Infectious Disease I
A 35-year-old male patient is referred to a dermatology clinic for management of external anogenital warts. Which of the following therapies is most likely to result in a resolution rate which approaches 100%? A Podophyllum resin B Acetic acid 3% C Electrocautery D Topical 5-fluorouracil
C
L.G. is a 49-year-old woman with a history of mitral valve prolapse. She presents to her physician's office with malaise and a low-grade fever. Her physician notes that her murmur is louder than usual and orders blood cultures and an echocardiogram. A large vegetation is observed on L.G.'s mitral valve, and her blood cultures are growing Enterococcus faecalis (susceptible to all antibiotics). Which is the best therapy for L.G.? A. Penicillin G plus gentamicin for 2 weeks. B. Vancomycin plus ceftriaxone for 2 weeks. C. Ampicillin plus ceftriaxone for 4-6 weeks. D. Cefazolin plus gentamicin for 4-6 weeks.
C
A 2-year-old patient presents to an urgent care clinic with unimproved otologic findings due to acute otitis media. The mother of the child reports no improvement after 48 hours of amoxicillin. Which of the following therapies should be initiated next? A Amoxicillin/clavulanate orally B Ciprofloxacin otic C Levofloxacin orally D Tympanocentesis
A
A 29-year-old female patient presents to her gynecologist after experiencing post-coital bleeding, as well as a frothy, green discharge several days later. Microscopy in the office reveals motile trichomonads. Which of the following therapies is most likely to result in clinical cure? A Metronidazole 2 grams orally x 1 dose B Clindamycin 300 mg orally twice daily for 7 days C Azithromycin 1 gram orally x 1 dose D Intravaginal povidone-iodine 0.3% once daily for 5 days
A
A 47-year-old female patient with acute myeloid leukemia (AML) is admitted for the hospital for induction chemotherapy with idarubicin plus cytarabine. She has been on levofloxacin 500 mg daily, valacyclovir 500 mg twice daily, and posaconazole 300 mg delayed-release tablet daily for antimicrobial prophylaxis. On day 7 of her hospital day, the patient develops chills and a fever to 101.3°F (38.5°C, measured orally). A chest X-ray is ordered and is negative for infiltrates. The patient denies any focal symptoms, and physical exam is unremarkable. The patient's peripherally inserted central catheter insertion site is clean and without erythema or swelling. Her WBC is 0.0 cells/mm3, blood pressure is 122/76 mm Hg, heart rate is 98 beats/minute, and respiratory rate is 20 breaths/minute. Regardless of your recommendation, KA is started on cefepime plus vancomycin. After 8 days (hospital day 15), KA continues to have fevers up to 38.8° C (101.8° F); she is otherwise clinically stable. Her WBC is 0.1 cells/mm3, and blood, sputum, and urine cultures are all negative to date. Which of the following changes to KA's antimicrobial therapy is most appropriate at this time? A Add liposomal amphotericin B, discontinue posaconazole B Add micafungin, discontinue posaconazole C Add isavuconazonium sulfate, discontinue posaconazole D No changes necessary, continue posaconazole
A
A 55-year-old male patient is admitted to the hospital with pneumonia and is empirically started on piperacillin-tazobactam and vancomycin. The patient has a past medical history significant for CKD requiring IHD on Tuesday, Thursday, and Saturday. Which of the following screening tools is most useful as part of an antimicrobial stewardship-driven de-escalation? A MRSA polymerase chain reaction (PCR) B MRSA nasal culture C Procalcitonin D Legionella urinary antigen
A
