a 65 - pacemaker

[ArchivalUser]

A 65-year-old man with a history of diverticular disease has a 2-day history of left lower quadrant abdominal pain and fever. On physical examination, temperature is 39 °C (102.2 °F), pulse rate is 100/min and regular, respiration rate is 16/min, and blood pressure is 160/80 mm Hg. Abdominal examination discloses pain on palpation of the left lower quadrant with rebound and guarding. The leukocyte count is 25,000/μL (25 × 109/L) with 90% segmented neutrophils.

A CT scan of the abdomen shows a pericolic abscess in the left lower quadrant. Radiologic-guided drainage of the abscess is performed, and culture specimens are obtained. The cultures are reported to be growing mixed enteric flora, including Klebsiella species and Bacteroides fragilis. Intravenous piperacillin“tazobactam is administered every 6 hours, and the patient subsequently improves. He is ready for discharge, and outpatient parenteral antimicrobial therapy is planned.

Which of the following antimicrobial agents can be given parenterally on a once-daily schedule?

A Imipenem
B Piperacillin“tazobactam
C Ceftriaxone plus metronidazole
D Ertapenem

[ArchivalUser]

C!!

[ArchivalUser]

C,, from me too...

[ArchivalUser]

C...

[ArchivalUser]

Correct Answer = D)
Key Point
Whenever possible, outpatient parenteral therapy should use drugs that can be given once daily for convenience and patient comfort.

Whenever possible, outpatient parenteral therapy should utilize drugs that can be given once daily for convenience and patient comfort. All of the antimicrobial agents listed will most likely be effective in treating this patient's infection. However, ertapenem is the only drug that will provide coverage for polymicrobial infection with once-daily administration.

Ertapenem is a carbapenem with activity against most enteric pathogens, including extended-spectrum β-lactamase“producing strains and anaerobes. It is also active against other streptococci and methicillin-sensitive Staphylococcus aureus but is ineffective against methicillin-resistant S. aureus, vancomycin-resistant enterococci, Pseudomonas species, and Acinetobacter species. The dose for all indications is 1 g/d, either intravenously or intramuscularly. The dose should be reduced by 50% for patients with a creatinine clearance less than 30 mL/min. Like most β-lactams, ertapenem has a low risk of adverse events.