Justice
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During February, a 37-year-old male respiratory therapist is seen in your office 1 day after developing fever, rigors, generalized muscle aches, and mild respiratory symptoms. He is otherwise in excellent health. The patient mentions that he had not received an influenza vaccination in the fall.
Physical examination is normal except for a temperature of 39.4 °C (103.0 °F) and coryza. Influenza A has been documented in your community, and you have seen several patients with similar symptoms this week.
Which of the following is most appropriate for managing this patient?
A. Obtain a chest radiograph and blood cultures
B. Obtain a nasopharyngeal culture for influenza and treat only if the result is positive
C. Prescribe either amantadine, rimantadine, zanamivir, or oseltamivir
D. Prescribe a fluoroquinolone antibiotic
E. Administer an intramuscular or intravenous dose of ceftriaxone and prescribe azithromycin
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| Markus2009
Forum Senior
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I am not sure but people who provide care those at high risk should get chemophrophylaxis with zanamivir or oseltamivir but not amantadine or rimantadine for resistance issues.
So C or A
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| nyimalay
Forum Elite
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Posts: 282
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C
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| dr.wad
Forum Senior
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A
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| Jcala
Forum Junior
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C
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| CocaCola
Forum Guru
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C
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| milestogo
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i think c too....
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| Justice
Forum Fanatic
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I apologize, colleagues, for delayed posts with correct answers. In the next set of Qns, I will post the answers exactly in a week... Thank you.
The correct answer is C
This patient likely has influenza based on the clinical presentation and the epidemiologic information. Empiric treatment is appropriate for someone who presents within 48 hours with a compatible illness if influenza has been documented in the community. However, empiric therapy for influenza alone would be inappropriate if the patient possibly had pneumonia, which would require additional evaluation for a bacterial source. Therapy would also be inappropriate if the epidemiologic data were not consistent with influenza (for example, if a patient presents during the summer and has not recently traveled outside the Northern Hemisphere). Any of the four drugs listed can be used to treat influenza A, although only the neuraminidase inhibitors (zanamivir and oseltamivir) would be appropriate if influenza B had been documented in the community.
A chest radiograph and blood cultures are unnecessary for a patient without concomitant medical problems and no signs of lower respiratory tract infection. A nasopharyngeal culture might be useful for epidemiologic purposes. However, it would not be helpful for deciding whether to treat this patient, as results of virus cultures require several days but therapy should be started within the first 2 days of symptom development and is continued for only 5 days. Antibacterial agents are not indicated because this patient has no suggestion of pneumonia or bacterial sinusitis.
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