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    Antibiotik Dan Antiseptik Saluran Kemih

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    Puterinugraha Wanca Apatya
    This document discusses antibiotics and antiseptics used for urinary tract infections. It provides details on common empirical antibiotic treatments for UTIs including trimethoprim-sulfamethoxazole, fluoroquinolones, beta-lactams, and macrolides. The antiseptics methamine and nitrofurantoin are also examined. Methamine works as a prodrug that generates formaldehyde with antibacterial properties, while nitrofurantoin forms reactive intermediates that damage bacterial DNA. Both have toxicities that require monitoring doses and restricting use in certain patients.

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    Antibiotik Dan Antiseptik Saluran Kemih

    Uploaded by

    Puterinugraha Wanca Apatya
    107 views14 pages
    This document discusses antibiotics and antiseptics used for urinary tract infections. It provides details on common empirical antibiotic treatments for UTIs including trimethoprim-sulfamethoxazole, fluoroquinolones, beta-lactams, and macrolides. The antiseptics methamine and nitrofurantoin are also examined. Methamine works as a prodrug that generates formaldehyde with antibacterial properties, while nitrofurantoin forms reactive intermediates that damage bacterial DNA. Both have toxicities that require monitoring doses and restricting use in certain patients.

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    Antibiotik Dan Antiseptik Saluran Kemih

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    This document discusses antibiotics and antiseptics used for urinary tract infections. It provides details on common empirical antibiotic treatments for UTIs including trimethoprim-sulfamethoxazole, fluoroquinolones, beta-lactams, and macrolides. The antiseptics methamine and nitrofurantoin are also examined. Methamine works as a prodrug that generates formaldehyde with antibacterial properties, while nitrofurantoin forms reactive intermediates that damage bacterial DNA. Both have toxicities that require monitoring doses and restricting use in certain patients.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    107 views14 pages

    Antibiotik Dan Antiseptik Saluran Kemih

    Uploaded by

    Puterinugraha Wanca Apatya
    This document discusses antibiotics and antiseptics used for urinary tract infections. It provides details on common empirical antibiotic treatments for UTIs including trimethoprim-sulfamethoxazole, fluoroquinolones, beta-lactams, and macrolides. The antiseptics methamine and nitrofurantoin are also examined. Methamine works as a prodrug that generates formaldehyde with antibacterial properties, while nitrofurantoin forms reactive intermediates that damage bacterial DNA. Both have toxicities that require monitoring doses and restricting use in certain patients.

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    © All Rights Reserved
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    You are on page 1of 14

    ANTIBIOTIK DAN

    ANTISEPTIK
    SALURAN KEMIH
    dr. Ave Olivia Rahman, MSc.
    Bagian Farmakologi FKIK UNJA

    Antibioti
    cs

    Antisepti
    cs

    Empirical Antibiotics for


    UTIs
    Trimethoprimsulfamethoxazole
    Fluoroquinolones: Ciprofloxacin,
    Levofloxacin
    Beta-lactams : penicillins and
    Cephalosporins. amoxicillin
    clavulanate, cefdinir, cefaclor, and
    cefpodoximeproxetil.
    Macrolide: clarithromycin,
    azithromycin, erytromycin used in
    STD-caused UTIs.

    Antiseptic
    METHANAMINE, NITROFURANTOIN
    The urinary tract antiseptics are
    concentrated in the renal tubules
    inhibit growth of many bacteria.
    Cannot be used to treat systemic
    infections effective concentrations
    are not achieved in plasma with safe
    doses.
    As local therapy only in kidney and
    bladder

    Methenamine
    Prodrug
    Generate formaldehyde that have
    antibacterial action.
    Acidification of the urine promotes
    the generate of formaldehyde
    should strive to keep the pH below
    5.5

    Continue...Antimicrobial
    Activity
    Nearly all bacteria are sensitive to
    free formaldehyde, at concentrations
    20 g/ml.
    Urea-splitting microorganisms (e.g.,
    Proteus spp.) tend to raise the pH of
    the urine inhibit the release of
    formaldehyde.
    Microorganisms do not develop
    resistance to formaldehyde

    Continue...Pharmacology
    Absorbed orally. 10-30% decomposes in
    the gastric juice (unless protected by an
    enteric coating)
    Produce ammonia contraindicated in
    hepatic insufficiency.
    MIC for most urinary tract pathogens : 18
    to 60 g/ml, achived with a daily dose of
    2 g at urine pH is 6 and the daily urine
    volume is 1000 to 1500 ml
    The acids commonly used are mandelic
    acid and hippuric acid (UREX, HIPREX).

    Continue...Toxicology
    Gastrointestinal distress
    Painful and frequent micturition,
    albuminuria, hematuria, and rashes.
    CONTRAINDICATION: in renal
    insufficiency can occur crystalluria
    Methenamine combines with
    sulfamethizole mutual
    antagonism.

    Continue...Therapeutic Uses and


    Status
    Not a primary drug for the treatment
    of acute urinary tract infections, but it
    is of value for chronic suppressive
    treatment.
    Most useful for E. coli, the common
    gram-negative offenders and often S.
    aureus and S. epidermidis .
    Enterobacter aerogenes and Proteus
    vulgaris are usually resistant.

    Nitrofurantoin

    A synthetic nitrofuran
    Formed highly reactive intermediates
    damage DNA.
    Active against E. Coli and enterococci.
    Resistant for Proteus, Pseudomonas,
    Enterobacter and Klebsiella.
    The antibacterial activity is higher in an
    acidic urine.
    Bacterial resistance to nitrofurantoin is
    frequent .
    Not recommended for treatment of
    pyelonephritis or prostatitis.

    Continue...Pharmacology
    Absorbed rapidly and completely from the
    GI tract.
    Drug is eliminated rapidly Antibacterial
    concentrations are not achieved in plasma.
    Plasma half-life is 0.3 to 1 hour. 40% is
    excreted unchanged into the urine.
    In impaired glomerular function
    efficacy of the drug and systemic
    toxicity.
    Nitrofurantoin colors the urine brown.

    Continue...Toxicology
    Gastrointestinal upset,
    Hypersensitivity reactions,
    leukopenia, hemolytic anemia
    [associated with G6PD),
    hepatocellular damage, Acute
    pneumonitis, Interstitial pulmonary
    fibrosis, Megaloblastic anemia,
    neurologic disturbance.
    CONTRAINDICATION : Pregnant
    women (>36 week), impaired renal
    function (creatinine clearance < 40

    Dosing of Nitrofurantoin
    Adults dose : 4x 50 to 100 mg/day,
    with meals and at bedtime.
    Child dose : 5 to 7 mg/kg in 4 divided
    doses (max 400 mg).
    Prevent recurrences : A single 50100mg dose at bedtime .
    A course of therapy should not exceed
    14 days, and repeated courses should
    be separated by rest periods.

    Acute cystitis in pregnancy


    Nitrofurantoin: 4 x 50 mg (avoid at > 36
    weeks)
    Trimethoprim: 1x 300 mg (avoid in the
    first trimester)
    Cephalexin: 2x 500 mg.
    Paracetamol can be used to relieve pain
    associated with acute cystitis.
    Recurrent UTIs require antibiotic
    prophylaxis.

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