Which bug? - sheetal044

[ArchivalUser]

A 33-year-old man had the sudden onset of a shaking chill and fever. Two weeks ago, he was diagnosed with acute myelogenous leukemia and was hospitalized for initiation of chemotherapy. He is pale and has rigors. His temperature is 38.6°C (101.5°F), blood pressure is 120/76 mm Hg, pulse is 110/min, and respirations are 32/min. There are multiple petechiae over his antecubital fossae. Physical examination is otherwise normal. Laboratory studies show:

Hematocrit 24%
Leukocyte count 4001mm3
Segmented neutrophils 1%
Lymphocytes 98%
Monocytes 1%
Platelet count 15,000/mm3

Blood is drawn for culture. Which of the following should be administered intravenously?

A) Clindamycin and cefazolin
B) Ticarcillin and tobramycin
C) Vancomycin
D) High-dose penicillin
E) High-dose trimethoprim-sulfamethoxazole

[ArchivalUser]

B
you don t know the bug but you know the pt has febrile neutropenia, so you need broad spectrum coverage (antipseudomonal broad spectrum penicillin + aminoglycoside). mono therapy never indicated ( C D E)