Kajian Literatur: Profil Resistensi Salmonella typhi dan Pemilihan Antibiotik Pada Demam Tifoid

Dwi Arymbhi Sanjaya, Herleeyana Meriyani, RR. Asih Juanita, Nyoman Budiartha Siada

Abstract

Demam tifoid merupakan penyakit infeksi yang disebabkan oleh bakteri Gram-negatif yaitu Salmonella typhi. Munculnya multidrug-resistant Salmonella typhi (MDRST) dan extensively drug-resistant (XDR) Salmonella typhi menjadi ancaman baru dalam keberhasilan terapi demam tifoid. Efektivitas terapi pada demam tifoid memerlukan kajian tentang profil resistensi Salmonella typhi terhadap antibiotik yang diamati dari minimum inhibitory concentration (MIC) dan mutasi genetika, sehingga dapat dilakukan pemilihan antibiotik yang tepat pada demam tifoid dengan MDR dan XDR Salmonella typhi. Kajian literatur ini mengumpulkan dan menelaah informasi yang diperoleh dari hasil-hasil penelitian dari berbagai artikel internasional tentang resistensi Salmonella typhi terhadap antibiotik pada deman tifoid. Pencarian artikel menggunakan database PubMed, PlosOne, dan ScienceDirect sejak tahun 2011 hingga September 2021. Artikel yang diperoleh dari 192 artikel, terdapat delapan (8) artikel yang relevan, yang mana diketahui bahwa isolat Salmonella thypi resisten terhadap Ampisilin, Amoksisilin, kombinasi Amoksisilin-Asam Klavulanat, Kloramfenikol, Siprofloksasin, Ofloksasin, Levofloksasin, Asam Nalidiksat, Trimetoprim, dan kombinasi Trimetoprim-Sulfametoksazol yang diamati pada MIC90. Nilai MIC akan berdampak pada penentuan dosis yang efektif untuk mencapai konsentrasi terapetik sehingga dapat mempengaruhi indeks farmakokinetik dan farmakodinamik. Gen yang bertanggung jawab terhadap MDRST dan XDR Salmonella typhi yaitu: blaTEM-1, catA, dhfr1b, sul1, sul2, class 1 integron, gyrA dan gyrB, serta parC. Azitromisin dan Seftriakson menjadi pilihan terapi utama untuk terapi empiris pada demam tifoid. Adanya nilai MIC dan parameter farmakokinetik/farmakodinamik dapat digunakan untuk menginterpretasikan sensitivitas bakteri terhadap antibiotik, yang dapat digunakan sebagai salah satu rujukan dalam menyusun kebijakan penggunaan antibiotik. 

Keywords

demam tifoid; farmakokinetik; farmakodinamik; gen; MIC; Salmonella typhi

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DOI: https://doi.org/10.20961/jpscr.v7i2.56656

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