PRUDENTIAL USE OF

ANTIBIOTIC IN
CHILDREN
BLOK 26

The War of Germs

every child with fever needs antibiotics

The concept of prescribing antibiotics that has been

squandered

2000 BC : makan akar dan daun ini !!

1945

: pil itu kurang manjur, gunakan penisilin

1955

: waah, kuman resisten, minum tetrasiklin

2007 : wah dan wah dan antibiotik yg kuat

20...... - germ winsss .... Minum akar ini !!

Minum daun ituu !!!!

Component of
Treatment

General principles of
the treatment of infection

Antimicrobial agents are among the most

commonly prescribed drugs.

The major impact on control of most bacterial

infections

Concerns that unnecessary use is compromising

their beneficial effect

Basic principle of
prescribing antibiotic
Benefit value for patient
Highly suggested bacterial infeciotn

Antibiotic selection
Class, dose, route, interval, duration
PK/PD

Adverse reaction

Clinical asessment

Clinical evaluation should define the anatomical

location and severity of the infective process.

Although such diseases may be caused by wide

variety of organisms, the range of pathogens are
usually limited.

The pattern of susceptibility reasonably

predictable.

Permits a rational selection of chemotherapy in

the initial management of such infections

Step 1
Clinical asassment
The likely
anatomical
locations
The most
Most
suitable choice of
pathogen
drug
Determined by accurate physical
Superficial (skin,
Invasive to the tissue or
examination
mucosa)

blood stream

Determine the route of administration

of the drug
Intramuscular/
Topical

intravenous

Accurate physical examination is necessary to

identify the location of infection and to define
antibiotic prescription

Step 2
Look for other issues
Epidemiological aspects

Age, sex, occupation

Over seas travel

Valvular
heart disease,
Pre-existing
medical
problems
Prosthetic
devices: V-P
underlying malignant
shunt
disease

Invading pathogen may be part of

hosts flora
Deficiency of circulating

Trauma, surgical incision

PMN

Factors to assist
antibiotic selection
indication
for
antimicro
bial agent
Monotherap
y or
combinaiton

Most common
organism
causing the
infection & the
local
susceptibility
pattern

Antibiotic
spectrum of
the chosen
empirical
agent

Host factor
that might
affect therapy

Adverse
reation

PK/PD that
are associated
with a
particular
antibiotic

Cost
effectivenes
s of
antibioitc
selection

Criteria in antibioitic
selection
Broad or
narrow
spectrum

Epmpiric or
definitive

IV or oral

Bacteriostat
ic or
bactericid

Moo or
combined

Antibiotic classes &

agents
Antibiotics are commonly
classified based on

@ chemical structure
and
@mechanism of action

Bacterial Basics
Bacteria aspects antibiotic
target
Bacterial Biosynthet
DNA
cell
ic
replication
envelope processes

14

Antibiotic classes

Narrow and broad

spectrum antibiotics
Narrow

Broad spectrum

Aim to specific bacteri

confirm

Narrow and broad

spectrum --> expire??
Location, etiology, and
susceptibility

Unknown etilogy

Emprirical

Potential serious
bacterial infection

Multiple antibioitc

Mono vs Combination

Mono or combination

Monotherapy : One antibiotic

Combination : two or more antibiotics

Antibiotic combination

Empiric therapy of potential serious infection

Mulitple causative agent

Reduce toxicity and resistency

Sinergy or additive

Unappropriate antagonist, adverse reaction

>>, cost >>

Common antibiotic
combination

Double lactam

-lactam &
aminoglycosi
de

-lactam &
quinolon

Antibiotic
administration
Preffered
easy and
cost-effective

Oral

i.v

When do we
give iv?

When give iv?

Severe illness

Advantage

Reach desirable
soon

Oral (-)

Reach therapeutic
level sooner

Contraindication for
oral

Empirical therapy
based on clinical
diagnostic and
suspected
microorganism
Drug of choice and
alternative drugs

Definitive
therapy
Based on positive
result of culture &
sensitivity test

Clinical indication : treatment of

the disease and etiology
organisms
Site of
infection (penetration of drugs)
Dosages of antibiotic
Renal impairment
Administration

Flowchart of bacterail
infection treatment
Recov
er

Narrow
spectrum
antiiotic

Probable
Bacte
rial
infect
ion

Empiric therapyCultur

Definitiv
e
therapy

Pathoge
n
identific
ation

Laboaratory
assesment
Few infective condition present a typical picture
with a definitive clinical & microbiological
diagnosis without lab. exam

Whenever possible a clinical diagnosis should be

supported by laboratory confirmation.

Strong clinical suspected, therapy should be

given as soon as possible; while lab assessment
should be taken

Serological test is important to antigen detection

Treatment evaluation

Antibiotic therapy
failure

Inaccurate dose

Inaccurate antibiotic selection

Necrotic inflammation area

Other infection source

Wrong diagnosis

Fight smarter not

harder

Antibiotic stewardship

The CDC Campaign to Prevent Antimicrobial

Resistance in Healthcare settings: 4
Strategies of the Campaign

Thank you