A 70-year-old woman has 2-day history of fever, nauseas and vomiting. On examination: Temp 39.8, HR 115/min, BP 120/65. Systemic examination is unremarkable. Laboratory investigations: WBC 20,000/microL On urine analysis, leucocytes more than 60/hpf. Gram-negative strains are seen under microscopic exam. The patient started empirically on piperacillin tazobactam. On the second day of admission, the urine culture revealed Escherichia coli susceptible to piperacillin tazobactam, meropenum, ciprofloxacin, ampicillin, gentamycin. What is the most appropriate treatment for this patient?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: C. discontinue piperacillin tazobactam and start ampicillin
Broad empiric cover (piperacillin-tazobactam) was right for urosepsis. Once culture and sensitivities return, de-escalate to the narrowest effective agent. The E. coli is ampicillin-susceptible, so switch to ampicillin. Continuing pip-tazo or escalating to meropenem wastes broad-spectrum drugs and selects for resistance. Ciprofloxacin and gentamicin are broader and/or more toxic choices when a narrow beta-lactam works.
ليش كل خيار صح أو غلط
-
A
ليش غلط
Piperacillin-tazobactam is listed as an empiric regimen. The notes' rule is empiric therapy after samples are taken, then, once culture and sensitivity are back, treatment directed against the organism; continuing the empiric drug ignores the sensitivity result.
✓ Antibiotics.pdf · p. 4 -
B
ليش غلط
Meropenem is a broad-spectrum carbapenem kept for multi-drug resistant nosocomial infections. This E. coli is susceptible to ampicillin, so it is not needed.
✓ Inefctious Diseases 🦠.pdf · p. 5 -
C
ليش صح
Empiric therapy starts after samples are taken; after detection, treatment is directed against the organism by culture and sensitivity. This E. coli is ampicillin-susceptible, so switching to ampicillin fits.
✓ Antibiotics.pdf · p. 4 -
D
ليش غلط
Ciprofloxacin has notable side effects (QT prolongation, hypoglycemia, C. difficile, tendinitis). A narrower susceptible beta-lactam (ampicillin) is available, so it is not the most appropriate choice.
✓ Antibiotic-1 (3).pdf · p. 23 -
E
ليش غلط
Gentamicin is an aminoglycoside whose adverse effects include ototoxicity and nephrotoxicity. With a susceptible beta-lactam available it is not the most appropriate choice.
✓ Antibiotics.pdf · p. 3
- المصدر
- Pancreatitis.pdf · p. 7
Step_Up_To_Medicine_6th_Edition_2024_CIRRHOSIS_AND_COMPLICATIONS.pdf · p. 8 - المحاضرة
- Antimicrobials · Infectious Diseases · Module B
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