Antimkrba u Basil Gr (-) & Mek.krjnya

7/26/2019 Antimkrba u Basil Gr (-) & Mek.krjnya

1/74

Curriculum Vitae

N a m a : Prof. Dr. dr. Rozaimah Zain-Hamid, MS, SpFK

Pekerjaan : * Gr !e"ar #e$ap Depar$emen Farmako%o&i dan #erape$ik,

Fak%$a" Kedok$eran, 'S', Medan * S$af Pen&ajar Pro&ram S( !iomedik ) Pro&ram dmini"$ra"i

Ke+ijakan Ke"eha$an Pro&ram S Kedok$eran,

Seko%ah Pa"a"arjana, 'S', Medan

* /aki% Ke$a Komi"i Na"iona% 0$ika Pene%i$ian Ke"eha$an1KN0PK2, 3ndone"ia

Ri4a5a$ Pendidikan:

* Dok$er 1dr2, dari Fak%$a" Kedok$eran, 'S'. Medan

* Ma&i"$er Sain" 1MS2, 3%m Kedok$eran Da"ar 16!a"i Media% Siene"72,dari Fak%$a" Pa"a"arjana, 'ni8er"i$a" 3ndone"ia, 9akar$a

* Dok$or 1Ph.D2, Farmako%o&i K%inik 16%inia% Pharmao%o&572, dari 3n"$i$$e

of Po"$-&rada$ed S$die", 'ni8er"i$i Sain" Ma%a5"ia, Ma%a5"ia

* Spe"ia%i" Farmako%o&i K%inik 1Sp.FK2, dari De4an Peni%ai Kepakaran

Per"a$an Dok$er h%i Farmako%o&i K%inik 3ndone"ia 1P0RDFK32 P"a$,

9akar$a.


2/74

R;Z3MH Z3N-HM3D

Depar$emen Farmako%o&i dan #erape$ik

Fak%$a" Kedok$eran

'ni8er"i$a" 3"%am Sma$era '$ara

ANTIMIKROBA UNTUK BASIL GRAM (-)

DANMEKANISME KERJANYA


3/74

Pemi%ihan an$imikro+a "eara empirik

n$k infek"i +ak$eri Gram 1-2

Kman pa$o&en n$imikro+api%ihan 3

n$imikro+aa%$erna$if

o%iform:

E.coli,Klebsiella,Proteus

mino&%5o"ide

epha%o"porin&enera"i

#MP-SMZ,

Pn "p$rm %a"iprof%o


4/74





Salmonella #MP-SMZ,

iprof%o


5/74





Vibrio"p #e$ra5%ine,

#MP-SMZ

iprof%o


6/74



Kman pa$o&en n$imikro+a

pi%ihan 3

n$imikro+a

a%$erna$if

Pseudomonaspseudomallei

1me%iodo"i"2

Pseudomonas

mallei1&%ander"2

#e$ra5%ine h%7amphenio%

Zain-Hamid, R Depar$emen Farmako%o&i ) #erape$ik FK-'3S'.


7/74





Helicobacter"p Me$ronidazo%e mo


8/74

n$imikro+a:!ak$eri Gram 1-2

Penii%%in, ampii%%in, amo


9/74

n$imikro+a:!ak$eri Gram 1-2


F%oro=ino%one

h%oramphenio%

0r5$hrom5in, %ari$hrom5in

Me$ronidazo%e

iprof%o


10/74

N#3M3KR;!G;A;NGN P0N33AA3N



11/74

Penii%%in G 1+enz5%penii%%in2:

-k$ifi$a" $erhadap +ak$eri Gram 1>2-k$ifi$a" $erhadap +ak$eri Gram 1-2 BB

-

#idak "$a+i% $erhadap a"am-C E $erika$ pro$ein

-Dir"ak o%eh -%a$ama"e

Zain-Hamid R De ar$emen Farmako%o i ) #era e$ik FK-'3S'.

