Many urinary tract infections are caused by sulfonamide-resistant microorganisms. Trimethoprim— sulfamethoxazole, a quinolone, trimethoprim, fosfomycin, or ampicillin are the preferred agents. Sulfisoxazole may be used in areas where the prevalence of resistance is not high or when the organism is known to be sensitive. The usual dose is 2-4 g initially, followed by 1—2 g, orally four times a day for 5—10 days. Patients with acute pyelonephritis should not be treated with a sulfonamide.
Sulfonamides are of value in treating infections due to Nocardia spp. Sulfisoxazole or sulfadiazine may be given in dosages of 6—8 g daily and is continued for several months after all manifestations have resolved. The administration of a sulfonamide together with a second antibiotic has been recommended, especially for advanced cases, and ampicillin, erythromycin, and streptomycin have been suggested for this purpose. The clinical response and the results of sensitivity testing may be helpful in choosing a companion drug. Some experts consider trimethoprim—sulfamethox-azole to be the drug of choice.
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