3. This patient with gonorrhea also has primary syphilis. The penile chancre, the
enlargednontender lymph nodes, and the microscopic identification of
treponemes in fluid expressed fromthe lesion are essentials of diagnosis.
Although a single dose of ceftriaxone may cure incubatingsyphilis, it cannot be
relied on for treating primary syphilis. The most appropriate course of actionin
this patient is to administer a single intramuscular injection of 2.4 million units of
benzathinepenicillin G. For penicillin-allergic patients, oral doxycycline or
tetracycline for 15 d (not 7 d) iseffective in most cases (see Chapter 44).
However, lack of compliance may be a problem withoral therapy. Fosfomycin and
vancomycin have no significant activity against spirochetes. Theanswer is C
5. Each of the drugs listed has activity against some gram-negative bacilli. All
penicillins should beavoided in patients with a history of allergic reactions to any
individual penicillin drug
Although the gray baby syndrome was initially described in neonates, a similar
syndrome hasoccurred with overdosage of chloramphenicol in older children and
adults, especially those withhepatic dysfunction. The answer is C
6. This patient is in the high-risk category for bacterial endocarditis and should
receive prophylacticantibiotics before many dental procedures. The American
Heart Association recommends thatclindamycin be used in patients allergic to
penicillins. Oral erythromycin is not recommendedbecause it is no more effective
than clindamycin and causes more gastrointestinal side effects
The answer is C
Although erythromycin does not inhibit loratadine metabolism, it does inhibit the
CYP1A2 form ofcytochrome P450, which metabolizes methylxanthines.
Consequently, cardiac and/or CNStoxicity may occur with excessive ingestion of
caffeine. Unlike the tetracyclines, the oralabsorption of erythromycin is not
affected by cations and the drug does not causephotosensitivity. Because
erythromycin undergoes biliary excretion, there is little reason toassess renal
function before treatment. The answer is C