!e+erapa an$imikro+a&o%on&an penii%%in


12/74

mpii%%in 1amino+enz5%penii%%in2:-k$ifi$a" $erhadap +ak$eri Gram 1>2-

Ae+ih ak$if $erhadap +ak$eri Gram 1-2-S$a+i% $erhadap a"am

-Dir"ak o%eh -%a$ama"e 1I pn G2

!e+erapa an$imikro+a&o%on&an penii%%in

mo


13/74

Farmakokine$ik an$imikro+a&o%on&an penii%%in

+"orp"i ora%, +er-+eda( di$en$kan

o%eh "$a+i%i$a" kea"aman ) ika$an pro$ein

paren$era%

a+"orp"i epa$ ) %en&kap


Di"$ri+"i %a" ke airan $+h ) jarin&an

3ka$an pro$ein JJ o


14/74

Farmakokine$ik an$imikro+a&o%on&an penii%%in


0k"kre"i

&inja%1 E me%a%i "ekre"i $+%ar )

L E me%a%i fi%$ra"i &%omer%"2

pro+eneid men&ham+a$ "ekre"i $+%ar

pn kadar pn da%am darah )memperpanjan& 4ak$ parhn5a

Aon&-a$in& penii%%in:-proaine pn G

-+enza$hine pn


15/74

Spek$rm an$imikro+a&o%on&an penii%%in


Narro4 "p$rm:-Pn @ ) G

-re"i"$en $erhadap

-%a$ama"e:

1;


16/74

!road "pe$rm:

-ar+enii%%in, piperi%%in, $iari%%in

-re"i"$en $erhadap-%a$ama"e:

1 $iari%%in > %a8%ani aid2

Spek$rm an$imikro+a

&o%on&an penii%%in



17/74

Mekani"me kerja an$imikro+a&o%on&an penii%%in

L. !erika$an P!P" "e+a&ai re"ep$or


. k$i8a"i enzim a$o%i$ik pada dindin& "e%

kema$ian "e% +ak$eri

(. Men&ham+a$ $ran"pep$ida"i pep$ido&%5an

men&ham+a$ "in$e"a dindin& "e%


18/74

Mekani"me $erjadin5a re"i"$en"i$erhadap penii%%in

L. !ak$eri men&ha"i%kan -%a$ama"e


. Permea+i%i$a" me%a%i %api"an $er%ar

+ak$eri 1- 2

(. Re"ep$or P!P 5an& "pe"ifik

o+a$ 1 - 2

O. Ga&a%n5a ak$i8a"i enzim a$o%i$ik

. Dindin& "e% +ak$eri 1-2


19/74

0fek "ampin& an$imikro+a&o%on&an penii%%in

L.Reak"i hiper"en"i$i8i$a":S5ok anafi%a


20/74

#ok"i"i$a" an$imikro+a&o%on&an penii%%in

Do"i" +e"ar penii%%in:Gan&&an "a%ran erna, na"ea, 8omi$", diare

1$er$ama ampii%%in ) amo


21/74

N#3M3KR;!

G;A;NGN 0PHA;SP;R3N



22/74

!e+erapa an$imikro+a&o%on&an epha%o"porin

Gen L.

- efadro


23/74

Farmakokine$ik an$imikro+a&o%on&an epha%o"porin

+"orp"i pem+erian ora% +er-+eda(:

1epha%e


24/74

Farmakokine$ik an$imikro+a&o%on&an epha%o"porin

Pro+eneid men&ham+a$ "ekre"i $+%arpn kadar eph7"porin da%am darah )

0k"kre"i

&inja%1me%a%i fi%$ra"i &%omer%" ) "ekre"i $+%ar2

K%iren" rea$inine ( -O m%Qmeni$

1LQ( do"i"2

K%iren" rea$inine B ( m%Qmeni$1LQ do"i"2

Zain-Hamid, R Depar$emen Farmako%o&i ) #erape$ik FK-'3S'


25/74

Spek$rm an$imikro+a&o%on&an epha%o"porin


Genera"i L:-San&a$ ak$if n$k o" &ram 1>2,

kea%i en$eroo"

Genera"i (:-JJ amph dari &enera"i L +ak$eri &ram 1-2

Genera"i :

-Spek$rm %e+ih %a" dari &enera"i L ) (-dapa$ di&nakan n$k +ak$eri &ram 1-2 )

p"edomona"


26/74

k$i8i$a" epha%o"porin &en.

