lq2006
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A previously health 17 year old girl is brought to the ER because of 1 day h/o fever, vomitng, myalgias, and rash over her body, especially on her hands and feet. She takes no medications. She is sexually active with one partner and uses condoms inconsistently. Menses occur at regular 28 day intervals. Her last menstrual period began 4 days ago. She alternates between using tampons and sanitary pads. Her temperature is 38.9 (102), pulse 90/min, and BP 90/60 mmHg. PE shows diffuse, erythematous, macular rash over the body. Pelvic examination shows external genitatlia that are tender to touch and erythema of the vagina. There are ulcerations over the cervix. Which of the following is the most appropriate pharmacotherapy?
1. Acyclovir
2. Clindamyacin
3. Fluconazole
4. Metronidazole
5. Vancomyocin
6. Zidovudine (AZT)
The diagnosis is Trichomonas vaginitis (pinky cervix), so metronidazole should be the choice. What's your choices??
Thanks!!
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| hero
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trichomonas with macular rash? including hands and feet?
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| hero
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2 - clindamycin for toxic shock syndrome
http://www.emedicine.com/EMERG/topic600.htm
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| smalley
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agree with hero..its mostly tss..so clindamycin
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| hero
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answer given - vanco
(question is from USMLE sample test)
Could smb explain?
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| zx_stien
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you know what i think that she has toxic shock syndrome! bc 4th menstural day
use tampon
and rash which diffuse and macular!
so Go for Clindamycin!
Think about it!
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| hero
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correct answer is vanco!
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| Vietnamese
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Disseminated condition of Staph. aureus (from tampon), then Vancomycine is appropriate.
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| GOGETA
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Also take the tampon out
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| doc649
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TSS mostky by strepto or staph...so Vanco should be ans
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| hero
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vanco is for MRSA,
for TSS - staph and strep coverage - nafcillin, clarythromycin, erythromycin.
But correct ans is vanco, but vanco is NOT for TSS!!!
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| hero
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we should not use vanco unless we absolutely have t. So, why do we have to use it in this case?
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| janan
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One reason for using vancomycin may be that the patient seems to have TSS. Vancomycin will cover up both MRSA and Non MRSA..You can't risk a trial of the drugs to which the bacteria may turn out to be resistant after the patient is in heaven....
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| arlete
Intern in 2009!!!!!
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I agree with vanco, she's very very sick (TSS).
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| hero
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me stupid. Why we suspect MRSA in previously healthy girl? And vanco is not empiric Tx for TSS. And vanco is not given bcs of severity of condition, but bcs of sensitivity of pathogen.
Can't get it.
http://www.emedicine.com/derm/topic425.htm
http://www.emedicine.com/EMERG/topic600.htm
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| arlete
Intern in 2009!!!!!
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Thanks for teaching me, guys! 
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| DrVirgo
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Its TSS and from the GIVEN choices, Vanco seems to be the right answer.
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| DrVirgo
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Emedicine says:
Antibiotics should include a parenteral antistaphylococcal/streptococcal semisynthetic penicillin or a first-generation cephalosporin in combination with clindamycin. When MRSA is suspected, vancomycin or linezolid and rifampin may be added to or in place of an antistaphylococcal/streptococcal penicillin or cephalosporin.
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| hero
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DrVirgo wrote:
Emedicine says:
Antibiotics should include a parenteral antistaphylococcal/streptococcal semisynthetic penicillin or a first-generation cephalosporin in combination with clindamycin. When MRSA is suspected, vancomycin or linezolid and rifampin may be added to or in place of an antistaphylococcal/streptococcal penicillin or cephalosporin.
but again why we have to suspect MRSA in previously non hospitalised patient?
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| DrVirgo
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1. Acyclovir -----------------------NO because thats an antiviral for Herpes
2. Clindamyacin ----------------NO because it's for Anaerobes (?)
3. Fluconazole ------------------NO because thats for yeast
4. Metronidazole ----------------NO because its for GET (giardia, entaemeba, trich)
5. Vancomyocin -----------------Looks like the only one that makes sense compared to the others
6. Zidovudine (AZT) ---------------NO because its an antiviral for HIV
So i got it from the process of elimination; I don't know if my logic makes sense but from the given choices Vanco seems like the right one.
And MRSA is a serious thing, even in a non-hospitalized patient... We don't want to get to that point of having resistance so its better to avoid it in the first place.
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| hero
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check this out
http://www.expertopin.com/doi/abs/10.1517/1465656...
(dont't need full article, summary is enough)
also on page 4 link below - about community-acquires MRSA, vanco is not a Tx choice
http://www.co.monterey.ca.us/health/ForPhysicians...
Edited by hero on 07/04/08 - 02:06 PM
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| MAB
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VANCO-is the only antibiotic listed that covers staph here.....so thats the answer...agree with dr virgo..it is answer-exclusion type of question...
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| drms
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Agree with Drvirgo
TSS Vancomycin
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| Tuscani
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vanco vanco vanco.....!
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