Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
AMINOGLYCOSIDES
A. OTOTOXICITY
Auditory or vestibular damage (or both)
maybe irreversible
Auditory impairment
- Amikacin and kanamycin
Vestibular dysfunction
- Gentamicin and tobramycin
TOXICITY
A. OTOTOXICITY
Risk is proportionate to the plasma
levels
High if dosage is not modified in renal
dysfunction
Increased with the use of loop diuretics
Contraindicated in pregnancy
TOXICITY
B. NEPHROTOXICITY
Acute tubular necrosis
Reversible
Most nephrotoxic
Gentamicin and tobramycin
TOXICITY
B. NEPHROTOXICITY
More common in elderly patients
Patients concurrently receiving
Amphotericin B
Cephalosporins
Vancomycin
AMINOGLYCOSIDES
TOXICITY
C. NEUROMUSCULAR BLOCKADE
Rare
Curare-like block may occur at high doses
Respiratory paralysis
Reversible
TOXICITY
C. NEUROMUSCULAR BLOCKADE
Treatment
Calcium
Neostigmine
Ventilatory support
AMINOGLYCOSIDES
TOXICITY
D. SKIN REACTIONS
Neomycin
Allergic skin reactions like contact
dermatitis
Makrolida
Spektrum kerja : bakteriostatik ,terutama gram +
Golongan makrolida : Eritromisin, Klaritromisin,
Azitromisin.
Indikasi : Infeksi saluran pernafasan , Pneumonia
mikoplasma, sifilis (triponema polidum)
Diphtheriae, Infeksi klamedia.
Efeksamping : Gangguan gastrointestinal, ikterus
kolestatik, ototoksisitas (sementara),
Kontraindikasi : gangguan fungsi hati
Obat pilihan pengganti penisilin.
Makrolida
Erytromosin secara alamiah macrolide adalah derivat
dari streptomycin erythreus
masalah :
1. labilitas asam
2. spektrum asam
3. kecil intolerans saluran pencernaan
4. eliminasi waktu paruh pendek
makrolida
Derivat secara struktural termasuk clarithromycin dan
azitromycin :
1. Spektrum aktifitas luas
2. Biovaibilitas lebih baik, penetrasi ke jaringan lebih
baik, waktu paruh lebih panjang
3. Tolerabilitas lebih baik
Struktur Makrolida
Erytromycin
Struktur Makrolida
Clarithromycin Azitromycin
Mekanisme Kerja
Menghambat sintesa protein oleh mengikat 50S
ribosomal subunit secara reversibel
- suppressi dari RNA dependent sintesa protein
Macrolida secara khusus mempunyai aktifitas
bacteriostatic, tetapi dapat bactericidal bila dalam
konsentrasi tinggi terhadap organisme susceptible.
Time- dependent activity
Spektrum aktifitas makrolida
Gram positive aerobes
- erytromycin memberikan aktifitas terbaik.
Clarithro > erytro > azitro
FQ baru :
1. Levofloxacin (levocin,Cravox,cravit) –PO, IV
2. Gatifloxacin (tequin) – PO, IV
3. Mexifloxacin (avelox) – PO, IV
Ciprofloxacin
Administration [Usual Dosage]: IV, PO [500 – 750 mg q 8-12h]
Spectrum: Gram- aerobic rods, and Legionella pneumophila, and other
atypicals. Poor activity against Strep. pneumoniae.
Indications:
-- Nosocomial pneumonia
-- Intra-abdominal infections
Anthrax exposure and prophylaxis
Unique Qualities:
Binds divalent cations (i.e. Ca & Mg) which decreases absorption
-- Increased effects of warfarin
ADRs
arrhythmias
Nausea, GI upset
Interstitial nephritis
Levofloxacin
Brand Name: Levaquin®, Quixin®
Administration [Usual Dosage]: IV, PO and ophthalmic
[500-750 mg q24h]
Spectrum: Gram-, Gram+ (S. aureus including MRSA & S.
pneumoniae) and Legionella pneumophila, atypical resp.
pathogens,
Mycobacterium tuberculosis
Indications:
Chronic bronchitis and CAP
-- Nosocomial pneumonia
Intra-abdominal infections
ADRs
Blood glucose disturbances in DM patients
Nausea, GI
Interstitial nephritis
Spektrum aktifitas FQ
Gram positif
- FQ lama aktifitas terbatas
- FQ baru potensi lebih luas
Gram Negatif
- semua FQ mempunyai aktifitas sangat baik
Cipro = levo > gati > moxi
WASSALAMU ALAIKUM W.W.