!a"i% &ram 1-2H. inluen!aeKlebsiella

Enterobacter

ProteusSerratiaS.pneumoniae

". gonorrhoeae". meningitidisP.aeruginosaS.aureus

efo$a


27/74

Mekani"me kerja an$imikro+a&o%on&an epha%o"porin

L. !erika$an P!P" "e+a&ai re"ep$or


. k$i8a"i enzim a$o%i$ik pada dindin& "e%

kema$ian "e% +ak$eri

(. Men&ham+a$ $ran"pep$ida"i pep$ido&%5an

men&ham+a$ "in$e"a dindin& "e%


28/74

Mekani"me $erjadin5a re"i"$en"i$erhadap epha%o"porin

L. Pene$ra"i o+a$ BBB


. De&rada"i o+a$ o%eh -%a$ama"e

(. Re"ep$or P!P 5an& "pe"ifik

o+a$ 1 - 2

. Mn%n5a -%a$ama"e 5an& kha"

O. Ga&a%n5a ak$i8a"i enzim a$o%i$ik


29/74

0fek "ampin& an$imikro+a&o%on&an epha%o"porin

L.Reak"i hiper"en"i$i8i$a":S5ok anafi%a


30/74

#ok"i"i$a" an$imikro+a&o%on&an epha%o"porin

L.#ok"i"i$a" $erhadap &inja%


(. Hipopro$rom+inemia

perdarahan1efamando%e, mo


31/74

N#3M3KR;!

G;A;NGN #0#RA3N0


! + $i ik +


32/74

!e+erapa an$imikro+a&o%on&an $e$ra5%ine

Kerja "in&ka$:

- $e$ra5%ine

- o


33/74

Farmakokine$ik an$imikro+a&o%on&an $e$ra5%ine

+"orp"i :

pem+erian ora% +er-+eda(

+"orp"i $er$ama pada "" ha%" +a&ian a$a"

+"orp"i $er&an&& ika$an den&an ka$ion

+er8a%en"i ( 1a(>, M&(>, Fe(>2, %>

da%am "", an$a"ida ) pH a%ka%i"2



34/74


Di"$ri+"i:

E $erika$ pada pro$ein p%a"ma$erdi"$ri+"i %a" ke +er+a&ai jarin&an dan

airan $+h, kea%i ke airan ere+ro"pina%

kadar JJ

air ma$a ) "a%i8a 1mino5%ine2dapa$ me%a%i "a4ar p%a"en$a ) S3

1+erika$an den&an a &i&i ) $%an& fe$"2



35/74


0k"kre"i :

$er$ama me%a%i emped )fi%$ra"i &%omer%" &inja%

do


36/74

Spek$rm an$imikro+a&o%on&an $e$ra5%ine

Pro$o$ipe an$imikro+a 6+road "pe$rm6

!ak$erio"$a$ik n$k +ak$eri &ram 1>2 ) 1-2,

+ak$eri anaero+, rike$$"ia, h%am5diae,

m5op%a"ma, pro$ozoa: ame+a



37/74

Mekani"me kerja an$imikro+a&o%on&an $e$ra5%ine

!erika$an den&an re"ep$or

pada ni$ S ri+o"om )men&ham+a$ ika$an aminoa5%-$RN

den&an $empa$ ika$ann5a pada ri+o"om

men&ham+a$ "in$e"a pro$ein1a"am amino2



38/74

Mekani"me $erjadin5a re"i"$en"i$erhadap $e$ra5%ine

Mekani"me $ran"por$ ak$if me%in$a"imem+ran "e% +ak$eri 1 - 2

!ak$eri 5an& re"i"$en $erhadap$e$ra5%ine, mennjkkan permea+i%i$a"

