Letters to the Editor

Trimethoprim-Sulfamethoxazole–Induced Methemoglobinemia in an HIV-Infected Patient

This chapter describes the different aspects of antibacterial drugs. The sensory systems and drugs interaction of amikacin, gentamicin, and fluoroquinolones are reviewed. In a meta-analysis of randomized, controlled trials in children there was a significantly worse outcome in secondary nephrotoxicity with multiple daily doses of aminoglycosides versus once-daily dosing. Thalidomidemay potentiate the nephrotoxicity of aminoglycosides. Three patients with refractory multiple myeloma taking thalidomide developed severe renal insufficiency shortly after starting to take amikacin for concurrent infections. Central nervous system adverse reactions can be important complications during quinolone therapy. The most common systemic adverse effects of the fluoroquinolones involve the gastrointestinal tract, including nausea, vomiting, abdominal pain, and diarrhea. Gentamicin can induce sclerochorioretinal necrosis after subconjunctival injection. In animals the combination of COX-2-selective inhibitors with gentamicin posed no additional risk of nephrotoxic renal insufficiency. The most common systemic adverse effects of the fluoroquinolones involve the gastrointestinal tract, including nausea, vomiting, abdominal pain, and diarrhea. It is found that ciprofloxacin chelates magnesium, with a resulting 60% reduction in fibroblast activity.

This chapter discusses the observational and comparative studies of antiprotozoal drugs. Chloroquine is widely used for the treatment and prophylaxis of malaria because of its low cost and relative safety. Chloroquine and its metabolite, hydroxychloroquine, are also commonly used for the treatment of connective tissue disorders such as rheumatoid arthritis and systemic lupus erythematosus. Hallucinations have been reported after hydroxychloroquine treatment for erosive lichen planus. Quick treatment of hypotension, gastric decontamination, continuous cardiac monitoring, and the treatment of dysrhythmias are critical in the management of hydroxychloroquine and that of chloroquine intoxication. In five comparisons of mefloquine with other chemoprophylaxis regimens, there was no difference in tolerability. Dapsone is combined with pyrimethamine in Maloprim, an effective chemoprophylactic agent for chloroquine-resistant malaria. It is found that methemoglobinemia is formed by altered Oxidative-reduction balance of hemoglobin and co-trimoxazole may trigger an increase in methemoglobin by interfering with reducing enzymes. Severe adverse reactions after treatment with co-trimoxazole are common in patients with HIV infection and can manifest as generalized sepsis with hemodynamic compromise, pulmonary infiltrates, and raised creatinine and hepatic transaminases.