im
HIV - 01-02-08 13:14
A 50 yo hospitalized man with H/O rheumatic aortic and mitral valve dz. complains of fever, back pain, and myalgias for the past 3 days. On intial examination, no definite focus of infection is found. His leukocyte count is 24000 with 40% PMN and 40% band forms. The next day, 2 sets of blood culture are growing gram + cocci. Until specific organism specificity is known, the most appropriate antibiotic tretment regimen at this time is:
a) ceftriaxone
b) ciprofloxacin
c) nafcillin
d) streptomycin and pencillin
e) vancomycin and gentamycin
HIV - 01-02-08 13:14
A 50 yo hospitalized man with H/O rheumatic aortic and mitral valve dz. complains of fever, back pain, and myalgias for the past 3 days. On intial examination, no definite focus of infection is found. His leukocyte count is 24000 with 40% PMN and 40% band forms. The next day, 2 sets of blood culture are growing gram + cocci. Until specific organism specificity is known, the most appropriate antibiotic tretment regimen at this time is:
a) ceftriaxone
b) ciprofloxacin
c) nafcillin
d) streptomycin and pencillin
e) vancomycin and gentamycin
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#3
Re: im 8401glacieres - 01-11-08 11:54 C--Naficillin
Untill unless the organism is resistant to methicillin, it's not advisable t start Vanc. Yes adding gentamycin is an appropriate thing if we din't know the prelimanary report saying gram positive cocci are identified.
So best theraphy is to start semisynthetic penicillins--NAFICILLIN/OXACILLIN/CLOXAXXILLIN/DICLOXACILLIN. And among the given options it's naficillin.
#4
Re: im drsri117 - 01-11-08 13:21 i completely agree with the above answer starting of with semisynthetic penicillin is the way to go for g+ve cocci
hase to be nafcillin-c
#5
Re: im InSitu - 01-11-08 14:55 
posted by 8401glacieres on 01-11-08 11:54
C--Naficillin
Untill unless the organism is resistant to methicillin, it's not advisable t start Vanc. Yes adding gentamycin is an appropriate thing if we din't know the prelimanary report saying gram positive cocci are identified.
So best theraphy is to start semisynthetic penicillins--NAFICILLIN/OXACILLIN/CLOXAXXILLIN/DICLOXACILLIN. And among the given options it's naficillin.
C--Naficillin
Untill unless the organism is resistant to methicillin, it's not advisable t start Vanc. Yes adding gentamycin is an appropriate thing if we din't know the prelimanary report saying gram positive cocci are identified.
So best theraphy is to start semisynthetic penicillins--NAFICILLIN/OXACILLIN/CLOXAXXILLIN/DICLOXACILLIN. And among the given options it's naficillin.
Great explanation. Can you guys post questions so we can find more participation in the forum for those who are preparing for step 2 ck (and also step 1)
#9
Re: im babbu5508 - 07-07-10 22:04 c) nafcillin U.S. clinical practice guidelines recommend either nafcillin or oxacillin as the first-line treatment of choice for staphylococcal endocarditis in patients without artificial heart valves
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