By:

dr. Aulia Chairani, MKK

Departemen Farmakologi

FK UPN Veteran JKT

Hampir separuh populasi dunia terinfeksi gastrointestinal helmint prevalensi Terutama di negara tropis dan subtropis dengan pendapatan perkapita rendahAnak-anak paling berisiko tertularUntuk spesies tertentu bisa tanpa gejala Morbiditas tinggi pada spesies yg lain schistosomiasis, fascioliasis dan hookwormInfeksi cacing tidak hanya terjadi pada manusia, tetapi jg menjadi masalah pada hewan peliharaan dan ternak

Obat yang digunakan untuk membebaskan tubuh dari infestasi cacing, baik dalam saluran cerna/ jaringan lain.

Beberapa obat cacing toksik diperlukan identifikasi jenis cacing sebelum pengobatan.

Identifikasi (+) bila menemukan : salah satu bentuk telur , larva dan cacing atau ketiganya

di dalam :- feses

- urin

- darah

- sputum

- jaringan

Cacing golongan cacing: Nematoda (bulat), Trematoda (pipih) dan Cestoda (pita)Infeksi campuran / tunggalBerikan Obat Pilihan UtamaOPU Nematoda: Ivermektin, Pirantel pamoat, Senyawa benzimidazol sintetik (Mebendazol, Albendazol, Tiabendazol)OPU Trematoda: Prazikuantel opisthorchiasis

Prazikuantel clonorchiasis

Triklabendazol fascioloasis

OPU Cestoda :Prazikuantel

(1) mempengaruhi motilitas cacing yaitu menghambat depolarisasi neuromuskular parasit

- befenium hidroksinaftoat : spastik paralisis

-pirantel pamoat: spastik paralisis

-piperazin: flaccid paralisis

(2) mengganggu pembentukan mikrotubulus parasit dan menggangu pembentukan energi cacing dengan menurunkan ambilan glukosa

- mebendazol/albendazol - tiabendazol

- pirvinium pamoat - niklosamid

Farmakologi obat:

Spektrum luas Efek :Vermicidal-Larvisidal-Ovisidal Absorpsi kecil sekali (< 5%) bekerja pada ususEkskresi melalui urin warning ps. ggn ginjal dan

hepar

KI : wanita hamil dan menyusui, anak umur

OPU untuk - S. stercoralis

- cacing tambang

- cutaneus larva migrans

ES : gangguan sal. cerna, kristaluria, mual, muntah diare, kejang perut, sakit kepala, lemah, pruritus di kulit, sindrom Steven Johnsons (pernah dilaporkan kematian).KI : payah ginjal

Triklabendazol : Dosis tunggal 10 mg/Kg BB

setelah sarapan

OPU untuk cacing kremi, gelang dan tambangabs. oral

Indikasi: N. americanusAbsorpsi: sedikit dalam usus halusToksisitas: rendahPreparat & Dosis :

- Kaps. gelatin : 0.2, 0.5, 2.5, 5 ml

- Dosis Dewasa : 5 ml

- Dosis Anak: 0.12 ml / kg BB

! ! Simpan di tempat dingin.

Bila terbentuk fosgen - toksik

Makanan harus bebas : lemak, minyak, alkohol

Spektrum luas - Untuk infeksi campuran

Toksisitas: rendah - dapat digunakan u/ anak

Kerja : paralisis otot cacing - kurang poten

(+) pencahar MgSO4 30 g (diulang stlh 3 jam)

Dosis : Dewasa 1 g (pasien dipuasakan dulu),

Anak ? (tidak praktis)

ES toksisitas : iritasi lokal, toksisitas sistemik (-)

Pemberian Topikal perianal korosif (tidak dianjurkan)

Pyrvinium pamoat - zat warna sianin

Indikasi : cacing kremi

Kerja: Menghambat enzim respirasi cacing Menghambat ambilan O2 dalam metab. KH cacing

E.S.: muntahan dan feses merah

mual, muntah - kejang perut

Levamisol Dosis Tunggal 150 mg (efektif)

OPU - T. saginata dan T. Solium

Dosis tunggal : 10 mg/Kg BB (+ MgSO4, stlh 2 jam) --Efektifitas mendekati 100% utk T.saginata

Befenium Hidroksinaftoat

N. americanus, A. duodenale, A. lumbricoidesabs - < eks : 0.5 % urinE.S. : yang serius tidak ada, sebab rasa pahit muntahDosis : dewasa : 5 gr - 2 dd 1 hari

anak : 2.5 gr - 2 dd 1-3 hari

OPU untuk askaris dan oxyuriasis

Dosis : BB>50 Kg = 3,5 g (sediaan: Tab 250 & 500 mg)

selama 2 hari berturut-turut

Otot cacing akan paralisis hidup keluar

dapat hidup (N) : suhu 35 C dalam garam faal

ES : gangguan sal. Cerna ( mual, muntah, diare)

nyeri abdomen

alergi

sakit kepala

Abs. : Baik, metabolisme hati - variasi individu besar

Efek sistemik tidak ada

KI : Insufisiensi ginjal, hepar

Epilepsi induksi serangan/kekambuhan

Indikasi Taeniasis , harus ditambahkan laksatif

Niklosamid

Dosis : 2 g (4 tab @ 500 mg), dikunyah+sedikit airT. saginata : tidak membunuh telur

Sistiserkosis infeksi btk larva bs ke SSP, dilaporkan kasus epilepsi

T. solium (+) laksan nekrosis skoleks, mencegah autoinfeksi penyebab sistiserkosis

Tidak di absorpsi, tidak menimbulkan iritasi lokal, gejala sal. cerna ringanDapat diberikan untuk ibu hamil dan anak.

