Antimicrobial Therapy Glossary

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Questions and Answers

Which of the following best describes a health care-associated infection (nosocomial infection)?

  • An infection that is caused by non-resistant microorganisms.
  • An infection that is contracted in a health care facility and was not present on admission. (correct)
  • An infection that occurs less than 48 hours after admission to a health care facility.
  • An infection acquired by a person who has not been hospitalized within the past year.

Disinfectants are applied to living tissue to inhibit the growth of microorganisms.

False (B)

Which of the following is the primary mechanism of action for sulfonamide antibiotics?

  • Inhibition of bacterial cell wall synthesis
  • Disruption of bacterial protein synthesis
  • Interference with bacterial DNA replication
  • Prevention of folic acid synthesis (correct)

What is the term for causative microorganisms that are often drug resistant and the most virulent?

<p>Health care-associated infections (nosocomial infections)</p> Signup and view all the answers

The action of sulfonamides is considered to be ______, meaning they inhibit the growth of bacteria but do not necessarily kill them.

<p>bacteriostatic</p> Signup and view all the answers

Match the following antibiotic classes with their mechanism of action:

<p>Penicillins = Inhibit cell wall synthesis Macrolides = Prevent protein synthesis Sulfonamides = Prevent synthesis of folic acid Tetracyclines = Inhibit protein synthesis by binding to the 30S ribosomal subunit</p> Signup and view all the answers

Which factor would be most important to assess before administering an antibiotic?

<p>Patient's allergy history (B)</p> Signup and view all the answers

Empiric therapy involves administering antibiotics based on culture and sensitivity results.

<p>False (B)</p> Signup and view all the answers

Which of the following is a common adverse effect associated with macrolide antibiotics?

<p>Hepatotoxicity (A)</p> Signup and view all the answers

What is the implication of bacteria being described as 'bacteriostatic'?

<p>They inhibit the growth of bacteria. (C)</p> Signup and view all the answers

Community-acquired infections are those contracted within a healthcare facility, such as a hospital.

<p>False (B)</p> Signup and view all the answers

Which of the following is an example of a beta-lactam antibiotic?

<p>Penicillin (C)</p> Signup and view all the answers

What is the key nursing action to take after administering penicillin to a patient for the first time, especially with a history of allergies?

<p>Monitor the patient for at least 30 minutes for signs of allergic reaction.</p> Signup and view all the answers

Giving cephalosporins with ______ may cause an acute alcohol intolerance reaction.

<p>alcohol</p> Signup and view all the answers

Match the generation of cephalosporins with their spectrum of activity:

<p>First Generation = Good gram-positive coverage and poor gram-negative coverage Second Generation = Better gram-negative coverage than first-generation agents Third Generation = Most potent against gram-negative bacteria Fourth Generation = Broader spectrum of activity against gram-positive bacteria</p> Signup and view all the answers

What specific advice should a nurse give to a patient taking tetracycline?

<p>Avoid exposure to sunlight due to increased photosensitivity. (D)</p> Signup and view all the answers

Clavulanic acid, when combined with certain penicillins, enhances the antibacterial effect.

<p>True (A)</p> Signup and view all the answers

Which of the following is a common indication for the use of SMX-TMP (sulfamethoxazole/trimethoprim)?

<p>Urinary tract infection (UTI) (B)</p> Signup and view all the answers

A patient is prescribed erythromycin. What should the nurse consider regarding the administration of this drug?

<p>It should be taken on an empty stomach to enhance absorption, but after a meal due to GI upset. (A)</p> Signup and view all the answers

What is antimicrobial stewardship?

<p>Antimicrobial stewardship involves a commitment to always using appropriate antimicrobials, whenever an antimicrobial is needed.</p> Signup and view all the answers

Carbapenems are typically the first-line antibiotics used for common infections due to their broad spectrum of activity.

<p>False (B)</p> Signup and view all the answers

Which adverse effect is most associated with tetracycline use in young children?

<p>Tooth discoloration (D)</p> Signup and view all the answers

A patient reports an allergy to penicillin. Which antibiotic class should the nurse be most cautious about administering?

<p>Cephalosporins (D)</p> Signup and view all the answers

Extended-spectrum penicillins such as piperacillin/tazobactam are effective against ______ bacteria.

