All of the following symptoms are evidence of a superinfection except:
A. White oral plaques
B. Creamy vaginal discharge
C. Skin rash
D. Darkened tongue
Correct Answer: C. Skin rash
Skin rashes are indicative of hypersensitivity reactions in clients on penicillin therapy. True penicillin allergy is rare with the estimated frequency of anaphylaxis at 1-5 per 10 000 cases of penicillin therapy. Hypersensitivity is, however, its most important adverse reaction resulting in nausea, vomiting, pruritus, urticaria, wheezing, laryngeal edema, and ultimately, cardiovascular collapse.
Option A: The antibiotic most frequently related to superinfection was ciprofloxacin (38.1%), followed by cefotaxime (23.3%), imipenem (12%), meropenem (10.2%), and cefepime (6.1%). The lowest percentage of superinfection was observed with the use of piperacillin-tazobactam (5.4%).
Option B: A superinfection develops when the antibacterial intended for the preexisting infection kills the protective microbiota, allowing another pathogen resistant to the antibacterial to proliferate and cause a secondary infection
Option D: Peri-implant superinfections are a major risk associated with broad-spectrum antibiotics in immunocompetent individuals. Lack of follow-up and antibiotic susceptibility testing and indiscriminate empiric treatment regimens may lead to ongoing microbial challenge that exacerbates and maintains the disease progression.