Chancroid Corimoxazole in Typhoid Initially cotrimoxazole was an effective alternative to chloramphenicol. However, in many areas resistant S. typhi have appeared and now it is seldom used. Cotrimoxazole in chancroid Corimoxazole for 7 days is a 3rd choice inexpensive alternative to ceftriaxone, erythromycin or iprofloxacin. Cotrimoxazole It is a combination of sulfonamide (sulfamethoxazole) and trime- thoprim in the ratio of 1 :5. Cotrimoxazole was claimed to be more effective than either of its components individually in treating bacterial infections. Because of its associated greater incidence of adverse effects including allergic responses its widespread use has been restricted in many countries to very specific circumstances where its improved efficacy is demonstracted. Uses of Cotrimoxazole Upper and lower respiratory tract infections - Exacerbations of chronic bronchitis - For otitis media and sinusitis. - It should never be used for streptococcal pharyngitis. Urinary tract infections -Uncomplicated cystitis in non pregnant women. Especially valuable for chronic and recurrent cases. - Prostatitis (cotrimoxazole is concentrated in goodamounts in prostate) Pneumocystic carinii pneumonia -Drug of choice next to pentamidine for the treatment and prophylaxis of pneumonias caused by Pneumocystic Jirovecci (commonly seen in imtnunocompromised patients including those suffering from HIV/AIDS). Other conditions where cotrimoxazole finds its use. -Listeria monocytogens infections - Meliodosis - Shigellosis - Traveller's diarrhoeas (E. coli, Campylobacter, Shigella, Y. enterocolitica) - Prophylaxis of cerebral toxoplasmosis - Whipple's disease - Salmonella (typhoid) initially it was responsive but now resistant strains have emerged. - Chancroid According to K.D.T. - Cotrimoxaxole can be used in both chancroid and typhoid. According to Harrison (18/e) Cotrimoxazole is used in Typhoid but it is not used in chancroid. Antiobiotic therapy in typhoid Empirical Ceftriaxone Azithromycin Fully susceptible Ciprofloxacin Amoxicillin Chloramphenicol Cotritnoxazole Multidrug resistant Ciprofloxacin Ceftriaxonl Azithromycin Nalidixic acid resistant Ceftriaxone Azithromycin High dose ciprofloxacin Treatment of chancroid Ciprofloxacin Ceftriaxone Azithromycin