Chapter·MicrobiologyMicrobial genetics and drug resistance

Antimicrobial stewardship principlesDownloads

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1

A 64-year-old woman with a past medical history of poorly managed diabetes presents to the emergency department with nausea and vomiting. Her symptoms started yesterday and have been progressively worsening. She is unable to eat given her symptoms. Her temperature is 102°F (38.9°C), blood pressure is 115/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for left-sided costovertebral angle tenderness, and urinalysis demonstrates bacteriuria and pyuria. The patient is admitted to the hospital and started on IV ceftriaxone. On day 3 of her hospital stay she is afebrile, able to eat and drink, and feels better. Which of the following antibiotic regimens should be started or continued as an outpatient upon discharge?

AAmoxicillin

BNitrofurantoin

CCiprofloxacin

DCeftriaxone

ETrimethoprim-sulfamethoxazole

2

An 87-year-old male nursing home resident is currently undergoing antibiotic therapy for the treatment of a decubitus ulcer. One week into the treatment course, he experiences several episodes of watery diarrhea. Subsequent sigmoidoscopy demonstrates the presence of diffuse yellow plaques on the mucosa of the sigmoid colon. Which of the following is the best choice of treatment for this patient?

AIntravenous vancomycin

BIntravenous gentamicin

COral metronidazole

DOral trimethoprim/sulfamethoxazole

EOral morphine

3

An 18-year-old female college student is brought to the emergency department by ambulance for a headache and altered mental status. The patient lives with her boyfriend who is with her currently. He states she had not been feeling well for the past day and has vomited several times in the past 12 hours. Lumbar puncture is performed in the emergency room and demonstrates an increased cell count with a neutrophil predominance and gram-negative diplococci on Gram stain. The patient is started on vancomycin and ceftriaxone. Which of the following is the best next step in management?

ATreat boyfriend with rifampin

BAdd ampicillin to treatment regimen

CAdd ampicillin, dexamethasone, and rifampin to treatment regimen

DAdd dexamethasone to treatment regimen

ETreat boyfriend with ceftriaxone and vancomycin

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