02-28-2008, 05:33 PM
Correct Answer = B)...good going guys
Key Point
Vancomycin plus cefepime is the most appropriate empiric antimicrobial therapy for a patient with an epidural abscess and a history of injection drug use.
This patient most likely has a bacterial epidural abscess. The spread to the spine is probably hematogenous because of the involvement of two adjacent vertebrae and the disc space and the presence of an epidural collection. Most epidural abscesses are caused by staphylococci and streptococci, but the possibility of gram-negative bacilli must also be considered in injection drug users. Vancomycin plus cefepime is the only therapeutic regimen listed that treats all these bacteria.
Vancomycin alone would not be effective. Although infection caused by Mycobacterium tuberculosis is possible, antituberculous chemotherapy (isoniazid, rifampin, pyrazinamide, and ethambutol) should not be started unless culture results or histopathologic findings document this infection. Amphotericin B lipid complex is inappropriate because a fungal infection is unusual in an injection drug user, and empiric antifungal coverage is not warranted.
Key Point
Vancomycin plus cefepime is the most appropriate empiric antimicrobial therapy for a patient with an epidural abscess and a history of injection drug use.
This patient most likely has a bacterial epidural abscess. The spread to the spine is probably hematogenous because of the involvement of two adjacent vertebrae and the disc space and the presence of an epidural collection. Most epidural abscesses are caused by staphylococci and streptococci, but the possibility of gram-negative bacilli must also be considered in injection drug users. Vancomycin plus cefepime is the only therapeutic regimen listed that treats all these bacteria.
Vancomycin alone would not be effective. Although infection caused by Mycobacterium tuberculosis is possible, antituberculous chemotherapy (isoniazid, rifampin, pyrazinamide, and ethambutol) should not be started unless culture results or histopathologic findings document this infection. Amphotericin B lipid complex is inappropriate because a fungal infection is unusual in an injection drug user, and empiric antifungal coverage is not warranted.