Supplemental Reading

Lewis K et al. (eds.). Bacterial Resistance to

Antimicrobials. New York: Marcel Dekker, 2001.

Levy SB. The challenge of antibiotic resistance. Sci Am 1998;278:46-53.

Nightingale Ch, Morakawa T, and Ambrose PG (eds.). Antimicrobial Pharmacodynamics in Theory and Clinical Practice. New York: Marcel Dekker, 2001.

Tufano MA et al. Antimicrobial agents induce monocytes to release IL-1 (3, IL-6, and TNFa and induce lymphocytes to release IL-4 and IFN-7 Immunopharmacol Immunotoxicol 1992;14:769-782.

Rosenblatt JE. Laboratory tests used to guide antimicrobial therapy. Mayo Gin Proc 1991;66:942.

Answer: You decide that a metabolite of imipenem is responsible for the sudden toxicity. You add a second drug, cilastatin, to the patient's regimen. Coadministration of cilastatin inhibits renal dipeptidase, the enzyme responsible for the metabolism of imipenem. This prevents the formation of the toxic metabolite and decreases the clearance of imipenem. The side effect disappears within 12 hours and the patient recovers from the infection.

Case Study A Beneficial Example of Pharmacokinetics

Synthetic Organic Antimicrobials: Sulfonamides, Trimethoprim, Nitrofurans, Quinolones, Methenamine

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