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doyoudig
Forum Guru Topics: 144 Posts: 609 |
45. A 2-year-old girl has had fever and bloody diarrhea for 10 days. A stool culture obtained 7 days ago grew Salmonella species sensitive to amoxicillin. A blood culture was negative. Despite beginning oral amoxicillin therapy 4 days ago, her diarrhea has persisted. Current examination shows no other abnormalities except for a temperature of 38.6 C (101.5 F). Which of the following is the most likely explanation for the failure of amoxicillin to improve her symptoms? A) Amoxicillin does not alter the course of Salmonella enteritidis B) Amoxicillin has caused pseudomembranous colitis C ) Amoxicillin is absorbed at the level of the jejunum, leaving no drug to be delivered to the colon D ) Oral amoxicillin is not absorbed into the systemic circulation in the presence of diarrhea E) Salmonella has expressed an inducible ß-lactamase that inactivates amoxicillin If any can give a refernce to the action of amoxicillin to back up their answer I'll be obliged!!
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robin082006
| Forum Hero  Topics: 468 Posts: 5028
E) Salmonella has expressed an inducible ß-lactamase that inactivates amoxicillin
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doc_clotaire
| Forum Guru  Topics: 161 Posts: 1288
I also took E in my test
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NNL
| Awaitin The Unexpected  Topics: 779 Posts: 6613
There was an Aritcle on CDC main site which is kinda closed for some reason; it said Amoxicillin is showing resistence against S. Enteridis https://www.prep4usmle.com/forum/comments.php?id=5... We have been Wrecking our brains over this one at the Step 1 Forum didnt know this was a Step 2 question. Half of them think the Answer is A but I m going with E
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doyoudig
| Forum Guru Topics: 144 Posts: 609
Guys check out Kap notes Peds & IM- 'GI' Chapters p169 let me know what u think
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eckimazuro
| Forum Newbie Topics: 2 Posts: 15
Guys, the answer is probably A. There was a study done in the 1980's that looked at precisely the question whether or not ampicillins shorten Salmonelle gastroenteritis and the answer was: Noooo. Ampicillin/amoxicillin/ceftriaxone helps in systemic S-infections. I also read the information on Salmonelle resistant outbreaks in the community and their increase, but these Salmonella spp. primarily had a resistance gene at the outset of them infecting people, while the girl in this question has "Salmonella species sensitive to amoxicillin". Please see following for the study abstract: pediatrics.aappublications....content/abstract/65/6/1125
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Akeen
| Forum Newbie  Topics: 1 Posts: 37
Read the refernce provided by eckimazuro. Answer should be A. Just hope no new study has been done to overturn this in the last 27 years. 
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