11-03-2007, 03:42 PM
A 73-year-old man has a 1-day history of increasing cough, dyspnea, fever, and chills. He has chronic obstructive pulmonary disease and type 2 diabetes mellitus complicated by mild azotemia. The patient has a 60-pack-year smoking history and continues to smoke. Current medications are inhaled ipratropium bromide, inhaled salmeterol, and glyburide. On physical examination, he is obese and in mild respiratory distress. Temperature is 38 °C (100.4 °F), pulse rate is 100/min, respiration rate is 20/min, and blood pressure is 135/85 mm Hg. Chest examination discloses decreased breath sounds bilaterally, scattered rhonchi, and a few crackles at the left base posteriorly. Arterial oxygen saturation is 86% by pulse oximetry with the patient breathing room air. The leukocyte count is 9700/μL (9.7 × 109/L) with 72% neutrophils, 10% band forms, and 18% lymphocytes. Blood urea nitrogen is 40 mg/dL (14.3 mmol/L), and serum creatinine is 2.4 mg/dL (112.16 μmol/L). A chest radiograph shows a patchy infiltrate at the left lung base. The patient is hospitalized. Which of the following is the most appropriate intravenous antibiotic therapy at this time?
A Ceftriaxone plus azithromycin
B Ampicillin“sulbactam
C Ticarcillin plus tobramycin
D High-dose penicillin
E Trimethoprim“sulfamethoxazole
A Ceftriaxone plus azithromycin
B Ampicillin“sulbactam
C Ticarcillin plus tobramycin
D High-dose penicillin
E Trimethoprim“sulfamethoxazole