RT Book, Section
A1 E. Beauduy, Camille
A1 Winston, Lisa G.
A2 Katzung, Bertram G.
SR Print(0)
ID 1148439947
T1 Beta-Lactam & Other Cell Wall- & Membrane-Active Antibiotics
T2 Basic & Clinical Pharmacology, 14e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9781259641152
LK accesspharmacy.mhmedical.com/content.aspx?aid=1148439947
RD 2024/04/23
AB CASE  STUDYA  45-year-old  man  is  brought  to  the  local  hospital  emergency  department  by  ambulance.  His  wife  reports  that  he  had  been  in  his  normal  state  of  health  until  3  days  ago  when  he  developed  a  fever  and  a  productive  cough.  During  the  last  24  hours  he  has  complained  of  a  headache  and  is  increasingly  confused.  His  wife  reports  that  his  medical  history  is  significant  only  for  hypertension,  for  which  he  takes  hydrochlorothiazide  and  lisinopril,  and  that  he  is  allergic  to  amoxicillin.  She  says  that  he  developed  a  rash  many  years  ago  when  prescribed  amoxicillin  for  bronchitis.  In  the  emergency  department,  the  man  is  febrile  (38.7°C  [101.7°F]),  hypotensive  (90/54  mmHg),  tachypneic  (36/min),  and  tachycardic  (110/min).  He  has  no  signs  of  meningismus  but  is  oriented  only  to  person.  A  stat  chest  x-ray  shows  a  left  lower  lung  consolidation  consistent  with  pneumonia.  A  CT  scan  is  not  concerning  for  lesions  or  elevated  intracranial  pressure.  The  plan  is  to  start  empiric  antibiotics  and  perform  a  lumbar  puncture  to  rule  out  bacterial  meningitis.  What  antibiotic  regimen  should  be  prescribed  to  treat  both  pneumonia  and  meningitis?  Does  the  history  of  amoxicillin  rash  affect  the  antibiotic  choice?  Why  or  why  not?