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There are conflicting clinical reports of interactions, resulting in serious haematological abnormalities, between imuran and co-trimoxazole.

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treatment depends on the underlying cause granulocyte colony stimulating factors g-csf are now available and may be of benefit control infections viridans streptococci are usually sensitive to penicillin, beta-lactams, vancomycin, roxithromycin , rifampicin, macrolides, teicoplanin, lincosamides and aminoglycosides; co-trimoxazole is not effective and there is increasing resistance to penicillin after prolonged exposure to it gram-negative infections should be treated with ticarcillin, mecillinam or a third generation cephalosporin such as ceftazidime or cefotaxime if fever develops, samples of blood, urine, sputum and faeces should be taken for culture to exclude septicaemia; the patient should be started on empirical systemic antibiotics, usually initially piperacillin tazobactam plus gentamicin or, if penicillin-allergic, ceftazidime.

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