untuk penderita kondisinya lemah atau gizi burukcacing lepas dari mukosa dicernametabolit bersifat pencaharE.S. : Relatif tidak ada

Schistosomiasis - OPUdisimpan lama toksikterkena sinar UV rusakpemberian IV lambat

S. japonicum intensif 14 hari

Stop terapi bila muntah, albuminuria, nyeri sendi, demamIndikasi : S. hematobium, S. mansoni, Granuloma inguinalKI : gangguan ginjal - jantungES : anemia hemolitik

OPU- W. bancrofti, B. malayi, Loa-loame mikrofilaria darah fagositosis lenyapnodul - hidrokel tidak efektif (operatif)ES : alergi, takikardia, sakit kepala, mual, muntahKI : relatif tidak adaPreparat & Dosis : Tab. 50 mgDosis anak : 3x sehari, 2 mg/Kg BB, 7-21 hrDosis dewasa (WHO) : 6 mg/Kg BB/hr, 12 hr

The elderly and people with an impaired immune system, such as HIV, cancer or those on immunosuppressive medications, are susceptible to crusted scabies, called "Norwegian scabiesOn those with a weaker immune system, the host becomes a more fertile breeding ground for the mites, which spread over the host's body, except the faceSufferers of crusted scabies exhibit scaly rashes, slight itching, and thick crusts of skin that contain thousands of mitesSuch areas make eradication of mites particularly difficult, as the crusts protect the mites from topical miticides, necessitating prolonged treatment of these areas

Scabies (from Latin: scabere, "to scratch"),known colloquially as the seven-year itchContagious skin infection that occurs among humans and other animalsCaused by a tiny and usually not directly visible parasite, the mite Sarcoptes scabiei, Burrows under the host's skin, causing intense allergic itchingInfection in animals (caused by different but related mite species) is called sarcoptic mangeDogs and cats are infected by different types of mites than those which infect humanWhen canine or feline mites land on human skin, they fail to thrive and produce only a mild itch that goes away on its own

Intense itching and superficial often linear burrows , to the point that a neat "line" of four or more closely placed and equally developed mosquito-like "bites," is almost diagnostic of the disease.

ItchingThe itch is made worse by warmth and is usually experienced as being worse at night, possibly because there are fewer distractionsAs a symptom it is less common in the elderlyRash:The superficial burrows of scabies usually occur in the area of the hands, feet, wrists, elbows, back, buttocks, and external genitals The burrows are created by excavation of the adult mite in the epidermisIn most people, the trails of the burrowing mites show as linear or s-shaped tracks in the skin, often accompanied by what appear as rows of small pimple-like mosquito, or insect bites. These signs are often found in crevices of the body, such as on the webs of fingers and toes, around the genital area, and under the breasts of womenSymptoms typically appear 26weeks after infestation for individuals never before exposed to scabies if previously exposed, the symptoms can appear within several days after infestation But can also appear after several months or yearsAcropustulosis, or blisters and pustules on the palms and soles of the feet, are characteristic symptoms of scabies in infants

An individual who has scabies, but isn't exhibiting symptoms can still spread them without knowing. Scabies Frequently Asked Questions, 2010.Most common place to contract scabies is:

FrotosGov/Ba, 2011.

Ulrichkarljoho, 2009.

Freeformkatia, 2008.

Miss_millions, 2010

Hospitals

Nursing homes

Child care facilities

Prisons

Scabies may be diagnosed clinically in geographical areas where it is common when diffuse itching presents along with either lesions in two typical spots or there is itchiness of another household memberThe classical sign of scabies is the burrows made by the mites within the skinTo detect the burrow the suspected area is rubbed with ink from a fountain pen or a topical tetracycline solution, which glows under a special lightThe skin is then wiped with an alcohol pad. If the person is infected with scabies, the characteristic zigzag or "S" pattern of the burrow will appear across the skin; however, interpreting this test may be difficult, as the burrows are scarce and may be obscured by scratch marksA definitive diagnosis is made by finding either the scabies mites or their eggs and fecal pellets Searches for these signs involve either scraping a suspected area, mounting the sample in potassium hydroxide, and examining it under a microscope, or using dermoscopy to examine the skin directly

Symptoms of early scabies infestation mirror other skin diseases, including dermatitis, syphilis, various urticaria-related syndromes, allergic reactions, and other ectoparasites such as lice and fleas

Intense scratching can cause a secondary skin infection, such as impetigo.

Mass treatment programs that use topical permethrin or oral ivermectinThere is no vaccine available for scabiesThe simultaneous treatment of all close contacts is recommended, even if they show no symptoms of infection (asymptomatic), to reduce rates of recurrence Asymptomatic infection is relatively common Objects in the environment pose little risk of transmission except in the case of crusted scabies, thus cleaning is of little importance Rooms used by those with crusted scabies require thorough cleaning

PermethrinPermethrin :Treatment of choiceApplied from the neck down usually before bedtime and left on for about 8 to 14hours, then showered off in the morningOne application is normally sufficient for mild infectionsFor moderate to severe cases, another dose is applied 714days laterMay cause slight irritation of the skin, but the sensation is tolerableIvermectinAn oral medication, often used as a single doseTreatment of choice for crusted scabies, and often used in combination with a topical agentNot tested on infants and not recommended for children under six years of ageTopical ivermectin preparations have been found to be effective for scabies in adults, and are attractive due to their low cost, ease of preparation, and low toxicityHas also been useful for sarcoptic mange (the veterinary analog of human scabies)OthersOther treatments include lindane, benzyl benzoate, crotamiton, malathion, and sulfur preparations