Figure 441

Folic acid and its component molecules.

available. Sulfonamides are used in treating infections caused by Toxoplasma gondii and occasionally chloro-quine-resistant Plasmodium falciparum.

Resistance occurs as the result of one or more alterations in the cellular metabolism of the bacteria; both mutation and plasmid-mediated resistance occurs. These changes, which can be irreversible, include alterations in the physical or enzymatic characteristics of the enzyme or enzymes that metabolize PABA and participate in the cellular synthesis of tetrahydrofolic acid. The appearance of alternative pathways for PABA synthesis within the bacteria or the development of an increased capacity to inactivate or eliminate the sulfonamide also may contribute to bacterial cell resistance. Bacteria that can use preformed folate are not inhibited by sulfon-amides.

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