A 64-year-old male admitted to the hospital for suspected native vertebral osteomyelitis (NVO). He initially presented with worsening back pain and new onset of fevers. He has a history of hyperlipidemia, hypertension, and chronic low back pain. Notably, he received an epidural injection of methylprednisolone 4 months prior to admission. Magnetic resonance imaging (MRI) results confirm a diagnosis of NVO without associated epidural or perivertebral abscess. HR 88 beats/minute, BP 128/88 mm Hg, RR 16 breaths/minute, and temperature 38.1°C (100.6°F). His WBC count is 10.9 x103 cells/mm3, and C-reactive protein (CRP) is 23 mg/dL; all other laboratory studies are within normal limits. Blood cultures grew Staphylococcus aureus with the following susceptibilities: Clindamycin R Doxycycline S Oxacillin S Trimethoprim/sulfamethoxazole S Vancomycin S (MIC = 1) Which of the following antibiotics is most appropriate to initiate? A Cefazolin 2 g every 8 hours B Ceftriaxone 2 g every 24 hours C Daptomycin 6 mg/kg every 24 hours D Vancomycin 15 mg/kg every 12 hours
A
A large academic medical center is considering adding fidaxomicin to the inpatient formulary in place of oral vancomycin for the treatment of Clostridioides difficile infection (CDI). Which of the following benefits could be attributed to the addition of fidaxomicin to formulary? A Decreased hospital readmission secondary to CDI B Allows for shorter treatment duration of initial episode C Demonstrates greater efficacy against the hypervirulent strain of C. difficile D Can be also be utilized for infections outside the gastrointestinal tract
A
A patient has septic shock on the ventilator in the ICU. The patient's wife is at bedside, and the medical team interacts with her daily regarding patient preferences and therapeutic plans. Which of the following results is a benefit of allowing flexible visitation and family engagement? A Decreased anxiety, confusion, and agitation B Decreased cost of hospitalization C Less likely to discharge to long-term care facility D Shorter time on the ventilator
A
An evaluation of antiretrovirals at the next Pharmacy and Therapeutics (P&T) Committee meeting is requested. There is a need for a recommendation for formulary status of available single-tablet antiretroviral regimens for the hospital inpatient formulary, including elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (EVG/c/FTC/TAF) and elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (EVG/c/FTC/TDF). Which of the following recommendations is best regarding maintaining EVG/c/FTC/TAF on the inpatient formulary? A Yes - The components are not available as single agents so the single-tablet regimen is needed. B Yes - There is strong "rapid-start" data in new diagnoses so it's important to have on formulary. C No - EVG/c/FTC/TDF can be temporarily substituted while patients are hospitalized inpatient. D No - It is not first-line in the Department of Health and Human Services (DHHS) guidelines so it is not used often.
A
B.K. is a 58-year-old woman (height 66 inches, weight 82 kg) who is scheduled to undergo a total knee replacement tomorrow. She has no significant medical history and no drug allergies. Which is the best surgical prophylaxis regimen for this patient? A. Cefazolin 2 g within 1 hour of the incision and no doses postoperatively. B. Cefazolin 2 g within 4 hours of the incision and three doses every 8 hours postoperatively. C. Cefazolin 1 g within 1 hour of the incision and three doses every 8 hours postoperatively. D. Cefazolin 1 g within 4 hours of the incision and no doses postoperatively.
A
B.Y. is an 85-year-old woman who is bedridden and lives in a nursing home. She is chronically catheterized, and her urinary catheter was last changed 3 weeks ago. Today, her urine is cloudy, and a urinalysis reveals many bacteria. B.Y. is not noticing any symptoms. A urine culture is obtained. Which option is best for B.Y.? A. No therapy because she is chronically catheterized and has no symptoms. B. No antibiotic therapy, but the catheter should be changed. C. Ciprofloxacin 500 mg orally twice daily for 7 days and a new catheter. D. Ciprofloxacin 500 mg orally twice daily for 14-21 days without a change in catheter.
