Aashi
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A 50 yo hospitalized man with H/O rheumatic aortic and mitral valve dz. complains of fever, back pain, and myalgias for the past 3 days. On intial examination, no definite focus of infection is found. His leukocyte count is 24000 with 40% PMN and 40% band forms. The next day, 2 sets of blood culture are growing gram + cocci. Until specific organism specificity is known, the most appropriate antibiotic tretment regimen at this time is:
a) ceftriaxone
b) ciprofloxacin
c) nafcillin
d) streptomycin and pencillin
e) vancomycin and gentamycin
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| robin082006
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e) vancomycin and gentamycin
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| NE
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why genta if he has G+ infection? And why Vanco if you don't know anything about resistance?
Aminoglycosides+ cepha gen III - gram -
Vanco - gram + if is MRSA or lifetreatening penicillin allergy
Quinolone- gram + if is not strep pneumoniae
Rulling out the answer is nafcilin....
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| sprint123
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I will go for Nafcillin ...what is the correct answer aashi?
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| Aashi
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Damaged heart valves + I.E--->MC organism is STREP.VIRIDANS/enterococcal--->TOC is PEN+ Aminogly
ANSWER---->D) streptomycin and pencillin
A combination of an inhibitor of cell wall synthesis (ie, penicillin, vancomycin) with an aminoglycoside (ie, gentamicin, streptomycin) is necessary to achieve bactericidal activity against the enterococci
Penicillin should be the mainstay of the therapy.. Vancomycin is an alternative for patients allergic to penicillin or IV drugs users, vancomycin enterococci resistant exists
Vancomycin does not appear to be as useful as penicillin, aminoglycosides, imipenem, ciprofloxacin, or ampicillin with sulbactam
Enterococcus faecalis may become resistant to the penicillins because of their production of beta-lactamases. These strains can be treated with ampicillin combined with sulbactam or with vancomycin combined with gentamicin. But not before the resistance has been developed
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