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PROLONGED ANTIBIOTIC

PROLONGED ANTIBIOTIC. Kasus 1. An. Bayi R, ♀, 4 hari D irawat d i RS : 9 -9- 2010 s/d 16-10-2010 Keluhan Utama : pasien rujukan dari RSIA RM dengan kelainan multi kongenital. Bayi dirawat di RSIA RM, mendapat tatalaksana : - IVFD : D 10% 8-10 tpm - Obat :

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PROLONGED ANTIBIOTIC

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  1. PROLONGED ANTIBIOTIC

  2. Kasus1 • An. Bayi R, ♀, 4 hari • Dirawatdi RS : 9-9-2010 s/d 16-10-2010 • KeluhanUtama : pasienrujukandari RSIA RM dengan kelainan multi kongenital

  3. Bayidirawatdi RSIA RM, mendapattatalaksana: - IVFD : D 10% 8-10 tpm - Obat : Cefotaxim 2x200 mg IV Gentamisin1x15 mg IV - Vitalac 10x20 ml/NGT Selamaperawatan, bayihipersalivasi, sianosisbiladiberiminumdandilepas O2 5/9/10 pk. 05.30 WIB • Bayilahirdi RSIA RM, S.C a/I polihidramnion • UG 40 mgg • Apgar score 4/7 • BL = 3500 gram • PL = 47 cm • saatlahirtidakmenangis • Resusitasi bayimenangislemas • Faktorrisikoibu: (-) Bayipadasaatdirujukdiantarolehbidan,perawatdandenganmenggunakanambulan, dibungkuskain 2 lapis, dengan O2, infustidak menetes

  4. Pemeriksaan fisis • KU : CM, sesak (-), sianosis (-), letargi • FDJ 140x/menit, reg, isi cukup, FP62 x/menit, reg, NCH (-), retraksi(-) S 37°C, BB 3,2 kg, PB 49 cm • BB 3,2 kg, PB 49 cm • Kepala : UUB terbuka, datar • Mata : konjungtivapucat (-), ikterik (-), edema palpebra (-) • Mulut : mukosa lembab • Jantung : BJ I-II N, bising (-), iramaderap (-) • Paru : vesikuler, rhonki -/-, wheezing -/- • Abd : datar, lemas, BU (+)N, hepatosplenomegali(-) • Ekst : akral hangat, CRT <3”, talipesequivarus • Genitalia eksterna : mikropenis, undescensus testis

  5. Pemeriksaanpenunjang • Hb 16 g/dL • Ht 46 vol % • Tr 274.000 /µL • Hitungjenis -/2/4/55/26/13 • GD sewaktu 133 • Sat O2 92 % tanpa O2

  6. Pertanyaankasus 1 • Apa diagnosis awalmenurutandapadapasienini ? • PadakasusinidiberikanterapiantimikrobaawalAmoksisilin-As. Clavulanat 2x150 mg, apakahmenurutandaterapinyasudahsesuai ?

  7. Kemungkinan diagnosis • Distress Pernapasan ? • Pneumonia kongenital ? • Sepsis ?

  8. Jawabanpertanyaankasus 1 Diagnosis awal : • Sepsis neonatorum awitan dini • AnomaliKongenital yang Multipel

  9. O2 0,5 l/mt • IVFD D10 % 13 ml/jam (80 ml/kg BB/hari) • Amoksisilin – As. Clavulanat 2 x 150 mg IV • Gentamycin 15 mg/36 jam • Periksa : CRP, IT Ratio dankulturdarah • Foto Baby gram • Puasa

  10. Oski’s pediatrics : principles and practice,

  11. Neonatal sepsis : (empiric) • First Line : Community base : Penicillin/Ampicillin + Gentamicin • Second line : Hospital aqcuired : Ampicillin/cloxacillin – Gentamicin/Amikacin : • Third line : Hospital-acquired spsis : Cefotaxime/Piperacillin-Tazobactam/Ciprofloxacin + Amikacin Indian J Pediatr 2008; 75 (3) : 261-266