A
In the ACTIVE study, isavuconazole was compared to caspofungin for the primary treatment of patients with candidemia. In this study, the pre-specified non-inferiority margin was set at 15%. The primary endpoint of the study was overall response at the end of intravenous therapy. With respect to the primary outcome, the authors reported an adjusted difference of -10.8%; 95% CI -19.9 to -1.8. Which statement represents an accurate interpretation of these results? A Isavuconazole is not non-inferior to caspofungin in the treatment of candidemia. B Isavuconazole is equivalent to caspofungin in the treatment of candidemia. C Caspofungin is superior to isavuconazole in the treatment of candidemia. D Caspofungin is non-inferior to isavuconazole in the treatment of candidemia.
A
P.E. is a 56-year-old man who comes to the clinic with a 3-day history of fever, chills, pleuritic chest pain, malaise, and productive cough. In the clinic, his temperature is 102.1°F (38.9°C) (all other vital signs are normal). His chest radiograph reveals consolidation in the right lower lobe. His white blood cell count (WBC) is 14,400 cells/mm3, but all other laboratory values are normal. He is given a diagnosis of community-acquired pneumonia (CAP). He has not received any antibiotics in 5 years and has no chronic disease states. Which is the best empiric therapy for P.E.? A. Doxycycline 100 mg orally twice daily. B. Cefuroxime axetil 250 mg orally twice daily. C. Levofloxacin 750 mg orally daily. D. Trimethoprim/sulfamethoxazole double strength orally twice daily.
A
The STOP IT trial provides evidence that 4 days of antimicrobial therapy is sufficient duration for IA infections, provided source control has been achieved. The infectious diseases pharmacist at the hospital, excited by these results, begins a new initiative to reduce the duration of therapy for patients with IA infections. Each day, she reviews all patients in the surgical ICU and surgical ward. When she identifies patients with IA infections who have documentation of source control and resolution of signs and symptoms of infection, she calls the surgical team and recommends stopping antibiotics after 4 days. This daily routine is best described by which of the following terms? A Antimicrobial stewardship B Lean Six Sigma C Medication use evaluation D Root cause analysis
A
V.E. is a 44-year-old man who presents to the emergency department with a warm, erythematous, and painful right lower extremity. There is no raised border at the edge of the infection. Three days ago, he scratched his leg on a barbed wire fence on his property (no puncture wound associated with the fence). His temperature has been as high as 101.8°F (38°C) with chills. Doppler studies of his lower extremity are negative. Blood cultures are negative. Which is the best empiric therapy for V.E.? A. Cefazolin 1 g intravenously every 8 hours. B. Penicillin G 2 million units intravenously every 4 hours. C. Piperacillin/tazobactam 3.375 g intravenously every 6 hours. D. Enoxaparin 80 mg subcutaneously twice daily and warfarin 5 mg daily orally.
A
Which of the following antimicrobial stewardship initiatives is most likely to significantly reduce Clostridioides difficile infection (CDI) rates in the inpatient setting? A Limiting antimicrobial prophylaxis to 24 hours postoperatively B Adding probiotics to community-acquired pneumonia order sets C Initiating oral vanco as primary prophylaxis in high risk CDI patients D Adding bezlotoxumab to the hospital formulary
A
Which of the following organizations promotes the use of proven guidelines to prevent infection after surgery? A The Joint Commission B Institute for Safe Medication Practices C Centers for Disease Control and Prevention D The Food and Drug Administration
A
A 32-year-old female patient living with HIV presents to clinic for routine follow-up. Her HIV is historically well-controlled. She reports she is doing well overall but complains of several skin-colored, painless "bumps" in her genital region that developed a few weeks ago. After a physical exam, she is diagnosed with genital warts. Which of the following treatments is most appropriate for this patient to apply on her own at home? A Cidofovir 1% B Imiquimod 5% C Salicylic acid 17% D Trichloroacetic acid 80%
B
