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or benzylpenicillin

Borrelia recur rcnus (relapsing fever)

a tetracycline

benzylpenicillin

Leptospira ileptosp;ro5*5)

benzylpenicillin

a tetracycline

Treponema pa/Mum (syphilis)

benzylpenicillin

a tetracycline or ceftriaxone

Treponema prrtenue (yaws)

benzylpenicillin

a tetracycline

* Resistance may be a problem; sensitivity tests should be performed.

* Resistance may be a problem; sensitivity tests should be performed.

Antibiotic-associated (or Clostridium difficile-associated) colitis is an example of a superinfection. It is caused by alteration of the normal bowel flora, which allows multiplication of Clostridium difficile which releases several toxins which damage the mucosa of the bowel and promote excretion of fluid. Almost any antimicrobial may initiate this condition, but the drugs most commonly reported today are injectable cephalosporins and amoxi/ ampicillin. Clindamycin, not commonly used in routine practice today, had an even greater propensity. It takes the form of an acute, nonspecific colitis (pseudomembranous colitis) with diarrhoeal stools containing blood or mucus, abdominal pain, leuco-cytosis and dehydration. A history of antibiotic use in the previous 3 weeks, even if the drug therapy has been stopped, should alert the physician to the diagnosis which is confirmed by typical appearances on proctosigmoidoscopy and detection of Clostridium difficile toxin in the stools. Mild cases usually respond to discontinuation of the offending antimicrobial allowing re-establishment of the patient's normal bowel flora. More severe cases merit treatment with oral metronidazole.

Opportunistic infection arises in patients whose immune systems are compromised or whose phagocytic cellular defences have been reduced by disease (e.g. AIDS, hypogammaglobulinaemia, leukaemia) or drugs (e.g. cytotoxics, adrenal steroids). Such infections involve organisms that rarely or never cause clinical disease in normal hosts. Treatment of possible infections in such patients should be prompt, initiated before the results of bacteriological tests are known and usually involving combinations of bactericidal drugs administered parenterally. Infections of this type include Pneumocystis carinii pneumonia and 'primary' septicaemia with gut organisms such as Escherichia coli and Klebsiella which cross the mucosa of the gut and invade the bloodstream directly. Local defences may also be compromised and allow opportunistic infection with lowly pathogens in otherwise healthy hosts: the best example is Staphylococcus epidermidis infection of intravenous catheters.

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