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CHAPTER 46 Sulfonamides, Trimethoprim, & Quinolones 841

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C ASE STUD Y ANSWER

A fluoroquinolone that achieves good urinary and systemic susceptibility. Her recent exposure to multiple courses of
levels (ciprofloxacin or levofloxacin) would be a reasonable trimethoprim-sulfamethoxazole increases her chances of
choice for empiric treatment of this patient’s complicated having a urinary tract infection with an isolate that is resis-
urinary tract infection. Given the possibility of a fluoroqui- tant to this antibiotic. The patient should be told to take the
nolone-resistant organism, one dose of a parenteral agent oral fluoroquinolone 2 hours before or 4 hours after her
such as ceftriaxone (given IV or IM) would be reason- calcium supplement, as divalent and trivalent cations can
able pending culture results confirming fluoroquinolone significantly impair the absorption of oral fluoroquinolones.