A 75-year-old-woman has 1-day history of fever, headache, and altered mental status. She has T2DM and hypertension. On examination, she is confused, temp 38.9, BP 104/66 mmHg, HR 105/min, and RR 20/min. Her neck is supple and she has no rashes. The WBC 19,000/uL; platelets count is 90,000/uL; and random plasma glucose is 120 mg/d. Cerebrospinal fluid analysis shows a leukocyte count of 1300/uL with 98% neutrophils, a glucose level of 20 mg/dl, and a protein level of 200 mg/dl. Dexamethasone is begun Which of the following antimicrobial regimens should now be initiated?
سؤال مجاني 5 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة: B. Ceftriaxone, Vancomycin, and ampicillin
The CSF (neutrophils 98%, very low glucose, high protein) indicates acute bacterial meningitis. In a patient >50 years with diabetes, empiric therapy is ceftriaxone + vancomycin + ampicillin; the ampicillin covers Listeria. Ceftriaxone alone misses resistant pneumococcus and Listeria. Dropping ceftriaxone leaves gram-negative and meningococcal coverage inadequate. Acyclovir is for viral (HSV) encephalitis.
ليش كل خيار صح أو غلط
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A
ليش غلط
Ceftriaxone alone is incomplete. For patients over 50 the empiric regimen adds vancomycin and ampicillin (L. monocytogenes is a likely pathogen at this age).
✓ Step Up To Medicine 6th Edition 2024 (CNS INFECTION).pdf · p. 5 -
B
ليش صح
This is acute bacterial meningitis in a patient over 50: the empiric regimen is ceftriaxone (or cefotaxime) + vancomycin + ampicillin, the ampicillin covering L. monocytogenes, a likely pathogen at this age.
✓ Step Up To Medicine 6th Edition 2024 (CNS INFECTION).pdf · p. 5 -
C
ليش غلط
Vancomycin and ampicillin without ceftriaxone drops the ceftriaxone backbone. The over-50 regimen is ceftriaxone (or cefotaxime) plus vancomycin plus ampicillin, which also covers N. meningitidis and gram-negative bacilli.
✓ Step Up To Medicine 6th Edition 2024 (CNS INFECTION).pdf · p. 5 -
D
ليش غلط
Acyclovir is the treatment for viral CNS infection. This CSF has low glucose and neutrophils, the bacterial pattern (viral CSF has normal glucose and lymphocytes), so acyclovir is not added.
✓ CNS infection.pdf · p. 2
- المصدر
- Step Up To Medicine 6th Edition 2024 (CNS INFECTION).pdf · p. 5
CNS infection.pdf · p. 2 - المحاضرة
- Antimicrobials · Infectious Diseases · Module B
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