<p>gram negative</p> Signup and view all the answers

Match the following antibiotic classes with their common uses:

<p>Sulfonamides = Urinary tract infections Penicillins = Infections caused by susceptible bacteria Macrolides = Respiratory tract infections Tetracyclines = Syphilis and Lyme disease</p> Signup and view all the answers

What is the therapeutic action of cilastatin when administered with imipenem?

<p>Prolongs the half-life of imipenem by preventing its breakdown. (D)</p> Signup and view all the answers

All cephalosporins are effective against MRSA (Methicillin-resistant Staphylococcus aureus).

<p>False (B)</p> Signup and view all the answers

Why is it important to infuse carbapenems over at least 60 minutes?

<p>To reduce the risk of drug-induced seizure activity (B)</p> Signup and view all the answers

A patient taking sulfonamides should be cautioned to report what symptoms immediately?

<p>Worsening abdominal cramps, stomach pain, diarrhea, hematuria, severe or worsening rash, shortness of breath, and fever. (B)</p> Signup and view all the answers

What dietary teaching is most important for a patient prescribed tetracycline?

<p>Avoid taking it with dairy products, antacids, or iron supplements.</p> Signup and view all the answers

The fifth generation cephalosporin, ______, is effective against MRSA.

<p>ceftaroline</p> Signup and view all the answers

Match each nursing intervention with its rationale related to antibiotic administration:

<p>Assess for drug allergies before starting therapy = Prevent allergic reactions Instruct patients to take antibiotics as prescribed = Ensure therapeutic drug levels and prevent resistance. Monitor for signs of superinfection = Detect secondary infections due to antibiotic use. Administer oral antibiotics with at least 180 mL of water = Enhance drug absorption</p> Signup and view all the answers

What is the MOST likely rationale for prescribing cefoxitin for a patient undergoing colorectal surgery?

<p>Cefoxitin has a broad spectrum of activity that includes anaerobic bacteria, making it suitable for abdominal surgeries. (B)</p> Signup and view all the answers

Macrolides, like erythromycin, are considered bactericidal at all concentrations.

<p>False (B)</p> Signup and view all the answers

Which of the following antibiotics inhibits protein synthesis by binding to the 30S bacterial ribosome?

<p>Tetracyclines (A)</p> Signup and view all the answers

A patient receiving clavulanate liquid solution through a percutaneous endoscopic gastrostomy tube. What is the purpose of the clavulanic acid?

<p>It inhibits the action of the enzymes produced by B-lactamase-producing bacteria. (C)</p> Signup and view all the answers

When completing an admission assessment, the patient reports being allergic to sulpha drugs. What will the nurse do next?

<p>Ask the patient for more information about the allergic reaction. (B)</p> Signup and view all the answers

Which does the nurse identify as being a concern for patients receiving tetracycline?

<p>Tetracyclines should not be administered with dairy products. (D)</p> Signup and view all the answers

The nurse identifies Clavulin as being a member of which group?

<p>Penicillins (B)</p> Signup and view all the answers

A patient has a health care-associated infection. What is the significance of this type of infection?

<p>The infection was contracted in a health care facility and was not present on admission. (C)</p> Signup and view all the answers

Cidal agents, such as disinfectants, are safe to apply directly to living tissue to inhibit the growth of microorganisms.

<p>False (B)</p> Signup and view all the answers

What is the term for an antibiotic that inhibits the growth of bacteria without necessarily killing them?

<p>Bacteriostatic</p> Signup and view all the answers

A patient develops pseudomembranous colitis due to the overgrowth of the bacteria Clostridium ______.

<p>difficile</p> Signup and view all the answers

Which of the following is an example of prophylactic antibiotic therapy?

<p>Prescribing antibiotics to prevent an infection before a surgery. (D)</p> Signup and view all the answers

The primary mechanism of action for antibiotics involves enhancing the host's immune response to fight off bacterial infections.

<p>False (B)</p> Signup and view all the answers

What specific advice should be given to patients taking tetracycline regarding the consumption of dairy products?

<p>avoid dairy products</p> Signup and view all the answers

Adverse reactions to penicillins can include urticaria, pruritus, and ______.

<p>angioedema</p> Signup and view all the answers

How do sulfonamides work to inhibit bacterial growth?

<p>By inhibiting the synthesis of folic acid, essential for bacterial DNA production. (C)</p> Signup and view all the answers

Sulfonamides are effective against only gram-positive bacteria, making them unsuitable for treating infections caused by gram-negative organisms.

