Adverse Effects

The major adverse reactions reported are hypersensi-tivity rashes and diarrhea. The rash is usually itchy, mor-billiform, and general. Gastrointestinal intolerance with abdominal pain, nausea, and vomiting occurs infrequently. Hepatotoxicity and bone marrow suppression have been noted.

It is important to differentiate between gastrointestinal irritation and pseudomembranous colitis. In its most extreme form, the colitis results in mucosal ulceration and bleeding and infrequently may necessitate colectomy. On rare occasions it has been fatal.

^ Study Questions

1. Which of the following best treats the initial stage of Lyme disease in adults?

(A) Penicillin V

(B) Erythromycin

(C) Clarithromycin

(D) Doxycycline

(E) Clindamycin

2. Chloramphenicol is the drug of choice for which of the following?

(A) S. pneumoniae meningitis

(B) B. fragilis in abdominal abscess infection

(C) H. influenzae epiglottitis

(D) Typhoid fever in the United States

(E) Typhoid fever in some developing countries

3. A 39-year-old man has AIDS and a CD4 count less than 50. Recently he has had chills and fever. Several blood cultures drawn especially for acid-fast bacilli are positive. Which antibiotic should be included in a treatment regimen for this disease?

(A) Tetracycline

(B) Amoxicillin

(C) Cephalexin

(D) Clarithromycin

(E) Doxycycline

4. A 37-year-old postal worker has a job at a mail sort facility. An envelope that passed through the facility and was delivered to a governmental office was noted upon opening to have anthrax spores. One of the postal worker's fellow employees subsequently developed inhalation anthrax. Because of this, medical authorities recommended that other employees working at the same facility be tested and receive prophylactic antimicrobial therapy. The drug of choice is a quinolone. However, this employee has a history of allergy to ciprofloxacin. Which of the following antibiotics is also recognized as being effective prophylactic therapy for potential anthrax exposure?

(A) Amoxicillin

(B) Erythromycin

(C) Clarithromycin

(D) Doxycycline

(E) Clindamycin

5. An 18-year-old man sustains a minor laceration of his right forearm. Approximately 2 days later the laceration site becomes red and swollen. He also begins to develop fever and chills. The patient eventually goes to the local hospital's emergency department. By this point his forearm is swollen and the skin is light brown. Cultures of his wound and two blood cultures 15 minutes apart are obtained. Intravenous cephalosporin is begun. However, over

3 days the discoloration of his forearm begins to ascend to the upper arm and shoulder. Blood cultures are positive in approximately 12 hours for grampositive cocci in chains. Wound cultures of the laceration also grow similar organisms, and high-dose penicillin G is prescribed. What other antibiotic would be extremely useful in treating this condition?

(A) Gentamicin

(B) Clindamycin

(C) Ciprofloxacin

(D) Clarithromycin

(E) Chloramphenicol

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