By:dr. Aulia Chairani, MKKDepartemen FarmakologiFK UPN “Veteran“ JKT

Hampir separuh populasi dunia terinfeksi Hampir separuh populasi dunia terinfeksi gastrointestinal helmintgastrointestinal helmint prevalensi ↑ prevalensi ↑

Terutama di negara tropis dan subtropis Terutama di negara tropis dan subtropis dengan pendapatan perkapita rendahdengan pendapatan perkapita rendah

Anak-anak paling berisiko tertularAnak-anak paling berisiko tertular Untuk spesies tertentu bisa tanpa gejala Untuk spesies tertentu bisa tanpa gejala Morbiditas tinggi pada spesies yg lain Morbiditas tinggi pada spesies yg lain

schistosomiasis, fascioliasis dan schistosomiasis, fascioliasis dan hookwormhookworm

Infeksi cacing tidak hanya terjadi pada Infeksi cacing tidak hanya terjadi pada manusia, tetapi jg menjadi masalah pada manusia, tetapi jg menjadi masalah pada hewan peliharaan dan ternakhewan 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 / tunggal‘Obat Pilihan Utama’ OPU 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 menghambat depolarisasi neuromuskular parasit- befenium hidroksinaftoat : spastik paralisis- pirantel pamoat : spastik paralisis- piperazin : flaccid paralisis

(2) mengganggu pembentukan mikrotubulus parasit & menggangu pembentukan energi cacing ↓ ambilan glukosamebendazol/albendazol/tiabendazol

- pirvinium pamoat - niklosamid

Farmakologi obat:• Spektrum luas• Efek :Vermicidal-Larvisidal-Ovisidal• Absorpsi kecil sekali (< 5%) bekerja pada usus

Ekskresi melalui urin warning ps. ggn ginjal danhepar

KI : wanita hamil dan menyusui, anak umur<2th

Kemasan dan Sediaan : • dus berisi 10 strip @ 4 tab, 400 mg/tab• botol berisi 10 ml suspensi• botol berisi 100 tab chewable

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 tambang

abs. oral << eks. 15% urin

Dosis : 10 mg/kg BB, maksimum 1 g

ES : ringan berupa gangguan saluran cerna, sakit kepala - Cacing kremi tunggal 10 mg/kg BB - Cacing gelang tak perlu pencahar/laksan

Cacing tambang perlu ditambah pencahar

Terapi ulangan, ditunggu - Interval 2 mgg.

Indikasi : N. americanus Absorpsi : sedikit dalam usus halus Toksisitas : rendah Preparat & 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 - toksikMakanan harus bebas : lemak, minyak, alkohol

Spektrum luas - Untuk infeksi campuran Toksisitas : rendah - dapat digunakan u/ anakKerja : 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. lumbricoides abs - < eks : 0.5 % urin E.S. : yang serius tidak ada, sebab rasa pahit

muntah Dosis : 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 air T. saginata : tidak membunuh telur

Sistiserkosis infeksi btk larva bs ke SSP, dilaporkan kasus epilepsiT. solium (+) laksan nekrosis skoleks, mencegah autoinfeksi penyebab sistiserkosis

Tidak di absorpsi, tidak menimbulkan iritasi lokal, gejala sal. cerna ringan

Dapat diberikan untuk ibu hamil dan anak.

untuk penderita kondisinya lemah atau gizi buruk

cacing lepas dari mukosa dicerna

metabolit bersifat pencahar

E.S. : Relatif tidak ada

Schistosomiasis - OPU disimpan lama toksik terkena sinar UV rusak pemberian IV lambat

S. japonicum intensif 14 hari Stop terapi bila muntah, albuminuria, nyeri

sendi, demam Indikasi : S. hematobium, S. mansoni,

Granuloma inguinal KI : gangguan ginjal - jantung ES : anemia hemolitik

OPU- W. bancrofti, B. malayi, Loa-loa (Afrika) me mikrofilaria darah fagositosis lenyap

(tidak dpt membunuh cacing dewasa) nodul - hidrokel tidak efektif (operatif) ES : alergi, takikardia, sakit kepala, mual,

muntah KI : relatif tidak ada Preparat & Dosis : Tab. 50 mg Dosis anak : 3x sehari, 2 mg/Kg BB, 7-21 hr Dosis 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 scabies“

On 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 face

Sufferers of crusted scabies exhibit scaly rashes, slight itching, and thick crusts of skin that contain thousands of mites

Such 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 itch

Contagious skin infection that occurs among humans and other animals

Caused by a tiny and usually not directly visible parasite, the mite Sarcoptes scabiei,

Burrows under the host's skin, causing intense allergic itching

Infection in animals (caused by different but related mite species) is called sarcoptic mange

Dogs and cats are infected by different types of mites than those which infect human

When 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.

Itching The itch is made worse by warmth and is usually experienced as being worse at night,

possibly because there are fewer distractions As a symptom it is less common in the elderly Rash: 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 epidermis

In 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 women

Symptoms typically appear 2–6 weeks 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 years

Acropustulosis, 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 member

The classical sign of scabies is the burrows made by the mites within the skin

To detect the burrow the suspected area is rubbed with ink from a fountain pen or a topical tetracycline solution, which glows under a special light

The 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 marks

A 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 ivermectin

There is no vaccine available for scabies The 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

Permethrin Permethrin : Treatment of choice Applied from the neck down usually before bedtime and left on for about 8 to

14 hours, then showered off in the morning One application is normally sufficient for mild infections For moderate to severe cases, another dose is applied 7–14 days later May cause slight irritation of the skin, but the sensation is tolerable Ivermectin An oral medication, often used as a single dose Treatment of choice for crusted scabies, and often used in combination with a

topical agent Not tested on infants and not recommended for children under six years of age Topical 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 toxicity

Has also been useful for sarcoptic mange (the veterinary analog of human scabies)

Others Other treatments include lindane, benzyl benzoate, crotamiton, malathion, and

sulfur preparations