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  • Snapshot
    • A 28-year-old man presents to the emergency department with worsening shortness of breath and fever. His symptoms began approximately 1 week ago. He has a medical history of HIV infection and he is non-adherent with his antiretroviral therapy. Physical examination is notable for bilateral adventitial sounds. A chest radiograph demonstrates bilateral interstitial infiltrates. His CD4 count is 180/uL. He is started on trimethoprim-sulfamethoxazole.
  • Introduction
    • Mechanism of action
      • dihydropteroate synthase inhibitor, impairing folate synthesis
        • has bactericidal activity when combined with trimethoprim
    • Mechanism of resistance
      • altered bacterial dihydropteroate synthase
    • Clinical use
      • gram-positive organisms
      • gram-negative organisms
      • Nocardia
    • Adverse reaction
      • hypersensitivity reactions
      • hemolysis in patients with G6PD deficiency
      • tubulointerstitial nephritis
      • Stevens-Johnson syndrome
      • photosensitivity
      • infantile kernicterus
      • displaces drugs that bind to albumin
        • e.g., raises warfarin levels
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