Alcoholic in the ICU after mutlivehicle accident develops fever and cogh

[Oak]

A 56 year old alcoholic is hospitalized in the intensive care unit after a multivehicle accident. Twenty hours after the accident, the patient develops a fever and a cough productive of purulent sputum. If a chest radiograph shows lobar consolidation and the sputum reveals the presence of gram-negative encapsulated rods, the most appropriate initial therapy would be

A. cefotaxime (IV)
B. erythromycin (IV)
C. gentamicin (IV) + vancomycin (IV)
D. ticarcillin-clavulanic acid (IV) + vancomycin (IV)
E. trimethoprim-sulfamethoxazole (PO)

[Hero]

This is of course a case of pneumonia---and intravenous Cefotaxime is the most appropriate treatment here.

[bharat]

seems like he have lobar pneumonia.
since he is in ICU A.Cefotaxim IV would be the best choice .....so i also support hero....
hi hero ke che afno halkaber??????????/ sorry hai ajkal te net pani disconected gare ko chu ani class pani dheri che tesile yeha aune pani teti milye ko chiine
i miss u guys hai....
le te oak bro . waiting for your response hai.....bye...take care

[Oak]

Thats right guys, 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 Enterococcus infections.

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.

Because of the severe nature of this infection, the use of an oral agent, such as trimethoprim-sulfamethoxazole (choice E), would be inappropriate.



Hey bharat nice to hear from you after such a long time. Keep rocking here.