new_n_lost
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A 33-year-old woman presents with fever, vomiting, severe irritative voiding symptoms, and pronounced costovertebral angle tenderness.
Laboratory evaluation reveals leukocytosis with a left shift; blood cultures indicate bacteremia.
Urinalysis shows pyuria, mild hematuria, and gram-negative bacteria.
Which of the following drugs would best treat this patient's infection?
A. Ampicillin and gentamicin
B. Erythromycin
C. Gentamicin and vancomycin
D. Phenazopyridine and nitrofurantoin
E. Tetracycline
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| angel^Doctor
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D ?
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| po
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A. Ampicillin and gentamicin
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| new_n_lost
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Come on ppl Show Up here!!
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| keepgoing
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A,PN-->e.coli
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| paheli
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A
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| new_n_lost
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po wrote:
A. Ampicillin and gentamicin
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| new_n_lost
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The correct answer is A.
Acute pyelonephritis is an infectious disease involving the kidney parenchyma and the renal pelvis. Gram-negative bacteria, such as Escherichia coli, Proteus, Klebsiella, and Enterobacter, are the most common causative organisms in acute pyelonephritis. Laboratory evaluation will often reveal leukocytosis with a left shift, and urinalysis typically shows pyuria, varying degrees of hematuria, and white cell casts. Since bacteremia is present, the patient should be hospitalized and empirically started on IV ampicillin and gentamicin. This regimen may be need to be changed, however, once the sensitivity results are available.
Erythromycin (choice B) and tetracycline (choice E) are both bacteriostatic antibiotics and would not be recommended in a patient with a severe infection, such as acute pyelonephritis with bacteremia.
Vancomycin (choice C) is primarily used in the treatment of severe gram-positive infections.
Phenazopyridine (choice D) is a urinary analgesic, and nitrofurantoin (choice D) is a urinary tract anti-infective. Although nitrofurantoin is indicated for the treatment of "mild" cases of pyelonephritis, as well as cystitis, this patient's condition is severe and should be treated with appropriate antibiotics.
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| Auron
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I don't know if these questions come from somewhere or if you're making them up, but
if you have blood cultures indicating bacteremia, you'll at least know whether you're dealing with gm+, gm- or mixed. Why treat empirically when you have lab results from a culture?
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| maoudoody
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with all respect to u nnl,
gentamycin is nephro toxic so wouldnot be the first choice
we start first by amoxicillin + 2nd or 3rd generation cephalosporin+nitrofurantoin
if condition is resistent add gentamycin .... if the patient is uremic - i think this case vomiting may be symptom of ureamia - so dose of genta should be divided by serum creatinie
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