continuing medical education fakultas kedokteran

Djoko Widodo

Division of Tropical Medicine and Infectious Disease, Department of Internal Medicine University of Indonesia

Abstract

Antibiotics rational usage now going to be a new challenges in 21st century. Many crucial micro-organism resistance problems were caused by antibiotics misuse. The prudent used of antibiotics need to be conducted in case for eradicating microorganism avoiding the collateral damage or resistance, and reaching a better cost effective.

Antibiotics usage in primary care will be ajJected by the physician knowledge which should consider the host condition, infection setting, microorganism susceptibility and both of drugs pharmacokinetic and pharmacodynamic. All of these consideration will guide physician to determine the empirical antibiotics treatment which were usually described in guidelines and consensus.

Now in the worldwide, there are four indication for antibiotics treatment: prophylaxis, pre-emptive, empirical, and definite. The majority problem of antibiotic usage were how to chose antibiotics empirically and properly. Good clinical outcomes were may showed if antibiotics were used properly. Hospital rational antibiotics usage could be evaluated by Gyssens method or any other that and measured adequacy the of ways, appropriation antibiotics.

Key words : antibiotics, usage, indication

Antibiotics in Renal Impairment

Suhendro

Division of Tropical Medicine and Infectious Disease

Department of Internal Medicine University of Indonesia

Abstract

In several cases of infection, renal impairment often arise become a problem that need to be concerned. Clinicians should eradicate pathogens beside considering the nephro-toxicity effect. To determine the antimicrobial using, the pharmacodynamic and pharmacokinetic of the drug should be fully understood. It will be related to dose or time adjusted when giving antibiotics for patients with renal impairment.

Oral antibiotics were relatively more safe than intravenous antibiotics. Usually, blood Cmax of oral antibiotics was lower than intravenous antibiotics, but the type of antibiotics also need to be concerned. There were two type of antibiotics : Dosed dependent Antibiotics and Time dependent Antibiotics. In the case of renal impairment, Dose dependent antibiotics such as : aminoglycoside suppose to be time adjusted when it’s given. But time dependent antibiotics such as : cephalosporine or carbapenem need to be dose adjusted when it’s administered.

A few kind of 3rd gen of cephalosporine such as : Ceftriaxone and Cefoperazone didn’t need adjust for renal impairment. They relatively safe with minimal nephro-toxicity effect. The antibiotics using in renal impairment should be done carefully even for patients with chronic hemodialysis.

Key Words Antibiotics, renal impairment

Eradicating Community Associated Methicillin Resistant Staphylococcus aureus

Ronald Irwanto Department of Internal Medicine University of Trisakti

Abstract

Methicillin Resistant Staphylococcus aureus (MRSA) was a S.aureus that resistant to betalactam with typical resistant to aminoglycoside, chloramphenicol, clindamycin, fluorquinolone and macrolides. MRSA now known as a global problem in world wide, in which, MRSA was spread both in communities and hospital. In community, that is called as Community Associated - MRSA, often appear as a definitive causal of infection, but also frequently found only as a colonization.

People with MRSA infection usually shows severe symptoms which caused by the panton-valentin leucocydin that produced by MRSA that have any high tissue toxicity.

Laboratory findings such as: direct gram smear, bacterial culture, or PCR should be used to prove the MRSA infection. MRSA infection has worst survival compared with MSSA, and faster eradication should be done to reduce mortality and morbidity.

Glycopeptide group (e.g. vancomycin and teicoplanin), or oxazolidindiones (linezolid) still in the front line for MRSA treatment. Linezolid was recognized as a narrow spectrum antibiotic. It was resistant to gram negative (e.g infuenza, Pseudomonas spp, etc), but has high sensitivity to gram positive and MRSA. Sulfa can also used to eradicated the Community Associated MRSA in daily practice.

Key Words: Eradication, MRSA

Antibiotics Treatment for Elderly

Herdiman T. Pohan

Division of Tropical Medicine and Infectious Disease, Department of Internal Medicine University of Indonesia

Abstract

Elderly with several specification now known need to be treat distinct antibiotics empirically and properly. Good clinical outcomes were may showed if antibiotics were used properly. Hospital rational antibiotics usage could from regular adult. Geriatric host special character should be lead to the severe infection, in which all these character should increased susceptibility to infections.

High morbidity and mortality, atypical clinical presentation need to be concerned by physician, that the presumption diagnostic done rather than etiologic diagnostic. Antibiotics treatment should be done carefully be done carefully and properly. Side effects of antibiotic treatment frequently ended as a multi-complication of poly­pharmacy and also appear the high cost of treatment, that’s why, antibiotics management in elderly should be included right indication, dosage, regimens, and should pay attention for the cost effectiveness. Setting of infection event, there were : community or hospital, and also source of infection such as : Lung, Skin and soft tissue infection, UTI. and GI tract infection should identified before treatment administering.

Key Words: Antibiotic. elderly

PENGGUNAAN ANTIBOTIKA SELAMA KEHAMILAN.

Laksmi Maharani

Bagian Obstetri dan Ginekologi Fakultas Kedokteran Universitas Trisakti

Antibiotika adalah senyawa kimia yang dihasilkan oleh suatu mikroorganisme atau dihasilkan secara sintetik yang dapat membunuh atau menghambat perkembangan bakteri dan organisme lain. Antibiotika banyak digunakan dalam kehamilan. Prinsip utama pemakainan antibiotika pada kehamilan adalah memikirkan penggunaan yang tepat agar efek samping bagi ibu dan janin menjadi minimal.