5an& pa"if $erhadap $e$ra5%ine 1 - 2

Re"i"$en"i di $ran"mi"i o%eh p%a"mid



39/74

0fek "ampin& Q $ok"i"i$a" $e$ra5%ine

Gan&&an "a%ran erna:

na"ea, 8omi$", diare,men&&an&& f%ora norma% ""

Men&a%ami depo"i"i di $%an& ) &i&i:1per+ahan 4arna &i&i 5an& "edan& $m+h,

deformi$a" $%an&2

Sindroma Fanoni1+erkai$an den&an pen&&naan o+a$ kada%4ar"a2

a"ido"i" $+%ar rena%i", amino aidria,

a%+minria ) hipoka%emiaZain-Hamid, R Depar$emen Farmako%o&i ) #erape$ik FK-'3S'


40/74

0fek "ampin& Q $ok"i"i$a" $e$ra5%ine

Hepa$o$ok"ik )7ho%e"$a$i jandie7

Dia+e$e" in"ipid" nefro&enik1deme%o5%ine2

Reak"i 8e"$i+%ar 1mino5%ine2

Fo$o "en"i$i8i$a"1deme%o5%ine2

Pemanjan&an 4ak$ pem+ekan darah



41/74

N#3M3KR;!

G;A;NGN M3N;GA;S3D0


!e+erapa an$imikro+a


42/74

!e+erapa an$imikro+a&o%on&an amino&%5o"ide

"$rep$om5in&en$amiin

$o+ram5inamikain

ne$i%miin

kanam5inneom5in

"pe$inom5in



43/74

Farmakokine$ik an$imikro+a&o%on&an amino&%5o"ide

+"orp"i :

pem+erian ora% a+"orp"i "an&a$ +rk

Di"$ri+"i :

L E +erika$an den&an pro$ein p%a"ma

0k"kre"i :

$er$ama me%a%i fi%$ra"i &%omer%"



44/74

Mekani"me kerja an$imikro+a&o%on&an amino&%5o"ide

3ka$an ionik - permkaan "e% +ak$eri

Pen&am+i%an o+a$ "eara ak$ifke da%am "i$op%a"ma +ak$eri

!erika$an den&an re"ep$orpada ni$ S ri+o"om

men&ham+a$ "in$e"a pro$ein1a"am amino2



45/74

Mekani"me $erjadin5a re"i"$en"i$erhadap amino&%5o"ide

3nak$i8a"i enzim 6p%a"mid media$ed7

;+a$ &a&a% mempene$ra"i amp%op +ak$eri

Si"$em $ran"por$ 5an& 6ener&5 dependen$7

1 - 2

6Ri+o"oma% re"i"$ane7



46/74

0fek "ampin& Q $ok"i"i$a" amino&%5o"ide

Nefro$ok"ik ) o$o$ok"ik

1o$o$ok"i$a" +er"ifa$ mene$ap2



47/74

N#3M3KR;!

G;A;NGN HA;RMPH0N3;A

Chl h i l


48/74

Dii"o%a"i dari Streptom$ces %ene!uelae

Kri"$a% $ak +er4arna +era"a pahi$

San&a$ %ar$ da%am a%koho%,

kran& %ar$ da%am air

#e$ap mem+erikan ak$i8i$a" an$i+ak$eri

"e%ama +e+erapa +%an,+i%a di"impan da%am %emari pendin&in )

+i%a di%indn&i dari aha5a1pada "h kamar2


Chloramphenicol


49/74

!ak$erio"$a$ik pada JJ mikroor&ani"me

!ak$eri"id den&an kadar

pada +ak$eri aero+ik1S. pneumoniae, ". meningitidis, H. inluen!ae &


Chloramphenicol


50/74

Spek$rm h%oramphenio%


n$i+io$ik "pek$rm %a"

