Lippincott Chapter 40: Quinolones, Folic Acid Antagonists, and Urinary Tract Antiseptics

Question 1

40.1 A 32-year-old male presents to an outpatient clinic with a
5-day history of productive cough, purulent sputum, and
shortness of breath. He is diagnosed with community-
acquired pneumonia (CAP). It is noted that this patient
has a severe ampicillin allergy (anaphylaxis). Which of
the following would be an acceptable treatment for this
patient?
A. Levofloxacin.
B. Ciprofloxacin.
C. Penicillin VK.
D. Nitrofurantoin.

Answer 1

Correct answer = A. Streptococcus pneumoniae is a com-
mon cause of CAP, and the respiratory fluoroquinolones
levofloxacin and moxifloxacin provide good coverage.
Ciprofloxacin does not cover S. pneumoniae well and is a
poor choice for treatment of CAP. Penicillin would be a poor
choice due to allergy. Nitrofurantoin has no clinical utility for
respiratory tract infections.

Question 2

40.2 A 22-year-old female presents with a 2-day history of
dysuria with increased urinary frequency and urgency. A
urine culture and urinalysis are done. She is diagnosed
with a urinary tract infection (UTI) caused by E. coli.
All of the following would be considered appropriate
therapy for this patient except:
A. Levofloxacin.
B. Cotrimoxazole.
C. Moxifloxacin.
D. Nitrofurantoin.

Answer 2

Correct answer = C. Moxifloxacin does not concentrate in
the urine and would be ineffective for treatment of a UTI. All
other answers are viable alternatives, and the resistance
profile for the E. coli can be utilized to direct therapy.

Question 3

40.3 Which of the following drugs is correctly matched with
the appropriate adverse effect?
A. Levofloxacin—hyperkalemia.
B. Nitrofurantoin—pulmonary fibrosis.
C. Cotrimoxazole—hepatic encephalopathy.
D. Methenamine—nystagmus.

Answer 3

Correct answer = B. Hyperkalemia may be caused by cotri-
moxazole, not fluoroquinolones. Hepatic encephalopathy
may be related to therapy with methenamine in patients
with hepatic insufficiency. Nystagmus is not associated with
methenamine therapy.

Question 4

40.4 Cotrimoxazole would be expected to provide coverage
for all of the following organisms except:
A. Pseudomonas aeruginosa.
B. Community-acquired MRSA.
C. Nocardia asteroides.
D. Stenotrophomonas maltophilia.

Answer 4

Correct answer = A. Cotrimoxazole is generally the drug of
choice for answers C and D. It is also an excellent option
for treatment of community-acquired MRSA skin and soft
tissue infections.