A 41-year-old male patient (5'6'', 65.77 kg (145 lbs), no known drug allergies) with past medical history significant for hypertension and hyperlipidemia presents to his primary care clinic with two days of nasal congestion, yellow sinus drainage, fatigue, and intermittent facial pain. He reports taking over-the-counter decongestants and antihistamine for symptom relief, but overall does not feel any better. Which of the following treatment options is most appropriate? A Moxifloxacin 400 mg daily for 5 days B Return to clinic in 8 days if symptoms do not improve C Amoxicillin 500 mg three times daily for 14 days D Amoxicillin/clavulanate 2 g/125 mg ER twice daily for 7 days
B
A 61-year-old male patient presents to the emergency department with reports of ear pain, fullness, and pain that occurs while chewing, in addition to being subjectively febrile at 101°F (38.33°C). The patient has a past medical history significant for poorly controlled diabetes, hypertension, and obesity. The patient is subsequently admitted and is diagnosed with malignant external otitis by an otolaryngologist. Which of the following empiric therapies is most appropriate? A Ofloxacin otic B Ciprofloxacin intravenous C Finafloxacin otic D Moxifloxacin intravenous
B
A 66-year-old female patient is admitted from an assisted living facility with altered mental status. The patient has a chronic indwelling catheter and a urine culture from the emergency department which is growing Candida glabrata. The patient denies any symptoms consistent with a urinary tract infection. Current creatinine clearance is 40 mL/min. Which of the following interventions is most appropriate? A Amphotericin B bladder irrigation B Removal of catheter C Fluconazole 200 mg intravenously daily D Flucytosine 25 mg/kg intravenously every 6 hours
B
A new drug is being studied for treatment of CAP. Which of the following aspects of the study is most likely to decrease external validity? A Non-inferiority study design B Narrow age range of study participants C Radiographic improvement as a secondary endpoint D Multiple participating centers
B
A study is designed to assess the risk of pneumococcal pneumonia in older adults 10 years or more after receiving their last pneumococcal vaccination, compared with older adults who have never received any pneumococcal vaccinations. Which study design is best? A. Case series. B. Case-control study. C. Prospective cohort study. D. Randomized controlled trial.
B
An 83-year-old male patient who weighs 80 kg is admitted to the medical-surgical floor for management of his stage 4 sacral decubitus ulcer. He is scheduled to undergo surgical incision and debridement in the OR tomorrow morning. He resides at a nursing home and is bed-bound. He has a past medical history of Alzheimer's dementia, major depressive disorder, and type 2 diabetes. His home medications include: Blood and wound cultures are taken, in addition to x-rays of sacrum. Non-pharmacological strategies being employed include dressing changes by wound care team, turning patient every 2 hours, maximizing glucose control, optimizing protein intake, physical therapy, and frequent bedding changes. The surgeon asks for clinical pharmacy input on empiric antimicrobial regimen selection. Which of the following selections is most appropriate? A Ceftriaxone 2 g intravenously + clindamycin 600 mg intravenously every 8 hours B Piperacillin/tazobactam 3.375 g intravenously every 8 hours (given as extended-infusion after first dose) + vancomycin 1,500 mg intravenously once, then 1000 mg intravenously every 12 hours C Ceftazidime 2 g intravenously every 12 hours + metronidazole 500 mg intravenously every 8 hours + linezolid 600 mg intravenously every 12 hours D Levofloxacin 750 mg intravenously every 24 hours and Linezolid 600 mg intravenously every 12 hours
B
As the clinical coordinator and pharmacotherapy specialist, you provide a monthly review of patients with sepsis to ensure adequate patient care and compliance with regulatory standards. Given the Joint Commission SEP-1 core measures, several "time-to" interventions have been described for institutions to follow. A Time to acetaminophen administration for antipyresis. B Time to cefepime administration for patients with Pseudomonas aeruginosa risk factors. C Time to enoxaparin administration for patients at risk of deep venous thrombosis (DVT). D Time to medication reconciliation for patients with outpatient medications.
