12-15-2008, 08:54 PM
A 25-year-old man is brought to the emergency department because of a severe headache and left-side weakness of several hours' duration. He was well until 3 weeks ago, when he developed an earache on the right that he self-treated with acetaminophen. The patient has a history of chronic otitis media for which he received several courses of empiric therapy with amoxicillin.
On physical examination, his temperature is 37.7 °C (99.9 °F), pulse rate is 80/min, respiration rate is 16/min, and blood pressure is 120/78 mm Hg. Neurologic examination shows left-sided weakness, more so of the arm than of the leg. Motor strength is 3/5 in the left arm and 4/5 in the left leg. Left central cranial nerve VII palsy is present. There are no sensory findings.
Laboratory studies are normal. MRI of the brain, with and without gadolinium enhancement, shows a 4-cm ring-enhancing lesion in the right temporal lobe with localized edema and midline shift to the left. Stereotactic CT-guided aspiration of the lesion reveals purulent fluid.
Which of the following empiric antimicrobial regimens should be initiated pending culture results?
A Penicillin
B Ceftriaxone
C Penicillin plus metronidazole
] D Ceftriaxone plus metronidazole
E Vancomycin plus metronidazole
On physical examination, his temperature is 37.7 °C (99.9 °F), pulse rate is 80/min, respiration rate is 16/min, and blood pressure is 120/78 mm Hg. Neurologic examination shows left-sided weakness, more so of the arm than of the leg. Motor strength is 3/5 in the left arm and 4/5 in the left leg. Left central cranial nerve VII palsy is present. There are no sensory findings.
Laboratory studies are normal. MRI of the brain, with and without gadolinium enhancement, shows a 4-cm ring-enhancing lesion in the right temporal lobe with localized edema and midline shift to the left. Stereotactic CT-guided aspiration of the lesion reveals purulent fluid.
Which of the following empiric antimicrobial regimens should be initiated pending culture results?
A Penicillin
B Ceftriaxone
C Penicillin plus metronidazole
] D Ceftriaxone plus metronidazole
E Vancomycin plus metronidazole