Burkholderia pseudomallei Isolates Resistance in Clinical and Environmental Responsible for Widespread Trimethoprim The BpeEF-OprC Efflux Pump Is

to many classes of antimi-crobials (7,8). The current recommended therapy includes an initialintensive phase followed by a lengthy eradication phase to preventrelapse (6, 9, 10). Most patients require at least 10 to 14 days of par-enteral ceftazidime or a carbapenem followed by 12 to 20 weeks oforal trimethoprim-sulfamethoxazole with or without doxycycline.Trimethoprim and sulfamethoxazole inhibit the folic acid biosyn-theticpathwaybytargetingdihydrofolatereductase(FolA)anddihy-dropteroate synthase (FolP), respectively (11). The synergistic tri-methoprim-sulfamethoxazole combination, co-trimoxazole, has apotentantimicrobialeffect.