| A |
aspire, cool doctor, inkspot, lq2006, guangyu, CocaCola, ansalshah, Markus2009, drems, becky, solitarius, Justice |
12 |
67% |
| B |
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0 |
0% |
| C |
fd, toofar, nyimalay, khiladi, smalley, shakespeare |
6 |
33% |
| D |
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0 |
0% |
| E |
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0 |
0% |
| Author | 8 Posts |
Justice
Forum Fanatic
Topics: 106
Posts: 2,113
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Please vote with your answer
A 25-year-old man is hospitalized because of right lower lobe pneumonia. Blood and sputum cultures growStreptococcus pneumoniae that is sensitive to levofloxacin (minimum inhibitory concentration, 2 μg/mL) but is resistant to erythromycin and penicillin (minimum inhibitory concentration, 4 μg/mL). Intravenous levofloxacin is begun. However, the patient remains febrile and hypotensive. On hospital day 5, he develops a petechial rash. Blood cultures drawn on day 5 again grow gram-positive diplococci.
In addition to discontinuing levofloxacin, which of the following is most appropriate at this time?
A. Begin intravenous vancomycin
B. Begin clindamycin
C. Begin quinupristin/dalfopristin
D. Begin moxifloxacin
E. Begin doxycycline
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| inkspot
Forum Guru
Topics: 30
Posts: 589
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what is gram positive diplococci? stap / strep ?
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| CocaCola
Forum Guru
Topics: 35
Posts: 908
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pneumococci is diplococci
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| inkspot
Forum Guru
Topics: 30
Posts: 589
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thnx 
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| yogesh
Forum Newbie
Topics: 5
Posts: 56
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Vancomycin..
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| aspire
Forum Senior
Topics: 24
Posts: 158
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eagerly waiting for your answers and explanation, Justice.
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| Markus2009
Forum Senior
Topics: 9
Posts: 191
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Vanco
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| Justice
Forum Fanatic
Topics: 106
Posts: 2,113
|
The correct answer is A
Streptococcus pneumoniae that is resistant to penicillin is usually resistant to multiple other chemically dissimilar antibiotics, such as the macrolides and trimethoprim/sulfamethoxazole, and may also be resistant to clindamycin, streptogramin b (a component of quinupristin/dalfopristin), and doxycycline. These strains exhibit no predictable cross-resistance to vancomycin, fluoroquinolones, or linezolid. However, this patient has likely developed levofloxacin resistance because of inadequate serum concentrations of levofloxacin relative to the minimal inhibitory concentration of the pathogen. Such strains may exhibit cross-resistance to all the fluoroquinolones.
The most appropriate antibiotic for this critically ill patient is intravenous vancomycin, asS. pneumoniae resistance to this agent has not been reported to date. Resistance has been reported to the other antibiotics.
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