B
J.M. is a 72-year-old woman with a history of atrial fibrillation, hypertension, a right total hip replacement 8 months earlier, and Crohn disease. She has no drug allergies. She presents to the hospital with increasing pain in her prosthetic hip over the past month. There is concern about hip osteomyelitis. Bone cultures are growing methicillin-sensitive Staphylococcus aureus. J.M. has normal renal function and no known drug allergies. Which is the best antibiotic regimen for this patient with a prosthetic hip infection? A. Vancomycin 1000 mg intravenously every 12 hours plus rifampin 300 mg orally twice daily for 2 weeks. B. Cefazolin 2 g intravenously every 8 hours plus rifampin 300 mg orally twice daily for 6 weeks followed by long-term oral antibiotics. C. Nafcillin 1 g intravenously every 4 hours for 6 weeks. D. Daptomycin 6 mg/kg intravenously daily for 6 weeks followed by long-term oral antibiotics.
B
8. R.K. is a 36-year-old woman who presents to the emergency department with a severe headache and neck stiffness. Her temperature is 99.5°F (37.5°C). After a negative computed tomographic scan of the head, a lumbar puncture reveals the following: glucose 54 mg/dL (peripheral, 104 mg/dL), protein 88 mg/dL, and WBC 220 cells/mm3 (100% lymphocytes). The Gram stain reveals no organisms. Which option describes the best therapy for R.K.? A. This is aseptic (probably viral) meningitis, and no antibiotics are necessary. B. Administer ceftriaxone 2 g intravenously every 12 hours until the cerebrospinal fluid (CSF) cultures are negative for bacteria. C. Administer ceftriaxone 2 g intravenously every 12 hours and vancomycin 15 mg/kg intravenously every 12 hours until the CSF cultures are negative for bacteria. D. Administer acyclovir 500 mg intravenously every 8 hours until the CSF culture results are complete.
C
A 33-year-old male has a known history of HIV, which is currently untreated. Today, he presents with altered mental status. Per his family, he had been reporting headaches, neck stiffness, and fevers over the last few weeks before acutely worsening over the last 24 hours. In the emergency department, a lumbar puncture is performed with an opening pressure noted of 23 mmHg. Cerebrospinal fluid analysis reveals white blood cells of 201 cells/mm3, no red blood cells, glucose of 27 mg/dL, and protein of 71.4 mg/dL. The Gram stain is negative, but a cryptococcal antigen test (CrAg) is positive. The patient's past medical history is significant only for HIV. His vital signs are as follows: HR 98 beats/minute BP 104/68 mm Hg RR 16 breaths/minute T 99.7°F (37.6°C) Notable labs: HIV viral load of 122,000 copies/mL, and a CD4 count of 61 cells/mm3. The patient is diagnosed with cryptococcal meningitis. Which of the following induction therapy regimens is most appropriate? A Fluconazole + flucytosine B Liposomal amphotericin B + fluconazole C Liposomal amphotericin B + flucytosine D Liposomal amphotericin B + fluconazole + flucytosine
C
A 64-year-old male admitted to the hospital for suspected native vertebral osteomyelitis (NVO). He initially presented with worsening back pain and new onset of fevers. He has a history of hyperlipidemia, hypertension, and chronic low back pain. Notably, he received an epidural injection of methylprednisolone 4 months prior to admission. Magnetic resonance imaging (MRI) results confirm a diagnosis of NVO without associated epidural or perivertebral abscess. Today, his vital signs are heart rate 88 beats/minute, blood pressure 128/88 mm Hg, respiratory rate 16 breaths/minute, and temperature 38.1°C (100.6°F). His WBC count is 10.9 x103 cells/mm3, and C-reactive protein (CRP) is 23 mg/dL; all other laboratory studies are within normal limits. Blood cultures grew Staphylococcus aureus with the following susceptibilities: Clindamycin R Doxycycline S Oxacillin S Trimethoprim/sulfamethoxazole S Vancomycin S (MIC = 1) Which of the following durations of antibiotic therapy is most appropriate? A 2 weeks B 4 weeks C 6 weeks D 8 weeks
