structure
Forum Junior
Topics: 26
Posts: 28
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One hr ago, a 33 yr old man had the sudden oneset of a a shaking chill and fever. two weeks ago, he was diagnosed with acute myelogenous leukemia ans was hospitalized for initiaion of chemotheray. He is pale and has rigors. His tenperatur is 38.6 OC, blood pressure is 120/76 mmHg, pusle is 110/ min, and respiration are 32/ min . there are multiple petechiae over his antecubital fossae. Physical examination is otherwise normal. Laboratory studies show:
Hematocrit 24%
Leukocyte count 400/mm3
Segmented neutrophils 1%
Lymphocytes 98%
Monocytes 1%
Platelet count 15,000/mm3
Blood is drawn for culture. Which of the following should be administered intraavenously?
A. Clindamycin and cefazolin
B. Ticarcillin and tobramycin
C. Vancomycin
D. High-dose penicillin
E. High-dose trimethoprim-sulfamethoxazole
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| shumaila
Forum Elite
Topics: 58
Posts: 347
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E???
pnemocystis carinni pneumonia but how we explan rash?
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| HighHopes
Forum Senior
Topics: 12
Posts: 165
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E, PCC in immunosupressive patient .. treat with trimethoprim-sulfamethoxazole
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| frank100
Forum Guru
Topics: 48
Posts: 586
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agree, coleagues itīs (e)
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| GDS2008
Forum Elite
Topics: 9
Posts: 144
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I think this is a clear cut case of febrile neutropenia (fever >38.5 with ANC <500) the patients can either be given montotherapy (with anti-pseudomonal agent) or combination therapy (B-lactam + aminogly). From the choices given, I think the most likely answer is B. Ticarcillin and tobramycin.
Shumaila -- rash is prb becuase of thrombocytopenia
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| Perhaps
Forum Elite
Topics: 61
Posts: 162
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I agree with B
I picked A when answering consdiering to cover anaerobes. Then checked UW, neutropenic with fever, B seems to be the right answer
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| s2ckdeficient
Forum Newbie
Topics: 0
Posts: 11
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2002 IDSA guidelines for the use of antimicrobial agents in neutropenic patients with cancer: summary
Initial antibiotic therapy
Monotherapy:
Cefepime or ceftazidime or imipenem or meropenem
Dual therapy:
Aminoglycoside plus antipseudomonal beta-lactam, cephalosporin (cefepime or ceftazidime), or carbapenem
Vancomycin should be added to either monotherapy or dual therapy only if criteria are met*
Oral therapy (only for low-risk adults):
Ciprofloxacin plus amoxicillin-clavulanate
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| s2ckdeficient
Forum Newbie
Topics: 0
Posts: 11
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Since ticarcillin is an antipseudomonal penicillin, dual therapy seems appropriate. answer: B
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