Posts: 3,675,935
Threads: 734,343
Joined:
Sep 2021
Reputation:
5
A 57-year-old man with severe bronchial asthma presents with white patches on the inside of the cheeks that can be easily wiped off, leaving a red, bleeding, sore surface. He is currently using beclomethasone and albuterol inhalers for his asthma and he is allergic to penicillin. Which of the following agents would be most appropriate for the treatment of this patient's oral condition?
A. Acyclovir
B. Amoxicillin
C. Cefixime
D. Erythromycin
E. Nystatin
Posts: 3,675,935
Threads: 734,343
Joined:
Sep 2021
Reputation:
5
ur correct
The correct answer is E. The patient most likely has candidiasis, which can appear in any area of the oral mucosa. Inhaled corticosteroids, such as beclomethasone, are associated with the development of candidiasis in asthmatic patients, especially those who do not "wash out" their mouth with water after each usage. On the basis of the description, the patient has the pseudomembranous form of oral candidiasis or "oral thrush." There is also an erythematous form that presents with flat red and white lesions that cannot be "rubbed off." Oral candidiasis responds very well to antifungal therapy. Nystatin is an antifungal agent used locally for treatment of infections caused by many different Candida species. As a side note, the fact that the patient is penicillin allergic does not impact the treatment decision; it is only a distracter.
Acyclovir (choice A) is an antiviral agent used in the treatment of infections caused by herpes simplex virus types 1 and 2 and varicella-zoster virus. This agent would be indicated in individuals with herpes zoster infections, which typically appear as vesicular eruptions and/or ulcers on the cheek, tongue, gingiva, or palate.
If the patient presented with lymphoid hyperplasia of the posterior pharynx covered by a punctuate or coalescent exudate that is gray, yellow, or white, one might suspect streptococcal infection, which is associated with severe pharyngitis and fever. The posterior pharynx is diffusely erythematous with a gray, yellow, or white exudate. If this were the case, erythromycin (choice D), a macrolide antibiotic, would be the treatment of choice in a penicillin-allergic patient.
Both amoxicillin (choice B) and cefixime (choice C) are β-lactam antibiotics used to treat a wide range of bacterial infections. These agents are both known to cause allergic reactions in penicillin-allergic patients.
