1 infec 43 - tabish60102

[ArchivalUser]

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

[ArchivalUser]

ddd?

[ArchivalUser]

DD

[ArchivalUser]

Correct Answer = D)
Key Points

* Brain abscesses that result from contiguous spread of head and neck infections may contain multiple organisms.
* Ceftriaxone plus metronidazole is the most appropriate empiric antimicrobial therapy for a brain abscess resulting from contiguous spread of an otitic focus of infection.

This patient likely has a bacterial brain abscess that resulted from contiguous spread from chronic otitis media. The most likely pathogens are aerobic and anaerobic streptococci, Bacteroides species, Prevotella species, and members of the Enterobacteriaceae family. Brain abscesses that result from contiguous spread of head and neck infection (e.g., otitis media) may contain multiple organisms. The only regimen listed that treats all of the possible infecting organisms is ceftriaxone plus metronidazole.

[ArchivalUser]

This is the case of brain abscess. Streptococcus is implicated in 60-70%, bacteroids in 20-40%, enterobacteriaceae 25-35% (Kaplan)

The best answer would be C (covers gram positive and anaerobes)

[ArchivalUser]

the most common cause of otitis media is streptococcus pneumonia (gram positive). So using penicillin is better using ceftriaxon (covers mainly gram negative)

[ArchivalUser]

I APPRECIATE UR FEEDBACK. ANYONE WHO WLD LIKE TO COMMENT?

[ArchivalUser]

thanks tabish...add me please mandrlval