1!ak$eri Gram 1>2 Gram 1-2 aero+ anaero+2

Chlam$dia, '$coplasma, (ic)ettsiae, *reponema,

E.coli, K. pneuminiae, Proteus mirabilis,

Salmonella, Shigella

!ak$eri 5an& re"i"$en :Serratia, Proteus rettgeri, P.aeruginosa


51/74

Farmakokine$ik h%oramphenio%

+"orp"i:1ora%2 "a%ran erna, +aik


Di"$ri+"i:

Aa" ke airan $+h )

+er"ifa$ %ipofi%ik

"a4ar darah o$akDapa$ me%in$a"i"a4ar p%a"en$a

Di "irk%a"i, ika$an pro$ein E


52/74


Me$a+o%i"me :

Se+a&ian +e"ar +er%an&"n& di hepar,

1me%a%i kon5&a"i 5an& %en&kap

den&an &%koronida2



53/74


0k"kre"i:

Diek"kre"i ke da%am S3


Pada &an&&an fn&"i &inja%,

$idak diper%kan pen5e"aian do"i"

Pada &a&a% hepar do"i"

F k ki ik h% h i %


54/74


0k"kre"i:

#LQ( : ? jamDiek"kre"i me%a%i rin

? L E da%am +en$k ak$if

1me%a%i fi%$ra"i &%omer%"

BB me%a%i emped2

? E da%am +en$k $idak ak$if

1me%a%i "ekre"i $+%ar &inja%2



55/74

Mekani"me kerja h%oramphenio%

!erika$an den&an "+ni$ OSdari TS ri+o"ome men&ham+a$ ak$i8i$a"

enzim pep$id5% $ran"fera"e


Sin$e"a pro$ein

Men&ham+a$ "in$e"a pro$ein mi$okondria

pada "e% "m"m $%an& mama%ia


56/74

0fek "ampin& h%oramphenio%

L. nemia ap%a"$ik 5an& $idak+erh+n&an den&an do"i"


Perdarahan fa$a%

Pan"i$openia den&an ap%a"$ik Q h5pop%a"$ik

"m"m $%an&


57/74


(. Penekanan "m"m $%an& 5an&+erh+n&an den&an do"i"


nemia pro&re"if

den&an kadar ferm 5an& $in&&i )re$ik%o"i$ BB

0f k i h% h i %


58/74


. Gra5 "5ndrome:komp%ika"i pada +a5i prema$raki+a$ &a&a%n5a kon5&a"i o+a$


# U JJJ ) akm%a"i o+a$

Per+ahan 4arna k%i$, pem+e"aran a+domen,

5ano"i", ke%emahan o$o$, mn$ah,

pernapa"an 5an& $ak $era$r, hipo$ermi,

ko%ap" "irk%a"i 5an& +eraki+a$ fa$a%

0f k i h% h i %


59/74


. Sperinfek"i +ak$eri+S. aureus, P.aeruginosa, C.albicans&


Ham+a$an JJJ f%ora norma% di ""

O. Gan&&an "a%ran erna ma%, mn$ah,

&an&&an pen&eapan, "$oma$i$i", &%o""i$i".Diare non-"pe"ifik aki+a$

ko%i$i" p"edomem+rano"a o%eh C.diicile

0f k i h% h i %


60/74


O. Si"$em "araf


Neri$i" perifer ) neropa$i op$a%mik

1pem+erian jan&ka %ama2

$ropi "araf op$ik" ) ke+$aan

3 $ k i + $ d h% h i %


61/74

3n$erak"i o+a$ den&an h%oramphenio%

Memperpanjan& #LQ( ) kadar


Phen5$oin, $o%+$amide,

h%orpropamide, 4arfarin

h%7amphenio%men&ham+a$ ak$i8i$a" enzim miro"om ha$i

Mekani"me $erjadin5a re"i"$en"i


62/74

Mekani"me $erjadin5a re"i"$en"i$erhadap h%oramphenio%

Di$ran"fer me%a%i p%a"mid aki+a$diha"i%kann5a enzim

h%oramphenio% ae$5%$ran"fera"e

e$5%a"i &&" h5dro


63/74

N#3M3KR;!