Seorang wanita hamil dapat sangat rentan dan mudah mengalami suatu infeksi berat. Lingkungan hormonal pada kehamilan memberi kontribusi tersupresinya imunitas sehingga infeksi bakteri, virus dan parasit lebih mudah terjadi. Oleh karena itu kehamilan merupakan faktor resiko untuk terjadinya beberapa penyakit infeksi. Infeksi yang mengenai ibu selama kehamilan dapat ditransmisikan ke janinnya baik selama persalinan dan masa nifas, beberapa diantaranya dapat memberi dampak yang serius.

Infeksi saluran kemih merupakan infeksi yang sering terjadi selama kehamilan. Bakteriuria asimtomatik ditemukan pada 4-7% wanita hamil. Selain itu infeksi saluran nafas bagian atas juga biasa terjadi dengan konsekuensi minimal. Infeksi gastrointestinal biasanya ringan dan terkadang tidak memerlukan obat­obatan khusus. Dapat pula terjadi demam saat persalinan. yang biasa disebabkan oleh ketuban pecah dini, pielonefritis dan influenza.

Masalah yang terjadi sekarang adalah adanya resistensi antibiotic spectrum luas yang semakin meningkat. Banyak strain kuman yang sudah resisten pada antibiotic b-lactam atau sefalosporin spectrum luas. Oleh karena itu perlu dipikirkan pemakaian antibiotika yang rasional.

Pemakaian Antimikroba di Bidang Pediatri

Tubagus Ferdi Abdilah

(Bagian Imu Kesehatan Anak ,Fakultas Kedokteran Universitas Trisakti)

Abstrak

Terapi antimikroba pada bayi dan anak-anak menyajikan banyak tantangan. Dalam memilih antimikroba untuk pasien anak, diperlukan pemahaman farmakologi klinis obat yang akan dipergunakan. Farmakologi klinis obat mengupas farmakodinamik obat yaitu interaksi. antara pejamu dengan obat, dan farmakokinetiknya mengenai pengetahuan bagaimana cara tubuh pejamu mengamankan pengaruh obat tersebut. Hal lain yang perlu diperhatikan adalah dosis, cara pemberian, dan indikasi pengobatan antimikroba: apakah sebagai pengobatan awal (pengobatan empiris), pengobatan definitif (berdasarkan hasil biakan) atau untuk pencegahan (profilaksis) .

Klinisi harus mempertimbangkan perbedaan-perbedaan penting di antara berbagai kelompok umur dari spesies patogen yang bertanggung jawab untuk infeksi bakteri; sesuai dengan usia dan toksisitas antibiotik dosis juga harus dipertimbangkan. Terapi antibiotik spesifik optimal didorong oleh diagnosis mikrobiologis, seperti isolasi patogen, dan didukung oleh pengujian resistensi antimikroba

Terdapat beberapa dasar perbedaan anak dengan orang dewasa pada penggunaan antimikroba. Sebagai contoh, volume distribusi beberapa jenis obat  Iebih besar pada anak daripada dewasa sehingga eliminasi waktu paruhnya pun lebih lama. Demikian pula daya ekskresi dan eliminasi obat pada anak lebih tinggi daripada dewasa. Sebaliknya daya ekskresi dan eliminasi pada neonatus reridah seiring dengan maturasi organ yang berperan pada metabolisme obat.

Optimizing antimicrobial treatment with PK-PD

Rianto Setiabudy,

Department of Pharmacology, Faculty of Medicine. University of Indonesia

Abstract

In the past, achieving high plasma concentration of antibiotic is believed to be the key determinant for a successful antimicrobial therapy. Today, however, various reports indicate that further information is needed to optimize antimicrobial treatment. New findings in pharmacokinetics and pharmacokinetics (PK/PD) suggest that the killing pattern of each antimicrobials have important impact on how the antimicrobials should be given.

The integration of PK/PD has introduced a new strategy to kill the responsible pathogen more quickly. This results in not only a better clinical outcome, but also with a reduced problem of resistance because the immediate death of the microorganism curtails opportunity for the pathogens to mutate. The currently accepted concept of pharmacodynamics and pharmacokinetics has also necessitated the National Committee of Clinical Laboratory Standards (NCClS) to redefine the breakpoint of susceptibility which are relatively higher than the old one.

Depending on their kinetic killing properties, antimicrobial agents can exhibit concentration-dependent or time­dependent killing pattern. The clinical consequent of these findings is obvious. Antimicrobials exhibiting concentration­dependent activity must be given by intravenous bolus, while those showing time-dependent activity must be given either by continuous infusion or by frequent administrations.

Antimicrobials to be given in high dose bolus may result in toxicity, while those administered by continuous infusion may be confronted with the problem of instability of the drug in the solution. These need to be carefully considered by the clinicians in applying the PK-PD in daily practice.

Antibiotic Resistance Pattern of Uropathogens in Community- Acquired Urinary Tract Infection

Widyasari Kumala

Department of Microbiology, Faculty of Medicine, Trisakti University

Abstract

Urinary tract infection (UTI), is still one of the most frequent bacterial infection disease in community and daily practice until now. Approximately 150 million people in the world suffer from this disease per year. The most frequent isolated species is E. coli (40-80%), followed by K pneumoniae, Staphylococcus aureus, Enterococcus spp, and other gram-negative bacteria. Unfortunately, recently there were many evidence showed increasing resistance of those pathogens against antibiotics. They begin to be resistant to ampicillin, cephalosporin, and quinolone. This condition leads to more difficult empirical therapeutic opsions for UTI.