07-22-2009, 03:45 PM
A 62-year-old man is admitted to the hospital for progressive shortness of breath, productive cough, fevers, and chills lasting for 2 days. Aside from respiratory symptoms, he suffers from mild diarrhea, diffuse abdominal pain, and a generalized malaise, both of which he attributes to being œrun down after a recent business trip to a large convention. While he denied any sick contacts, he did note that some of his colleagues at the convention also seemed to be coming down with something near the end of the trip. Chest x-ray shows a left lower lobe consolidation, and he is treated for presumed community-acquired pneumonia with empiric ceftriaxone. Sputum gram stain shows a large number of neutrophils, few squamous cells, and no organisms. Repeated sets of blood and sputum cultures are negative, including one set of fungal cultures. Over the course of 6 days, his condition deteriorates and he is intubated and transferred to the intensive care unit. Chest x-ray shows a progressive lobar pneumonia. Laboratory studies at this time are remarkable only for a mild hyponatremia and a continued leukocytosis. Which of the following is the most appropriate additional treatment at this time?
A. Amphotericin B
B. Ciprofloxacin
C. Clindamycin
D. Piperacillin/tazobactam
E. Vancomycin
A. Amphotericin B
B. Ciprofloxacin
C. Clindamycin
D. Piperacillin/tazobactam
E. Vancomycin