Carafate

By H. Brontobb. Georgia Perimeter College.

Conversely trusted carafate 1g, PIs can raise rifampin concentrations to potentially toxic levels. The other four drugs listed may be used to treat HIV-seroposi- tive patients with tuberculosis. Rifabutin (in lower than usual doses) is also used in place of rifampin. He has had several courses of anti- retroviral therapy but has been intermittently noncompliant with treatment. He is admitted to the hos- pital with fevers, chills, night sweats, severe diarrhea, and weight loss. Chest x-ray reveals fibrotic changes at the bases but no infiltrates. Results of physical examination are as follows: temperature, 101. Generalized lymphadenopathy and hepatosplenomegaly are present. Which of the following cultures is most likely to reveal the diagnosis for this patient? Stool Key Concept/Objective: To be able to recognize Mycobacterium avium complex infection in AIDS M. Patients present with a disseminated infection, and symptoms 14 BOARD REVIEW can be protean. Systemic symptoms (fever, sweats, weight loss) are common. Diarrhea and malabsorption may overshadow pulmonary symptoms. Aggressive culturing may be necessary to make the diagnosis. The organism may be recovered from blood, bone marrow, lymph nodes, stool, and many other sites.

Despite receiving appropriate antibiotics for com- munity-acquired pneumonia order carafate 1g with amex, his clinical picture continues to worsen. Respiratory failure ensues, requir- ing that the patient be mechanically ventilated. On hospital day 3, admission sputum and blood cul- tures reveal gram-negative rods. Mechanical ventilation Key Concept/Objective: To understand the risk factors for gram-negative pneumonia Staphylococci and gram-negative bacilli are much less common but more serious caus- es of community-acquired respiratory infections. Significant predisposing conditions are required for these organisms to produce pneumonia. In the community setting, staphylococcal pneumonia usually follows influenza. Gram-negative pneumonias in the community setting are most common in patients who have recently been hospital- ized and treated with antibiotics, in smokers and others with chronic lung disease, and in immunosuppressed individuals. Because this patient was admitted with pneumonia 68 BOARD REVIEW and because initial cultures were drawn on admission, mechanical ventilation cannot be a causal factor. Sex and age are not known risk factors for pneumonia caused by gram-negative rods. A 34-year-old air-conditioning repairman is admitted to the hospital because of respiratory distress. He reports fever, chills, a mildly productive cough, myalgias, headache, and nausea. Physical examination shows a toxic-appearing man in moderate respiratory distress. Crackles at both lung bases with diffuse wheezes are noted. Laboratory data show pro- found leukocytosis with a left shift and a serum sodium level of 126 mEq/L. He is admitted to hospital for treatment of community-acquired pneumonia.