Tuesday, December 14, 2010
7:57 AM | Posted by Shams Burki | Edit Post
A. cefotaxime IV
B. erythromycin IV
C. gentamicin IV + vancomycin IV
D. ticarcillin-clavulanic acid IV + vancomycin IV
E. trimethoprim-sulfamethoxazole PO
The correct answer is A. The patient is presenting with signs and symptoms of pneumonia. Since the
patients signs and symptoms are appearing 20 hours after admission, his pneumonia is most likely a "community-acquired" pneumonia; one of the criteria for diagnosing a nosocomial infection is that the
infection must not occur before 48 hours after admission. The appearance of plump gram-negative encapsulated rods in an alcoholic is highly suggestive of Klebsiella pneumonia. The most appropriate treatment of Klebsiella pneumonia in this patient is the administration of a third-generation cephalosporin, such as cefotaxime, ceftriaxone, or ceftazidime.
Erythromycin (choice B) is a macrolide antibiotic used in the treatment of a variety of gram-negative
and gram-positive infections. Although it is not the treatment of choice in this patient, it is the treatment of
choice of Legionella pneumonia.
Gentamicin (choice C) is an aminoglycoside antibiotic that is generally added to improve the efficacy
of broad spectrum antibiotics, such as penicillin and cephalosporins, in the treatment of Pseudomonas and
Vancomycin (choices C and D) is an antibiotic used in the treatment of life-threatening infections
caused by gram-positive infections; the use of this agent in a gram-negative infection is inappropriate.