Pengenalan asas mengenai Intestinal Antibiotics & Sulfonamides

1. Intestinal Antibiotics & Sulfonamides
Intestinal Antibiotics
Ubat yang digunakan untuk merawat infeksi bacteria di bahagian usus.
Tindakan
• Bactericidal
- membunuh bacteria
- inhibit synthesis of bacterial cell wall
- inhibit synthesis of protein & nucleic acid
- disturbance in chemical activity in bacteria
• bacteriostatic
- inhibit synthesis of protein
- inhibit synthesis of folic acid
Indikasi umum
• cholera(mempercepatkan pemulihan)
• amoebic dysentery
• bacillus dysentery
Contoh ubat
1. Doxycycline ( vibramycin )

2. Dose : oral
- Adult : initial :
100mg q 12 hr PO, then 100-200mg/d PO
- Peads > 9 years :
4.4mg/kg PO on day 1, followed by 2.2 – 4.4mg/kg/d PO
Kesan sampingan
- diarrhea or loose stools
- nausea
- abdominal pain
- vomiting.
2. Tetracycline ( achromycin )
Dose : oral
- Adult : 1 – 2g/d PO ( 2 – 4 equal dose ) or 500mg qid PO
- Peads > 9 years : 25 – 50mg/kg/d PO ( 4 equally divided dose )
Kesan sampingan
- GI disturbances : nausea, vomiting & diarrhea
- Hypersensitivity
- Photosensitivity
- Discloloration of teeth ( < 9 years )
Kontraindikasi
- Allergic to tetracycline

3. - Pregnancy
- Lactation
- Children < 9 years
3. Chloramphenicol
Dose : oral and parental
- Adult : 250 -500mg q 6 hr PO or 250mg – 1g q 6 hr IV
Kesan sampingan
- Fatal blood dyscrasias
- Superinfection
- Hypersensitivity
- Nausea
- Vomiting
- Diarrhea
Kontraindikasi
- Allergic to chloramphenicol
Cautious
- Liver & kidney disease
- D6PD deficiency

4. 4. Norfloxacin ( noroxin )
Dose : oral
- Adult : 400mg q 12 hr PO
- Peads : not recommended
Kesan sampingan
- Nausea & diarrhea
- Abdominal discomfort
- Allergic reactions
- Superinfection
- Photosensitivity
Kontraindikasi
- Allergic to norfloxacin
- Lactation
Cautious
- Renal dysfunction
- Seizure ( sawan )
- Pregnancy

5. 5. Metronidazole ( flagyl )
Dose : oral
- Adult : 750mg tid PO ( 5 – 10 days )
- Peads : 35 -50mg/kg/d PO ( 3 doses for 10 days )
Kesan sampingan
- Nausea & diarrhea
- Anorexia
- Seizure
- Numbness
- Allergic reactions
Kontraindikasi
- Allergic to metronidazole
- Pregnancy
Cautious
- CNS & hepatic disease
- Blood dyscrasias
- Lactation
Intestinal Sulfonamides
Ubat yang digunakan untuk merawat infeksi bacteria(beberapa species) di bahagian
usus. Boleh digunakan bila antibiotic GI tidak member kesan.
Tindakan

6. • Bactericidal
- Membunuh bacteria
- Inhibit synthesis of bacterial cell wall.
- Inhibit synthesis of protein & nucleic acid
- Disturbance in chemical activity in bacteria
• Bacteriostatic
- Menghalang pembiakan bacteria
- Inhibit synthesis of PABA (para aminobenzoic acid)
- PABA diperlukan bagi pertumbuhan beberapa bacteria
Indikasi umum
• Gastro-Intestinal
Contoh ubat
1. Co-trimoxazole(Bactrim)
Kandungan:
- Trimethoprim(TPM)80mg
- Sulphamethoxazole(SMZ)400mg
Dose adult:
- 2 tab bid PO
- Increase to 3 tab bid PO(severe infection)

7. - 1 tab bid PO(if treated > 14 days)
Dose peads:
- 2 yrs: 2.5ml bid PO
- 2-5 yrs: 2.5-5ml bid PO
- 6-12 yrs: 5-10ml bid PO
Indikasi
- treatment and prophylaxis of pneumonia caused by Pneumocystis jirovecii
(formerly identified as P. carinii) (Commmonly seen in immunocompromised
patients including those suffering from HIV/AIDS)
- infections caused by Listeria monocytogenes, Nocardia spp.,
Stenotrophomonas maltophilia (Zanthomonas maltophilia)
- melioidosis
- shigellosis
- traveller’s diarrhoea
- prophylaxis of cerebral toxoplasmosis in HIV patients
- Whipple’s disease
2. Sulfasalazine(Azulfidine)
Dose Adult:
- Initial : 3-4g/d PO(evenly dividd dose)
- Maintenance : 500mg qid PO

8. - Max : 4g/d
Dose Peads:
- Initial: 40-60mg/kg/d PO (3 to 6 divided doses)
- Maintenance: 30mg/kg/d PO ( 4 equally divided doses )
- Max: 2g/d
3. Sulphadimidine
Dose :
- 1-1.5g q 6 hr PO
4. Silver sulphadiazine(Silvadene)
Dose:
- Topical cream
- Apply to affected area 1-2 times/d
Kesan sampingan (serious)
• Agranulocytosis
• Thrombocytopenia
• Aplastic anemia
• Leucopenia

9. Kesan sampingan (others)
• Allergic reactions(Steven-Jonhson syndrome)
• Pruritis
• Nausea, Vomitting, Diarhea
• Stomatitis
• Crystalluria
Kontraindikasi
• Allergic to sulfonamides
• Lactation
• Pregnancy
• Child < 2 yrs

10. Kesan sampingan (others)
• Allergic reactions(Steven-Jonhson syndrome)
• Pruritis
• Nausea, Vomitting, Diarhea
• Stomatitis
• Crystalluria
Kontraindikasi
• Allergic to sulfonamides
• Lactation
• Pregnancy
• Child < 2 yrs