<p>False (B)</p> Signup and view all the answers

What is the term for the combination of sulfamethoxazole and trimethoprim, commonly used in antibiotic therapy?

<p>SMX-TMP</p> Signup and view all the answers

A potential adverse effect of sulfonamide therapy is ______, which can manifest as a significant itchy rash or hives.

<p>photosensitivity</p> Signup and view all the answers

What is the primary mechanism of action for penicillins?

<p>Disrupting the synthesis of the bacterial cell wall. (D)</p> Signup and view all the answers

All penicillins are administered intravenously to ensure optimal absorption and distribution.

<p>False (B)</p> Signup and view all the answers

What dietary restriction is important for patients taking cloxacillin sodium to ensure proper absorption?

<p>empty stomach</p> Signup and view all the answers

Clavulanic acid is often combined with amoxicillin to inhibit the action of ______, which can degrade the antibiotic.

<p>beta-lactamase</p> Signup and view all the answers

A patient with a known penicillin allergy is prescribed cephalosporins. What action should the nurse prioritize?

<p>Consult the provider about using an alternative antibiotic due to potential cross-sensitivity. (A)</p> Signup and view all the answers

Cephalosporins are only effective against gram-positive bacteria, limiting their use in treating infections caused by gram-negative organisms.

<p>False (B)</p> Signup and view all the answers

What is the primary use of cefazolin in clinical practice?

<p>surgical prophylaxis</p> Signup and view all the answers

Ceftriaxone is advantageous for the treatment of central nervous system infections because it easily passes the ______.

<p>meninges</p> Signup and view all the answers

Why must carbapenems be infused over at least 60 minutes?

<p>To prevent drug-induced seizure activity. (D)</p> Signup and view all the answers

Carbapenems are typically the first-line choice for treating common bacterial infections due to their broad spectrum of antibacterial activity.

<p>False (B)</p> Signup and view all the answers

What enzyme does cilastatin inhibit in order to protect imipenem from breakdown?

<p>dehydropeptidase</p> Signup and view all the answers

Macrolides prevent bacterial growth by inhibiting ______ synthesis within bacterial cells.

<p>protein</p> Signup and view all the answers

A patient is prescribed erythromycin but complains of significant gastrointestinal upset. Considering the adverse effects of macrolides, what alternate macrolide might be a better choice?

<p>Azithromycin (D)</p> Signup and view all the answers

Flashcards

What is a bactericidal antibiotic?

An agent that kills bacteria.

What is a bacteriostatic antibiotic?

An agent that inhibits bacterial growth, slowing their reproduction.

What is Colonization in microbiology?

The presence of bacteria on the surface of the body without causing disease.

What is a community-acquired infection?

An infection acquired outside of healthcare facilities.

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What is empiric therapy?

Treatment initiated before lab results are available, based on likely pathogens.

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What is targeted therapy?

Targeted therapy, treatment tailored to a specific identified pathogen.

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What is prophylatic therapy?

Preventative treatment with antibiotics to prevent an infection from occurring.

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What is a nosocomial infection?

An infection acquired in a hospital or other healthcare facility.

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What are Host Factors?

Factors relating to the patient that influence susceptibility to infection and response to treatment.

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What does subtherapeutic mean?

Drug levels are lower than needed to achieve a therapeutic effect.

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What is a health-care associated infection?

Acquired in a health care facility and not present on admission, occurring more than 48 hours after admission.

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What is coccus?

Bacterial shape that is spherical or round.

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What is bacillus?

A rod-shaped bacterium.

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What is coccobacillus?

A short, thick oval shaped bacterium.

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What shapre is Vibrio bacteria?

A curved, comma-shaped bacteria.

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What shapre is Spirillum bacteria?

Helical or spiral-shaped bacteria.

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What shapre is Spirochete bacteria?

A more tightly coiled spiral-shaped bacteria

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What is pseudomembranous colitis?

Occurs due to toxins released by Clostridium difficile, often following antibiotic use.

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What is secondary infection?

An infection that occurs during or after treatment for another infection.

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What is antimicrobial resistance?

The ability of bacteria to withstand the effects of an antibiotic.

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What is Antimicrobial stewardship?

Efforts to reduce antibiotic misuse to slow resistance.

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What is a Food-drug Interaction?

Altered effect of a drug when taken with food.

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What is a therapeutic response?

