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  #1  
Old 04-22-2011
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Heart Infective endocarditis empiric treatment

A fit and healthy man presented with 2 weeks-fever, breathlessness and clinically splinter hemorrhage, systolic murmer. Echo showed mitral valve vegitation. What is the most appropriate antibiotic regimen while awaiting blood culture result?

A. Ceftriaxone
B.
Nafcillin, penicillin, gentamicin
C.
Nafcillin, vancomycin
D.
Penicillin
E.
Vancomycin, gentamicin, rifampin
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  #2  
Old 04-22-2011
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Default Kill Staph

C...Vancomycin when suspecting MRSA
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  #3  
Old 04-22-2011
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I think E is the correct answer.

This person, given he is healthy, has Staph endocarditis.
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Old 04-22-2011
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I think ans shud be B
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Old 04-22-2011
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The best empiric therapy when culture is not yet available is vancomycin and gentamicin, so looking at the combinations, I choose E.

When culture is available:

Viridans streptococci --> ceftriaxone for 4 weeks.
Staph aureus (sensitive) --> oxacillin, nafcillin, or cefazolin.
Fungal --> amphotericin and valve replacement.
Staph epidermidis or resistant Staph --> vancomycin and gentamicin.
Enterococci --> ampicillin and gentamicin.
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Old 04-22-2011
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hmm.... im stuck between A and E. but for someone with mitral regurgitation who is about to undergo dental procedures, they would normally have to tk only amxicillin the day before. but 3 combinations of drugs seems a little redundant.
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Old 04-29-2011
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Correct Answer

According to Kaplan, acceptable empiric therapy should be a combination of antistaph (oxacillin etc) + penicillin + Gentamycin!! means B

However, according to Harrison's we should look for clues also. For eg :empirical therapy for acute endocarditis in an injection drug user should cover MRSA and gram-negative bacilli. The initiation of treatment with vancomycin plus gentamicin immediately after blood is obtained for cultures covers these as well as many other potential causes
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Old 04-30-2011
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Default Answer

I'll pick up E
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Old 04-30-2011
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err.... so whats the answer then for this question?

E?
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Old 05-01-2011
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Answer is B

patient is fit and healthy.. strep most common. MRSA in drug addicts...vANCO
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Old 05-02-2011
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Quote:
Originally Posted by Oodesh View Post
Answer is B

patient is fit and healthy.. strep most common. MRSA in drug addicts...vANCO
ok... thank u.
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Old 05-02-2011
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Hey..although I totally c ur point...according to both Kaplan n MTB..vanco and genta are the std empiric treatment for IE..to quote "it says acceptable empiric ... a/staph (nafcillin) a/strep (penicillin) and genta" but follows it up with vanco n genta..
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Old 05-02-2011
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Default that is perfect

Quote:
Originally Posted by qentank View Post
The best empiric therapy when culture is not yet available is vancomycin and gentamicin, so looking at the combinations, I choose E.

When culture is available:

Viridans streptococci --> ceftriaxone for 4 weeks.
Staph aureus (sensitive) --> oxacillin, nafcillin, or cefazolin.
Fungal --> amphotericin and valve replacement.
Staph epidermidis or resistant Staph --> vancomycin and gentamicin.
Enterococci --> ampicillin and gentamicin.

thx a lot
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Old 05-02-2011
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Is'nt vanco given to penicillin allergy cases please?
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Old 05-02-2011
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Quote:
Originally Posted by Oodesh View Post
Answer is B

patient is fit and healthy.. strep most common. MRSA in drug addicts...vANCO
Yes. Answer is B.

Sorry guys! I've been off for a few days and din't manage to reply earlier!
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Old 05-02-2011
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Here is the explanation. (source US consult)

This patient has infective endocarditis (IE) and is otherwise healthy. He is not predisposed to any unusual organisms and thus, the most appropriate empiric coverage is with nafcillin, penicillin, and gentamicin.

This provides adequate coverage for the most likely causes of IE, including Staphylococcus, Streptococcus, and
Enterococcus.


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Cardiology-, Infectious-Diseases, Internal-Medicine-, Step-2-Questions

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