C
A patient presents to the hospital with an intra-abdominal abscess, and she is started on moxifloxacin and taken to the operating room for surgical drainage and washout of the abdomen. Post-operatively in the surgical ICU, she experiences cardiac arrest. Analysis of the electrocardiogram reveals Torsades de Pointes, and the patient is successfully resuscitated following administration of intravenous magnesium. The clinical pharmacist suspects the cardiac arrest was in part precipitated by QTc prolongation from moxifloxacin. Which of the following is the most appropriate location for the pharmacist to report a suspected adverse drug event? A FDA Form 3500A B ISMP VERP C MedWatch D VAERS
C
A.B. is a 63-year-old woman who presents to the emergency department with left leg pain and erythema. The pain and erythema have worsened over the past 24 hours, and in the emergency department, large blisters formed and the leg became numb. The left leg is significantly swollen with a large area of erythema and large bullae extending from the thigh to the upper leg. There is crepitus within the soft tissue. A.B. is found to have rapidly progressing necrotizing fasciitis. A.B. has normal renal function and no known drug allergies. Which is the best empiric therapy for A.B.? A. Vancomycin 15 mg/kg intravenously every 12 hours. B. Piperacillin/tazobactam 4.5 g intravenously every 8 hours. C. Vancomycin 15 mg/kg intravenously every 12 hours plus meropenem 1 g intravenously every 8 hours plus clindamycin 900 mg intravenously every 8 hours. D. Linezolid 600 mg intravenously every 12 hours plus ceftriaxone 1 g intravenously every 24 hours plus azithromycin 500 mg intravenously daily.
C
N.L. is a 28-year-old woman with no significant medical history. She reports to the emergency department with fever and severe right lower quadrant pain. The pain had been dull for the past few days, but it suddenly became severe during the past 8 hours. Her temperature is 103.5°F (39.7°C), and she has rebound tenderness on abdominal examination. She is taken to surgery immediately, where a perforated appendix is diagnosed and repaired. Which is the best follow-up antibiotic regimen? A. Vancomycin 1000 mg intravenously every 12 hours plus metronidazole 500 mg intravenously every 8 hours. B. Cefazolin 1 g intravenously every 8 hours plus ciprofloxacin 400 mg intravenously every 12 hours. C. Ceftriaxone 1 g intravenously every 8 hours plus metronidazole 500 mg intravenously every 8 hours. D. No antibiotics needed after surgical repair of a perforated appendix.
C
N.R. is a 28-year-old woman who presents to the clinic with a 2-day history of dysuria, frequency, and urgency. She has no significant medical history, and the only drug she takes is oral contraceptives. Which is the best empiric therapy for N.R.? A. Nitrofurantoin extended release (ER) 100 mg orally twice daily for 3 days. B. Ciprofloxacin 500 mg orally twice daily for 7 days. C. Trimethoprim/sulfamethoxazole double strength orally twice daily for 3 days. D. Cephalexin 500 mg orally four times daily for 3 days.
