can have severely detrimental effects systemically.
Opportunistic Infections in HIV• Bacterial/ Mycobacterial
– Mycobacterium Avium Complex (MAC)
– Salmonellosis– Syphilis– Tuberculosis– Bacterial pneumonia
• Fungal– Candidiasis– Coccidioidomycosis– Cryptococcal meningitis– Histoplasmosis
Protozoal Cryptosporidium Pneumocystis carinii Pneumonia
(PCP) Toxoplasmosis
Viral Cytomegalovirus Hepatitis Herpes simplex Herpes zoster Human papiloma virus Oral hairy leukoplakia Progressive Multifocal
Leukoencephalopathy (PML)
Bentuk imunitas thd bakteri
1.Imunitas thd toksin bakteri Exotoxin dan endotoksin dari bakteri akan
dimusnahkan oleh respons imun penjamu penyakit dpt dicegah.
2.Imunitas thd kapsul bakteri Bakteri menghindari fagositosis melapisi dirinya
dgn polisakarida menghambat fagositosis.
3.Imunitas bakteri yg hidup intraseluler
Bakteri menghindari respons imun penjamu, utk berkembang biak di dlm sel khusus sel fagosit
Respon imun tertadap infeksi :
1.Jumlah & fungsi Th, Ts dan Tc yg teraktivasi.
2.Jumlah & fungsi sel B
3.Jumlah sel memori
Pola reaksi imunologik bergantung pada jenis dan sifat mikroorganisme
Infeksi bakteriMekanisme pertahanan dipengaruhi oleh:
1.Struktur ddg sel2.Jenis bakteri (Gram + / Gram -)3.Mikrobakteria4.Spiroketa
Lapisan luar bakteri Gram (–) terdiri lipid peka thd lisis C dan sel sitotoksik tertentu.
Untuk yang lain fagositosis.
• Sel NK lisis membran sel Gram (- )
• Sel Tc infeksi bakteri intraseluler merusak membran sel bakteri bakteri keluar dan dihancurkan dengan cara lain.
Sifat patogenitas bakteri
1.Toksik tanpa infansif C.difteria & V.cholerae diikat oleh Ab2.Infasif tanpa toksisitas
Sebagian besar gabungan invasif dgn aktivitas toksin lokal dan produksi enzim merusak jaringan bakteri menyebar
Interaksi mikroba dgn imunitasMenghindari respon imun1.Produksi toksin menghambat khemota ksis 2.Membentuk kapsul fagosit tdk terjadi3. Memproduksi molekul yang menghambat fungsi
lisosom dgn fagosom atau menghambat makrofag berinteraksi dg IFN
4.Menurunkan sitokin proinflamatorik TNF-α,IL-1ß,IL-6
Three basic principles of antimicrobial therapy:
1.Selective toxicity - kill organisms not a man!
2.Reach the site of infection at adequate concentrations
3.Penetrate and bind to target microbe
Klasifikasi & Mekanisme Kerja AB
Dinding kuman
Penisilin, sefalosporin, glukopeptida, fosfomisin.
Inhibisi biosintesis protein
Makrolid, Tetrasiklin, Kloramfenikol.
As.folat antagonis
Sulfa-TrimethoprimInhibisi b-laktam
As.klavulanat, sulbaktam
Sitesis As nukleat
Rifampisin, quinolon.
Membran sitoplasma
Polimiksin B, Amfoterisin B
1. Cell wall synthesis
1. Cycloserine2. Glycopeptides (vancomycin, teicoplanin)3. Bacitracin4. Beta-lactams (penicillins, cephalosporins,
carbapenems, monobactams)
Inhibitors of bacterial cell wall synthesis
Cytoplasmic membranesynthesis of
new cell wall subunit
attached to lipid carrier
Glycopeptidesbind to terminal
D-ala-D-ala residues;prevent incorporation
of subunit into growing
peptidoglycan
NAG NAM P P C55 lipidBacitracin Prevents dephosphorylation of phospholipid carrier, which prevents regeneration of carrier necessary for synthesis to continue
L- lysine
2. Inhibitors of protein synthesis
• Ribosomal subunits involved in mRNA translation in bacterial systems are smaller (30S & 50S) than in eukaryotic (mammalian) translation (40S & 60S)
• Most antibiotics acting upon the ribosome are bacteriostatic, but aminoglycosides are bactericidal
Inhibitors of protein synthesis
1. Aminoglycosides2. Macrolides3. Tetracyclines 4. Chloramphenicol5. Fusidic acid
3. Nucleic acid synthesis:
• Inhibition of synthesis of precursors : Sulphonamides, Trimethoprim
• Inhibitors of DNA replication :Quinolones
• Inhibitors of RNA polymerase :Rifampicin
Use Antimicrobials Wisely Action: Treat infection,
not contaminationFact: A major cause of antimicrobial overuse is “treatment” of contaminated
cultures.
Actions: use proper antisepsis for blood & other cultures culture the blood, not the skin or catheter hub use proper methods to obtain & process all cultures
Use Antimicrobials WiselyAction: Treat infection,
not colonization
Fact: A major cause of antimicrobial overuse is treatment of colonization.
Actions: treat pneumonia, not the tracheal aspirate treat bacteremia, not the catheter tip or hub treat urinary tract infection, not the indwelling
catheter
Antimicrobial Key Prevention Strategies
Optimize Use
PreventTransmission
PreventInfection
EffectiveDiagnosis& Treatment
PathogenAntimicrobial-Resistant Pathogen
Antimicrobial Resistance
Antimicrobial Use
Infection
Susceptible Pathogen
TERIMA KASIH
Recommended