ANTIBIOTIK

BLOOD BRAIN BARRIER

Noor Wijayahadi
 The “blood-brain barrier (BBB)”
• Kapiler pembuluh darah di SSP mempunyai
tight junctions yang menyusun BBB.

• Kapiler pembuluh darah di SSP terbungkus

sel glia pericapillar yang menyusun BBB.

• Sel endotel kapiler pembuluh darah di SSP

mempunyai P-glycoprotein yang memompa
obat keluar endotel
 The “blood-brain barrier (BBB)”

• BBB hambat masuknya obat yang hidrofilik

(larut air) ke dalam SSP

• BBB tidak berfungsi pada ischemia dan

inflammation.

• BBB menyebabkan berkurangnya efek

samping ke SSP
 Blood-Brain Barrier, Cont’d

1. Lipid soluble molecules will cross

2. Negatively charged molecules cross more
freely than positively charged ones
3. High CO2/low O2 produce vasodilation and
decrease resistance of BBB
4. Injury or inflammation decreases resistance
of BBB (allows some antibiotics to be used
for treatment)
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4
 Blood-Brain Barrier, Cont’d
5. Selected brain areas are not protected by the BBB –
the circumventricular organs (CVO) bordering on
the 3rd and 4th ventricles
• parts of the hypothalamus - median eminence
• Neurohypophysis
• pineal gland
• area postrema
• subfornical organ
• subcommissural organ

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 Selectivity of the Blood Brain Barrier

Peripheral Capillary Brain Capillary

Protein permeability restricted to:

• small molecules (<600D)
Glucose
• lipophilic substances
(hydroxyl group)

(amine group)
 ANTIBIOTIK
KUMAN GRAM (+)
 Penisilin
• Narrow-spectrum
– Penicillin G (IV)
– Penicillin VK (PO)
• Penicillinase-resistant  Antistaphylococcal
– Cloxacillin, dicloxacillin (PO)
– Nafcillin (IV)
– Oxacillin (IV)
• Extended-spectrum
– Ampicillin/.Amoxicillin (PO)
– Amoxicillin + clavulanate (PO)
– Piperacillin (IV)
– Ticarcillin (IV)
 Cephalosporins

1st  Gram (+)

2nd  spektrum lebih luas  Gr (-) Gr (+)
3rd  spektrum Gr (-) Gr (+)
 Serious Gram negative infections
– CeftriAXone and cefotAXime  meningitis
– Ceftazidime  anti-Pseudomonal
4th cefepime  Anti-Pseudomonal coverage
Spektrum Gr (-)/Gr (+) baik
5th Ceftaroline
 MRSA
DAYA PENETRASI ANTIBIOTIK
BBB