Sensitivity Pattern of Gram Negative Bacteria Nasal Swab Isolates in Patient with Allergic Rhinitis to Amoxicillin and Ciprofloxacin

By: Danita Dwityana Gamalwan (20090310024) Medical Faculty and Health Science Muhammadiyah University of Yogyakarta 2012

Background
Prevalence Allergic Rhinits Symptoms Infection Gram Negative Bacteria Antibiotic

Amoxicillin Ciprofloxacin

The Formulation of Problem

1. Is gram negative bacteria nasal swab isolates in patients with allergic rhinitis still sensitive to the antibiotic Amoxicillin? 2. Is gram negative bacteria nasal swab isolates in patient with allergic rhinitis still sensitive to the antibiotic Ciprofloxacin?

The purpose of research

A. General Purpose

=> to determine sensitivity pattern of gram negatif bacteria nasal swab isolates in patient with allergic rhinitis to antibiotics B. Special Purpose 1. To determine sensitivity of gram negative Bacteria nasal swab isolates in patient with allergic rhinitis to amoxicillin 2. To determine sensitivity of gram negative Bacteria nasal swab isolates in patient with allergic rhinitis to ciprofloxacin

The Objectivity of research

1. Amin R et al (2009), considering respiratory tract infections and antimicrobial sensitivity 2. Ndip RN et al (2008), Antimicrobial resistance of bacterial agents of

the upper respiratory tract of school children in Buea, Cameroon.

3. Nursyasni (2005), Sensitivity pattern of gram negative bacteria in Lower respiratory infection to Amoxiciliin in Microbiology MFUI. 4. Refdanita et al (2004), Sensitivity pattern of bacteria to antibiotic in intensive care unit Fatmawati Hospital, Jakarta 2001-2002

5. Setianingrum F, (2009), Sensitivity pattern of gram negative bacteria in Lower respiratory tract infection to ciprofloxacin in Microbiology Laboratorium Medical Faculty UI 6. Nursiah S, (2003) Pattern of aerob Bacteria caused OMSK and sensitivity to antibiotic in USU 7. Utami F, et al (2010) Allergic Rhinitis as a risk factor Otitis Media Supuratif Cronic.

The differences : Sample => Nasal swab of allergic rhinitis patient

Literature Review
A. Gram Negative Bacteria

B. Allergic Rhinitis

C. Antibiotic (amoxicillin & ciprofloxacin)

Amoxicillin Penicillin Ciprofloxacin Quinolon

Mechanism

PBP reseptor, then activates the enzim autolysis and cause cell lysis

Inhibit the synthesis of bacterial DNA gyrase

Conseptual Framework
Allergic Rhinitis Patient Antibiotic Normal Flora of the Nose Gram Negative Bacteria

Gram Positive Bacteria

Sensitive

Resistance

Hypothesis
1. Gram negative bacteria nasal swab in patient with allergic rhinitis still sensitive to Amoxicillin 2. Gram negative bacteria nasal swab in patient with allergic rhinitis still sensitive to Ciprofloxacin

Research Method
Research Desaign -Observational study with cross sectional method Population and samples The population in this study are student of medical faculty and health science of UMY => 39 samples Research Location and time Microbiology laboratorium of medical faculty and health science of UMY in July 2011

Variable of research
1. Independent Variable Gram negatif bacteria nasal swab in allergic rhinitis patient 2. Dependent variable Inhibitory zone of gram negatif bacteria

Operational Definition
a. Allergic Rhinitis b. Gram Negatif Bacteria c. Sensitivity pattern

Research Instrument
1. Tools : steril cotton sticks, test tubes, ose, petri dishes, measuring pipette, tweezers, incubator,

spiritus light, autoclave, nasal speculum, paper

label, ruler. 2. Materials : allergic rhinitis patients with nasal swabs, blood agar media, trytic soy agar, gram strain, antibiotic disc (amoxicillin and ciprofloxacin)

Plan Working
Allergic Rhinitis Patient Nasal Swab Incubation 24 hours, 37C Culture Result Gram Negatif Bacteria sens itive Res ista nce Amox Cip Sensitivity Pattern

sensi tive

Res ista nce

Result and Discussion

Haemophillus influenzae to Amoksisilin

Haemophillus influenzae to Siprofloksasin

23.07 %

28.20 %

76.93 % resisten sensitif

71.80 %

resisten

sensitif

Enterobacteriaceae to Amoksisilin

Enterobacteriaceae to Siprofloksasin

12.82 %
5.13%

25.64 %
2.56%

82.05 % Intermediet Resisten Sensitif

71.80 %
Intermediet

Resisten
Sensitif

Amoxicillin
Amin R (2009) => Considering respiratory tract infections and antimikrobial sensitivity. Amoxicillin has sensitivity 7,9%

Nuryasni. (2005) => Sensitivity pattern of gram negatif

bacteria in Lower respiratory tract infection to Amoxicillin . Gram negative bacteria had resistance to Amoxicillin

 El-mahmood A.M, et al. (2010) => Antimicrobial

suspencibility of some respiratory tract pathogens to

commonly used antibiotics at the specialist hospital, Yola Ada Mawa State, Nigeria. Penicillin had been resistance to H.influezae except flouroquinolone.

The differences in this reasearch=> gram

negative bacteria had been sensitive to

amoxicillin

Risk Factor of resistance

1. Genetic mutation, genetic antimicrobial transfer 2. The use of antibiotic isnt accordance with the term of theraphy

3. The diagnose isnt acurate, so that the theraphy

isnt acurate 4. The use of antibiotic is increasing

Ciprofloxacin
Research in Medical Faculty of UI (2009) shows that The sensitivity of ciprofloxacin to gram negatif bacteria is decrease

Research in USU (2005) shows that Ciprofloxacin had

high sensitivity to gram negative and positive bacteria.

This research shows that gram negative bacteria has been sensitive to ciprofloxacin.

Antibiotic Mechanism
Amoxicillin mechanism to gram negative bacteria => Cell wall of Bacteria Ciprofloxacin mechanism to gram negative bacteria DNA synthesis

Conclusion
Gram negative bacteria nasal swab isolates in patient with allergic rhinitis is still sensitive to amoxicillin and ciprofloxacin.

Suggestion
Examination of nasal swab culture isolates should be considered carefully regarding sample storage and retrieval techniques to avoid contamination by other bacteria

Futher research needs to investigate the sensitivity patterns of bacteria isolates another swab with other classes of antibiotic

References
1. Amin R, Hoque A.M.W, Khan RF and Rahman M, (2009). Considering

respiratory tract infections and antimicrobial: An exploratory analysis. Malaysian Journal of Microbiologi Vol 5 (2), pp 109-112. 2. Jawetz, E., J.L. Melnick, E. A. Adelberg, G. F. Brooks, J. S. Butel and L. N. Orston. (2008). Mikrobiologi Kedokteran. Edisi 23. Diterjemahkan oleh E. Nugroho & R.F. Maulany : Jakarta Buku Kedokteran EGC. hal 153-160, 188, 190 & 211-217. 3. Katzung BG (2007). Farmakologi Dasar dan Klinik Edisi VI. Jakarta : ECG