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Chapter 46: Sulfonamides, Trimethoprim, & Fluoroquinolones

Trimethoprim-sulfamethoxazole is established to be effective against which of the following opportunistic infections in the HIV-infected patient?

(A) Cryptococcal meningitis

(B) Herpes simplex

(C) Oral candidiasis

(D) Pneumocystis pneumonia

(E) Tuberculosis

Trimethoprim-sulfamethoxazole is not effective in the treatment of infections caused by viruses, fungi, or mycobacteria. However, the drug combination is active against certain protozoans, including Toxoplasma, and is the first-line therapy for the treatment of Pneumocystis pneumonia in HIV-infected patients. The answer is D.

A 65-year-old woman has returned from a vacation abroad suffering from traveler’s diarrhea, and her problem has not responded to antidiarrheal drugs. A pathogenic gram-negative bacillus is suspected. Which drug is most likely to be effective in the treatment of this patient?

(A) Ampicillin

(B) Ofloxacin

(C) Sulfadiazine

(D) Trimethoprim

(E) Vancomycin

The second-generation fluoroquinolones are very effective in diarrhea caused by bacterial gram-negative pathogens, including E coli, Shigella, and Salmonella. None of the other drugs listed would be appropriate. Many coliforms are now resistant to amoxicillin and ampicillin. Although trimethoprim is available as a single drug, resistance emerges rapidly during treatment unless it is used for urinary tract infections, in which high concentrations can be achieved. Vancomycin has no activity against gram-negative bacilli. The answer is B.

Which statement about the clinical use of sulfonamides is correct?

(A) Cannot be used topically for treatment of chlamydial infections of the eye

(B) Effective as sole agents in the treatment of prostatitis

(C) Effective in Rocky Mountain spotted fever

(D) In some bacterial strains resistance occurs via reduced PABA formation

(E) Reduced intracellular uptake is a mechanism of sulfonamide resistance in some bacterial strains

Reduced uptake of sulfonamides is one way organisms can become resistant. All of the other statements about sulfonamide antimicrobial drugs are incorrect. The answer is E.

A 31-year-old man has gonorrhea. He has no drug allergies, but a few years ago acute hemolysis followed use of an antimalarial drug. The physician is concerned that the patient has an accompanying urethritis caused by C trachomatis, although no cultures or ...

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