WBR0853

Author	[[PageAuthor::Mohamed Moubarak, M.D. [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Infectious Disease, SubCategory::Infectious Disease
Prompt	[[Prompt::An 11 year-old boy brought to the ED by his mother complaining of progressive severe pain, and swelling in his left foot. The mother said that she used some analgesic medications that were prescribed to him 2 weeks ago for fever after he injured himself during playing, but neither the pain nor the fever subsided. He is a diabetic on insulin, taking no other medications. On examination, the patient is feverish with temperature 39 C (102 F), heart rate 100/min, blood pressure 140/80 mmHg, and respiratory rate of 22/min. His left foot is severely tender, red, and hot, with decreased range of motion on examination. You ordered x-ray which turned back with no pathology. You ordered a blood culture. What is the best antibiotic treatment of choice in this patient?]]
Answer A	AnswerA::IV nafcillin for 4-6 weeks
Answer A Explanation	[[AnswerAExp::Correct nafcillin/oxacillin is the antibiotic of choice to start with as most of the causative organism is Staphylococcus aureus or coagulasenegative (methicillin-sensitive) Staphylococci]]
Answer B	AnswerB::IV Vancomycin for 4-6 weeks
Answer B Explanation	[[AnswerBExp::Incorrect We don’t start vancomycin unless the result of the culture denotes methicillin-resistant staphylococci or Penicillin-resistant S. pneumoniae]]
Answer C	AnswerC::I.V Ceftazidime for 4-6 weeks
Answer C Explanation	[[AnswerCExp::Incorrect Ceftazidime is the drug of choice if the blood culture reveals Serratia species or Pseudomonas aeruginosa]]
Answer D	AnswerD::I V Clindamycin for 4-6 weeks
Answer D Explanation	[[AnswerDExp::Incorrect Clindamycin is used when anaerobes is the causative organism]]
Answer E	AnswerE::I.V Ciprofloxacin for 4-6 weeks
Answer E Explanation	[[AnswerEExp::Incorrect Ciprofloxacin is used with Enteric gram-negative rods]]
Right Answer	RightAnswer::A
Explanation	[[Explanation::Antibiotic therapy should be directed to culture and susceptibility findings. When culture results are bending, broad spectrum empiric therapy should be administered. Antibiotic treatment of Osteomyelitis consists of a 4- to 6-week course, and the best choice to start with is the intravenous nafcillin/oxacillin. Organism Antibiotic(s) of first choice Staphylococcus aureus or coagulasenegative (methicillin-sensitive) Staphylococci Nafcillin (Unipen), 2 g IV every 6 hours, or clindamycin phosphate (Cleocin Phosphate), 900 mg IV every 8 hours S. aureus or coagulase-negative (methicillin-resistant) staphylococci Vancomycin, 1 g IV every 12 hours Various streptococci (groups A and B β-hemolytic organisms or penicillin-sensitive Streptococcus pneumoniae) Penicillin G, 4 million units IV every 6 hours Intermediate penicillin-resistant S. pneumoniae Cefotaxime (Claforan), 1 g IV every 6 hours, or ceftriaxone, 2 g IV once daily Penicillin-resistant S. pneumoniae Vancomycin, 1 g IV every 12 hours Enterococcus species Ampicillin, 1 g IV every 6 hours, or vancomycin, 1 g IV every 12 hours Enteric gram-negative rods Fluoroquinolone (e.g., ciprofloxacin [Cipro], 750 mg orally every 12 hours) Serratia species or Pseudomonas aeruginosa Ceftazidime (Fortaz), 2 g IV every 8 hours (with an aminoglycoside given IV once daily or in multiple doses for at least the first 2 weeks) Anaerobes Clindamycin, 600 mg IV or orally every 6 hours Mixed aerobic and anaerobic Organisms Amoxicillin-clavulanate, 875 mg and 125 mg, respectively, orally every 12 hours http://www.aafp.org/afp/2001/0615/p2413.html Educational Objective: References: ]]
Approved	Approved::No
Keyword	[[WBRKeyword::Osteomyelitis]]
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::