05-19-2007, 06:28 PM
A 55-year-old woman has the acute onset of severe pain in the left lower extremity. On physical examination, temperature is 38.9 °C (102.0 °F), pulse rate is 110/min, and respiration rate and blood pressure are normal. The left leg is swollen, erythematous, warm, and tender below the knee with red streaks extending up the thigh to the groin. The right leg appears normal.
Laboratory Studies
Leukocyte count 17,000/μL (20% band forms)
Blood urea nitrogen 14 mg/dL
Serum creatinine 0.9 mg/dL
Serum electrolytes Normal
Liver chemistry studies Normal
Blood culture specimens are obtained, and intravenous nafcillin is begun. One day later, the microbiology laboratory reports that blood cultures are growing group A β-hemolytic streptococci. The patient is still febrile, her leukocyte count has increased to 22,000/μL, the erythema has not diminished, and bullous lesions are now present on the left calf.
Which of the following antibiotics should be added to this patient™s regimen?
( A ) Ceftriaxone
( B ) Vancomycin
( C ) Ciprofloxacin
( D ) Clindamycin
( E ) Gentamicin
Laboratory Studies
Leukocyte count 17,000/μL (20% band forms)
Blood urea nitrogen 14 mg/dL
Serum creatinine 0.9 mg/dL
Serum electrolytes Normal
Liver chemistry studies Normal
Blood culture specimens are obtained, and intravenous nafcillin is begun. One day later, the microbiology laboratory reports that blood cultures are growing group A β-hemolytic streptococci. The patient is still febrile, her leukocyte count has increased to 22,000/μL, the erythema has not diminished, and bullous lesions are now present on the left calf.
Which of the following antibiotics should be added to this patient™s regimen?
( A ) Ceftriaxone
( B ) Vancomycin
( C ) Ciprofloxacin
( D ) Clindamycin
( E ) Gentamicin