G;A;NGN MR;A3D0


64/74

0r5$hrom5in

zi$hrom5in

%ari$hrom5in


!e+erapa an$imikro+a&o%on&an maro%ide


65/74

n$imikro+a &o%on&an makro%ide

#idak %ar$ da%am air ) +era"a pahi$

Diinak$ifa"i o%eh a"am1"aa$ ini +en$k "in$e$ikn5a %e+ih $ahan a"am2


Erythromycin


66/74

Profi% farmakokine$ik

an$imikro+a &o%on&an makro%ide

;+a$ #LQ( !ioa8ai%. 3ka$an 0%imina"i 1jam2 ora% pro$ein $ama

0r5$hrom5in L, L- O E T( E emped

zi$hrom5in - C E O E emped

%ari$hrom5in O- T O E V.. emped



67/74

Farmakokine$ik er5$hrom5in

+"orp"i :

k$if da%am "a"ana a%ka%i"

1ak$i8i$a" an$imikro+ia%

pH B T.2

Dir"ak o%eh a"am %am+n&

16en$eri oa$ed72

!en$k "$eara$ ) e"$er: $ahan a"am

;ra% a+"orp"i di in$e"$inm JJJ



68/74

Di"$ri+"i:

#erdi"$ri+"i %a" ke +er+a&ai jarin&an,1kea%i ke jarin&an o$ak ) airan ere+ro"pina%2

Dapa$ me%in$a"i "a4ar p%a"en$a



F k ki $ik $h i


69/74

0k"kre"i:

#er$ama me%a%i emped

1kadarn5a O W J darah2

Men&a%ami "irk%a"i en$erohepa$ik

O E diek"re"i me%a%i rin

# U : L- jam pada rena% 5an& +aik1# U azi$hrom5in ) %ari$hrom5in J er5$hrom5in2



S k$ $h i


70/74

Spek$rm er5$hrom5in

!ak$erio"$a$ik n$k JJJ+ak$eri &ram 1>2,

5an&re"i"$en $erhadap penii%%in

+Pneumococcus, Streptococcus, Staph$lococcus,Cor$nebacteria&

!ak$eri 5an& j&a peka:

'$coplasma, Legionella, Chlam$dia trachomatis,

Helicobacter, '$cobacterium )ansasii,

'$cobacterium scrouloceum



71/74

Mempene$ra"i den&an epa$

mem+ran +ak$eri ) +erika$an

den&an (S "+ni$ OS ri+o"om


Mekani"me kerja er5$hrom5in

Ham+a$an "in$e"a pro$ein

Mekani"me $erjadin5a re"i"$en"i


72/74

Mekani"me $erjadin5a re"i"$en"i$erhadap er5$hrom5in

Me$h5%a"i re"ep$or rRN pada ni$ OS

ri+o"om di +a4ah kon$ro% p%a"mid

Re"i"$en"i "i%an& $erhadap %inom5in


Pada kman o%iform: $ran"mi"i me%a%i

p%a"mid e"$era"e men&hidro%i"a inin

%ak$on maro%ide

0fek "ampin& er5$hrom5in


73/74

0fek "ampin& er5$hrom5in

L. Gan&&an "a%ran erna:1norek"ia, ma%, mn$ah, di"pep"ia,

iri$a"i %am+n&, diare2


(. #ok"i"i$a" hepar:Kh""n5a er5$hrom5in e"$o%a$e

Hepa$i$i" ko%e"$a$ik

1demam, ik$er", &an&&an fn&"i hepar2

. Reak"i a%er&i:1demam, eo"inofi%ia, ram k%i$2

3n$erak"i o+a$ den&an er5$hrom5in


74/74

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Antimkrba u Basil Gr (-) & Mek.krjnya