What is the drug of choice for Stenotrophomonas maltophilia infections?

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Multiple Choice

What is the drug of choice for Stenotrophomonas maltophilia infections?

Stenotrophomonas maltophilia has intrinsic resistance to many common antibiotics, so choosing an agent with reliable activity is essential. Trimethoprim-sulfamethoxazole is the drug of choice because most S. maltophilia isolates are susceptible to it, and clinical experience shows solid effectiveness across various infections. It also offers good tissue penetration and manageable monitoring. If TMP-SMX cannot be used (due to allergy, hyperkalemia, renal dysfunction, or intolerance), alternatives like a fluoroquinolone or a tetracycline (minocycline or doxycycline) can be considered, but susceptibility testing is important because not all strains respond. Drugs such as imipenem or vancomycin are not reliable against S. maltophilia and are not preferred options.

Stenotrophomonas maltophilia has intrinsic resistance to many common antibiotics, so choosing an agent with reliable activity is essential. Trimethoprim-sulfamethoxazole is the drug of choice because most S. maltophilia isolates are susceptible to it, and clinical experience shows solid effectiveness across various infections. It also offers good tissue penetration and manageable monitoring.

If TMP-SMX cannot be used (due to allergy, hyperkalemia, renal dysfunction, or intolerance), alternatives like a fluoroquinolone or a tetracycline (minocycline or doxycycline) can be considered, but susceptibility testing is important because not all strains respond. Drugs such as imipenem or vancomycin are not reliable against S. maltophilia and are not preferred options.

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