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Azithromycin Ototoxicity — SCE Infectious Diseases MCQ

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HardRespiratory InfectionAzithromycin OtotoxicitySCE Infectious Diseases

Voriconazole is planned for azole-susceptible invasive aspergillosis, but the patient is taking rifampicin for tuberculosis. Which interaction statement is correct?

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Correct answer: C — Co-administration is contraindicated because rifampicin reduces voriconazole exposure by about 96% by AUC

Explanation lettering: C = shown as B · D = shown as C · E = shown as D · B = shown as E

D is correct. Rifampicin is a potent enzyme inducer that reduces voriconazole Cmax by about 93% and AUC by about 96%; the combination is contraindicated. Timing separation and intravenous administration cannot overcome hepatic induction, and empirical dose doubling is unsafe and unreliable. The tuberculosis and antifungal regimens need coordinated specialist redesign, taking organism susceptibility, disease severity and all rifamycin interactions into account.

Reference: Vfend 200 mg tablets SmPC: https://www.medicines.org.uk/emc/product/7973/smpc