The antibiotic is effective against the identified organism.

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What is a subtherapeutic response?

The antibiotic is not effective against the identified organism.

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What is a Superinfection?

An infection that occurs during antibiotic treatment, when the antibiotic kills some but not all bacteria.

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Name the class of Antibiotics that inhibit cell wall synthesis.

They include Beta-lactams, Vancomycin, Isoniazid, Ethambutol, Bacitracin, and Polymyxin.

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Name the class of Antibiotics that interfere with metabolites.

They include Antimetabolites, Sulfonamides, Dapsone and Trimethoprim.

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Name the class of Antibiotics that interfere with DNA replication.

They include Quinolones and Metronidazole

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Name the class of Antibiotics that interfere with RNA synthesis.

They include Rifampin and Rifabutin.

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Name the class of Antibiotics that interfere with protein synthesis.

They include Protein synthesis (30S ribosomes)) and Aminoglycosides.

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What the properties of B-Lactam Antibiotics?

All have the same chemical structure and MOA – β-lactam ring.

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What are Sulfonamides?

One of the first groups of antibiotics, often combined with another antibiotic.

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How do Sulfonamides work?

They Prevent synthesis of folic acid required for synthesis of purines and nucleic acid

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What are adverse effects of Sulfonamides?

Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia.

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What are contraindications of Penicillins?

Variety of reaction that occurs in patients who state they are allergic to penicillins.

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How do Macrolides work?

Macrolides prevent protein synthesis within bacterial cells - binding reversibly to the 50S ribosomal subunits.

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What is Macrolides used for?

Treats Strep infections, Mild to moderate upper and lower respiratory tract infections Spirochetal infections, Syphilis and Lyme disease and Gonorrhea, Chlamydia, Mycoplasma

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What are the drugs in the class Macrolides?

Azithromycin, clarithromycin, erythromycin and Fidaxomicin (Dificid)

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What are the adverse effects of Macrolides?

GI effects, primarily with erythromycin.

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What are the drugs in the class Tetracyclines?

Doxycycline hyclate (Doxycin®, Vibramycin®) and minocycline hydrochloride (Minocin®).

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How do Tetracyclines work?

They are bacteriostatic - inhibit protein synthesis - binding to the 30S bacterial ribosome.

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What is an important side effect of Tetracyclines?

Photosensitivity

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What are fourth generation cephalosporins used for?

They are used to treat Uncomplicated and complicated urinary tract infection.

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What are Carbapenems primairly used for?

Drugs that are reserved for complicated body cavity and connective tissue infections in acutely ill hospitalized patients.

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What should you educate patients on when giving Antibiotics??

Instruct patients to take antibiotics exactly as prescribed and for the length of time prescribed

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What should you educate patients on when giving Sulfonamides??

Encourage patients to immediately report worsening abdominal cramps, stomach pain, diarrhea, hematuria, severe or worsening rash, shortness of breath, and fever.

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What is important to adminster with Antibiotics??

All oral antibiotics are absorbed better if taken with at least 180 mL of water.

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It is imporant to Assess for penicillin allergy when giving which drug??

Patients may have cross-allergy.

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Before beginning which drug class therapy, assess which factors??

Assess drug allergies; renal, liver, and cardiac function, and other laboratory studies.

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Study Notes

Glossary of Terms

  • Bactericidal: Kills bacteria directly.
  • Bacteriostatic: Inhibits bacterial growth without killing them.
  • Colonization: Presence of microorganisms without causing disease.
  • Community-acquired infection: Infection acquired by a person who has not been hospitalized or had a medical procedure within the past year.
  • Targeted therapy: Treatment aimed at a specific pathogen.
  • Empiric therapy: Treatment initiated before knowing the exact pathogen.
  • Prophylactic therapy: Treatment given to prevent infection.
  • Health care-associated infection (nosocomial infection): Infection acquired in a healthcare setting.
  • These infections are not present on admission.
  • These infections occur more than 48 hours after admission.
  • These infections are one of the top 10 causes of death in Canada.
  • Causative microorganisms are often drug resistant and the most virulent.
    • Methicillin-resistant Staphylococcus aureus (MRSA)
    • vancomycin-resistant Enterococcus (VRE)
  • Prevention includes:
    • Handwashing
    • Masking
    • Disinfectants and antiseptics
  • Host factors: Patient-specific factors (e.g., immune system, age) affecting infection and treatment.
  • Subtherapeutic: Drug levels below the effective concentration.
  • Disinfectant: Kills organisms on nonliving objects.
  • A disinfectant is a cidal agent.
  • Antiseptic: Inhibits the growth of microorganisms on living tissue.
  • Antiseptics do not necessarily kill microorganisms.
  • Antiseptics are static agents.