C
Patient living with HIV/AIDS presents with decreased central vision in the left eye. At the last clinic visit three months ago, CD4 t-cell count was 53 cells/mm3 due to non-adherence to antiretrovirals. After an ophthalmoscopic examination, the patient is found to have sight-threatening lesions and diagnosed with Cytomegalovirus (CMV) retinitis. Which of the following initial therapies for the management of CMV retinitis is best? A Valganciclovir oral B Acyclovir oral C Ganciclovir intravitreal injections plus valganciclovir oral D Ganciclovir intravitreal injections
C
A 25 year old male was recently diagnosed with HIV 2 weeks ago: CD4: 563 cells/mm3 HIV-RNA: 34,724 copies/mL HLA-B*5701: positive Genotype: no significant resistance mutations Scr: 0.85 mg/dL Height: 70.87 in Weight: 88 kg He is interested in starting antiretroviral therapy. He has a history of depression, not on therapy, and asthma, managed with scheduled inhaled fluticasone / salmeterol and PRN inhaled albuterol. Which of the following initial antiretroviral regimens is most appropriate? A Elvitegravir / cobicistat / emtricitabine / tenofovir alafenamide 1 tablet orally daily B Dolutegravir / lamivudine / abacavir 1 tablet orally daily C Efavirenz / emtricitabine / tenofovir disoproxil fumarate 1 tablet orally daily D Bictegravir / emtricitabine / tenofovir alafenamide 1 tablet orally daily
D
A 32-year-old female patient living with HIV presents to clinic for routine follow-up. Her HIV is historically well-controlled. She reports she is doing well overall but complains of several skin-colored, painless "bumps" in her genital region that developed a few weeks ago. After a physical exam, she is diagnosed with genital warts. A Pap testing is needed more often B Treatment will cure the infection C Infection occurred 2-3 weeks ago D Condoms help prevent transmission
D
A 33-year-old pregnant female patient presents to an emergency department with reports of vaginal discharge which the patient describes as "thin and stringy." In addition, the patient endorses vaginal itching and fishy odor. Diagnostic tests reveal "clue cells" on microscopy, as well as an elevated pH of vaginal secretions. Which of the following therapies is most likely to result in clinical cure? A Ceftriaxone 250 mg intramuscularly x 1 dose plus doxycycline 100 mg orally twice daily for 14 days B Clindamycin cream 2%, 5 g intravaginally at bedtime for 7 days C Boric acid vaginal suppository 600 mg daily for 14 days D Clindamycin 300 mg orally twice daily for 7 days
D
A 47-year-old female patient with acute myeloid leukemia (AML) is admitted for the hospital for induction chemotherapy with idarubicin plus cytarabine. She has been on levofloxacin 500 mg daily, valacyclovir 500 mg twice daily, and posaconazole 300 mg delayed-release tablet daily for antimicrobial prophylaxis. On day 7 of her hospital day, the patient develops chills and a fever to 101.3°F (38.5°C, measured orally). A chest X-ray is ordered and is negative for infiltrates. The patient denies any focal symptoms, and physical exam is unremarkable. The patient's peripherally inserted central catheter insertion site is clean and without erythema or swelling. Her WBC is 0.0 cells/mm3, blood pressure is 122/76 mm Hg, heart rate is 98 beats/minute, and respiratory rate is 20 breaths/minute. Which of the following initial empiric antibiotic regimens is most appropriate? A Ceftazidime plus daptomycin B Ceftriaxone C Meropenem plus vancomycin D Piperacillin/tazobactam
D
H.W. is a 38-year-old woman who presents with a fever, malaise, dry cough, nasal congestion, and severe headaches. Her symptoms began suddenly 3 days ago, and she has been in bed since then. She reports no other illness in her family, but several people have recently called in sick at work. It is influenza season. Which is best for H.W.? A. Azithromycin 500 mg, followed by 250 mg daily orally for 4 more days. B. Amoxicillin/clavulanic acid 875 mg orally twice daily for 5 days. C. Oseltamivir 75 mg twice daily orally for 5 days. D. Symptomatic treatment only.
D
O.R. is a 73-year-old man who presents to the emergency department with a 3-day history of fever, chills, frequency, urgency, and perineal pain. A urinalysis reveals many bacteria. A rectal examination reveals a swollen, tender prostate. He is given a diagnosis of acute bacterial prostatitis. Which is the best regimen for this patient? A. Amoxicillin/clavulanate 875 orally twice daily for 7 days. B. Trimethoprim/sulfamethoxazole double strength orally twice daily for 14 days. C. Cefprozil 500 mg orally twice daily for 21 days. D. Ciprofloxacin 500 mg orally twice daily for 28 days.
D