  12. 42 41 40 39 38 37 Amoksiklav 2x160 mg (2) (3) (4) Pip-tazol3x260 mg (2) Gentamisin 16 mg/36 jam Amikasin 3x26 mg (2)

  13. 42 41 40 39 38 37 Amp-Sulb4x125 mg Piperacillin tazobactam 3x260 mg iv (6) (7) Amikasin1x26 mg iv (5)(6) (7)(8) Azithromycin 1x35mg(3) (4)

  14. 42 41 40 39 38 37 Meropenem 3x135 mg iv Ampicillin sulbactam 4x125 mg iv(5) (6) STOP Azithromycin 1x35 mg po (9) (10) (11) (12) Amikasin1x26 mg iv (11) (12) STOP

  15. 42 41 40 39 38 37 Meropenem 3x 135 mg (5) (6) (7) (8) (9) Amikasin 3x28 mg (2) • Lendir >>> • Berotec + NS 2,5 ml/6jam • pH 7.346 • pCO2 62.9 • pO2 74.7 • HCO3 38.3 • BE 13.3 • Sat O2 95.1 • Na 145.2 • K 5.47 • Ca 1.42

  16. 42 41 40 39 38 37 Meropenem 3x135 mg (13)(14) (15) (16) (17) Amfoterisin B 1x2mg 1x3mg 1x4mg (5) (6) (7) Amikasin 3x30mg (2 ) (3) (4) (5)

  17. 42 41 40 39 38 37 Meropenem 3x135 mg iv (19) Cefepime 3x225 mg iv Amikasin1x26 mg iv Amfoterisin B 4 mg

  18. Pertanyaan • Bagaimanapendapatandamengenaipengobatanantimikrobapadapasienini ?

  19. 42 41 40 39 38 37 Amoksiklav 2x160 mg (2) (3) (4) Pip-tazol3x260 mg (2) Gentamisin 16 mg/36 jam Amikasin 3x26 mg (2)

  20. 42 41 40 39 38 37 ? Amp-Sulb4x125 mg Piperacillin tazobactam 3x260 mg iv (6) (7) Amikasin1x26 mg iv (5)(6) (7)(8) Azithromycin 1x35mg(3) (4)

  21. 42 41 40 39 38 37 ? Meropenem 3x135 mg iv Ampicillin sulbactam 4x125 mg iv(5) (6) STOP Azithromycin 1x35 mg po (9) (10) (11) (12) ? Amikasin1x26 mg iv (11) (12) STOP

  22. 42 41 40 39 38 37 Meropenem 3x 135 mg (5) (6) (7) (8) (9) ? Amikasin 3x28 mg (2) • Lendir >>> • Berotec + NS 2,5 ml/6jam • pH 7.346 • pCO2 62.9 • pO2 74.7 • HCO3 38.3 • BE 13.3 • Sat O2 95.1 • Na 145.2 • K 5.47 • Ca 1.42

  23. 42 41 40 39 38 37 Meropenem 3x135 mg (13)(14) (15) (16) (17) ? Amfoterisin B 1x2mg 1x3mg 1x4mg (5) (6) (7) Amikasin 3x30mg (2 ) (3) (4) (5)

  24. 42 41 40 39 38 37 ? + Meropenem 3x135 mg iv (19) Cefepime 3x225 mg iv Amikasin1x26 mg iv Amfoterisin B 4 mg

  25. Jawabanpertanyaan • Pilihanantibiotika : • indikasipemberian • kombinasiantibiotika • Dosisdan lama pemberian • Penggantianantibiotika

  26. Kesimpulan • Berikanantibiotikauntukpengobatanempirikberdasarkanindikasi yang kuatdenganpilihan yang rasional : • Kepustakaan • Pola/petakuman • Pemberianantibiotikaselanjutnyaharusberdasarkanindikasi yang benar, yaituresponsklinis, hasilbiakandansensitifitasnyadenganmemperhatikandosisdan lama terapi yang tepat

  27. Kesimpulan • Lama pengobatanantibiotikadisesuaikandengan guidelines terapimasing-masingpenyakit, termasukbilaharusmenggantidenganterapiliniberikutnya

  28. Terimakasih

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