Infections: Sites of Origin

  • Infections are classified based on where they are acquired.
  • Community acquired infections are contracted outside of medical facilities.
  • Healthcare-associated infections are contracted within a healthcare facility.

Antibiotic Therapy Concepts

  • Pseudomembranous colitis: A condition often caused by Clostridium difficile.
  • Secondary infection: An infection that occurs during or after treatment for another infection.
  • Resistance: Microorganisms' ability to withstand antibiotics.
  • Antimicrobial stewardship: Responsible use of antimicrobials to combat resistance.
  • Food-drug interactions: Altered drug effects due to food consumption.
  • Dairy, antacids, and tetracyclines can interact with antibiotics.
  • Empiric therapy: Antibiotic therapy started before the causative organism is known.
  • Definitive therapy: Antibiotic therapy tailored to a specific identified organism.
  • Prophylactic therapy: Antibiotics used to prevent infections.
  • Therapeutic response: Antibiotic treatment is effective in eliminating infection.
  • Subtherapeutic response: Signs and symptoms of infection do not improve with antibiotic treatment.
  • Superinfection: A secondary infection caused by opportunistic pathogens due to antibiotic use.

Antibiotic Therapy: Mechanism Of Action

  • Antibiotics interfere with cell wall synthesis, protein synthesis, and DNA replication.
  • Antibiotics act as antimetabolites to disrupt critical bacterial cell reactions.

Antibiotic Therapy Considerations

  • Common allergic reactions include use of:
  • Penicillins
  • Sulfonamides
  • Severe reactions include:
  • Difficulty breathing
  • Throat swelling
  • Itchy rash
  • Hives
  • Severe gastrointestinal intolerance
  • Host factors include:
  • Age, allergies, kidney/liver function, pregnancy status, genetic characteristics, infection site, and host defenses.
  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency may result in hemolysis.
  • Slow acetylation can lead to toxicity due to slow metabolism.

Antibiotic Classes

  • Sulfonamides were introduced in the 1930s.
  • Penicillins (beta-lactam) were discovered in 1928 and widely used in the 1940s.
  • Cephalosporins (beta-lactam) were introduced in the 1960s.
  • Carbapenems are beta-lactam antibiotics.
  • Macrolides and tertracyclines are also antibiotic classes.

Sulfonamides

  • Sulfonamides were among the first antibiotics used.
  • These often combine with another antibiotic
  • Sulfamethoxazole is combined with trimethoprim (a non-sulfonamide antibiotic).
  • This combination is also known as SMX-TMP.
  • This combination has synergistic effects.
  • Sulfonamides are bacteriostatic.
  • Sulfonamides prevent synthesis of folic acid, which is required in the synthesis of purines and nucleic acid.
  • Sulfonamides do not affect human cells.
  • They affect organisms that synthesize their own folic acid.
  • Sulfonamides are effective against both gram-positive and gram-negative bacteria.
  • Sulfonamides are administered PO (by mouth).

Sulfonamides: Indications and Adverse Effects

  • Sulfonamides treat UTIs caused by:
  • Enterobacter
  • Escherichia coli
  • Klebsiella
  • Proteus mirabilis
  • Proteus vulgaris
  • Staphylococcus aureus
  • Sulfonamides treat Pneumocystis jiroveci pneumonia (HIV), using sulfamethoxazole/trimethoprim (SMX-TMP).
  • They treat upper respiratory tract infections.
  • SMX-TMP is used for outpatient Staphylococcus infections due to community-acquired MRSA.
  • Adverse effects include:
  • Hemolytic and aplastic anemia, agranulocytosis, thrombocytopenia.
  • Photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, epidermal necrolysis.
  • Nausea, vomiting, diarrhea, pancreatitis, hepatotoxicity.
  • Convulsions, crystalluria, toxic nephrosis, headache, peripheral neuritis, urticaria, cough.
  • Contraindications include pregnancy and infants.
  • Adverse interactions include sulfonylureas, phenytoin, warfarin and cyclosporin.

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