Trimethoprim-sulfamethoxazole complicated

Complicated Trimethoprim-sulfamethoxazole Trimethorpim Norfloxacin 1 DS tablet 100 mg 400 mg Twice a day 7-10 days 7-10 days 7-10 days... 

A 59-year-old woman presents to an urgent care clinic with a 4-day history of frequent and painful urination. She has had fevers, chills, and flank pain for the last 2 days. Her physician advised her to immediately come to the clinic for evaluation. In the clinic she is febrile (38.5°C [101.3°F]) but otherwise stable and states she is not experiencing any nausea or vomiting. Her urine dipstick test is positive for leukocyte esterase. Urinalysis and urine culture are also ordered. Her past medical history is significant for three urinary tract infections in the past year. Each of these episodes was uncomplicated, treated with trimethoprim-sulfamethoxazole, and promptly resolved. She also has osteoporosis for which she takes a daily calcium supplement. The decision is made to treat her with oral antibiotics for a complicated urinary tract infection with close follow-up. Given her history what would be a reasonable empiric antibiotic choice Depending on the antibiotic choice are there potential drug interactions she should be counseled on ... 

Many antimicrobial agents have similar pharmacokinetic properties when given orally or parenterally (ie, tetracyclines, trimethoprim-sulfamethoxazole, quinolones, chloramphenicol, metronidazole, clindamycin, rifampin, linezolid and fluconazole). In most cases, oral therapy with these drugs is equally effective, is less costly, and results in fewer complications than parenteral therapy. 

Uncomplicated urinary tract infections can be managed most effectively with short-course (3 days) therapy with either trimethoprim-sulfamethoxazole or a fluoroquinolone. Complicated infections require longer treatment periods (2 weeks) usually with one of these agents. 

Oral Therapy Sulfonamides Trimethoprim-sulfamethoxazole (TMP-SMX) These agents generally have been replaced by more agents due to resistance. This combination is highly effective against most aerobic enteric bacteria except Pseudomonas aeruginosa. High urinary tract tissue levels and urine levels are achieved, which may be important in complicated infection treatment. Also effective as prophylaxis for recurrent infections. 

Complicated Trimethoprim-sulfamethoxazole 1 DS tablet Twice a day 7-10 days... 

Three-day courses of trimethoprim-sulfamethoxazole or a flu-oroquinolone (e.g., ciprofloxacin, levofloxacin, norfloxacin, or gatifloxacin) are superior to single-dose therapies." " The flnoro-qninolone moxifloxacin is not recommended for nse in UTIs owing to the inadequate urinary concentrations. The use of amoxiciUm and sulfonamides is not recommended because of the high incidence of resistant coli. For most adult females, short-course therapy is the treatment of choice for uncomplicated lower UTIs. Short-conrse therapy is inappropriate for patients who have had previons infections caused by resistant bacteria, for male patients, and for patients with complicated UTIs. If symptoms do not respond or recur, a urine cniture should be obtained and conventional therapy with a snitable agent instituted. ... 

Pulmonary infection with P. jiroveci is a relatively infrequent complication of HSCT. Mortality rates in this population, however, are approximately 60% and are especially high in patients with GVHD. " Prophylactic use of trimethoprim-sulfamethoxazole (one double-strength tablet three times per week or one singlestrength tablet daily) is employed commonly in this setting. Toxoplasmosis is not a common infection in HSCT patients but is associated with mortality rates of approximately 70%. Toxoplasmosis also should be prevented by trimethoprim-sulfamethoxazole prophylaxis. ... 

Bacterial resistance increasingly complicates treatment and often results from the acquisition of a plasmid that encodes an altered dihydrofolate reductase. Emergence of trimethoprim-sulfamethoxazole-resistant Staphylococcus aureus and Enterobacteriaceae is a special problem in AIDS patients receiving the drug for prophylaxis of Pneumocystis jiroveci (formerly called Pneumocystis carinii pneumonia. 

You will probably be given an antibiotic to treat the disease. Three commonly prescribed antibiotics are ampicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin. Persons given antibiotics usually begin to feel better within 2 to 3 days, and deaths rarely occur. However, per.sons who do not get treatment may continue to have fever for weeks or months, and as many as 20% may die from complications of the infection. 

Siegel WH. Unusual complication of therapy with sulfamethoxazole-trimethoprim. J Urol 1977 117(3) 397. 

Trimethoprim and sulfamethoxazole (TMP-SMZ) This important drug combination is currently accepted treatment for complicated urinary tract infections and for respiratory, ear, and sinus infections due to H influenzae and Moraxella catarrhalis. In the immunocompromised patient, TMP-SMZ is used for infections due to Aeromonas hydrophila and is the drug of choice for prevention and treatment of pneumocystis pneumonia. TMP-SMZ is a possible backup drug for typhoid fever and shigellosis and has been used in the treatment of infections caused by methicillin-resistant staphylococci and Listeria monocytogenes. 

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