MENU
MT is 47-year-old man who presents to the ER with painful, red, swollen area on his left leg. His temperature is 38.4, respiratory rate 30 and heart rate 95. He has been taking cephalexin day 4 today, as prescribed by his primary care physician. His CMP is normal a CBC shows elevated WBC of 16,000/mm3.
What would be the most appropriate antibiotic/s to initiate on MT empirically?
Suggested Answer: A
Get Premium NAPLEX Questions
as Interactive Web-Based Practice Test or PDF
Real Exam Format
Detailed Explanations
Instant Access
Get Your Practice Test
This patient is displaying signs of a severe case of cellulitis. Severe cellulitis is defined as having one of the following: failed oral antibiotic treatment, immunocompromised, clinical signs of deeper infection, or meeting the SIRS criteria. Based on this patient's presentation they have failed antibiotic treatment and meet SIRS criteria. For severe cellulitis, IDSA SSTI guidelines recommend using Vancomycin along with Zosyn.
https://academic.oup.com/cid/article/59/2/e10/2895845/Practice-Guidelines-for-the-Diagnosis-and
32 comments · newest first
ME
Melvin
10 months ago
Surprised no one mentioned the cephalexin not working!
AL
Alison
11 months ago
Really? I thought Ceftriaxone would be more appropriate.
CO
Corrina
11 months ago
But what about Nafcillin? Isn’t that good for skin infections too?
DO
Donette
11 months ago
Definitely agree, especially with the fever and elevated WBC.
AL
Almeta
11 months ago
I think Vancomycin IV is a solid choice here.
DE
Deeanna
12 months ago
I recall that if the patient is already on cephalexin and not improving, we might need to switch to something stronger, like Vancomycin.
LE
Lelia
12 months ago
I practiced a similar question where we had to choose between Vancomycin and Nafcillin. I think Nafcillin is for MSSA, but I’m leaning towards Vancomycin for this case.
SI
Simona
12 months ago
I'm not entirely sure, but I feel like Piperacillin/Tazobactam is more for broader coverage, maybe not the best choice here?
DU
Dusti
1 year ago
I remember discussing skin infections in class, and I think Vancomycin is often used for MRSA coverage, especially with the redness and swelling.
AL
Alonso
1 year ago
I'm leaning towards the Vancomycin IV and Piperacillin/Tazobactam option. It's a good broad-spectrum approach to cover the likely pathogens in this case of complicated cellulitis.
KA
Kaitlyn
1 year ago
Okay, let's think this through. The patient has cellulitis, fever, and an elevated WBC. Vancomycin would cover gram-positive organisms, and Piperacillin/Tazobactam would cover a wider range of gram-negatives. Seems like the best empiric choice.
KA
Kara
1 year ago
I'm a bit confused here. The patient is already on an antibiotic, but has an elevated WBC. Should we be considering something more broad-spectrum like the Vancomycin and Piperacillin/Tazobactam?
CR
Cristal
1 year ago
Hmm, the patient is already on cephalexin, so I'm not sure if I'd want to add another cephalosporin like ceftazidime. Maybe the Vancomycin and Piperacillin/Tazobactam would be the safer bet.
MA
Margery
1 year ago
This looks like a classic case of cellulitis. I'd go with Vancomycin IV and Piperacillin/Tazobactam to cover both gram-positive and gram-negative organisms.
DE
Delfina
2 years ago
Nafcillin seems like a good choice, as it's an effective antibiotic for skin and soft tissue infections like this. Plus, it's got a catchy name - who doesn't love a bit of 'nafcillin' in their life?
CE
Cecil
2 years ago
I would go with vancomycin IV and piperacillin/tazobactam for broader coverage.
LA
Lai
2 years ago
I think vancomycin IV would also be a good option to cover for MRSA.
SU
Suzi
2 years ago
I agree, nafcillin is a good choice for skin infections.
LE
Lenna
2 years ago
I would go with Vancomycin IV as well, it's a broad-spectrum antibiotic.
TE
Teddy
2 years ago
I think Vancomycin IV and Piperacillin/Tazobactam would be more appropriate in this case.
DO
Dottie
2 years ago
I agree, nafcillin is a good choice for skin and soft tissue infections.
DE
Delsie
2 years ago
The elevated WBC and fever suggest a bacterial infection, so I'd choose the IV Doxycycline and Ceftazidime option to target a wide range of gram-positive and gram-negative bacteria.
SH
Sharen
2 years ago
Vancomycin IV alone could also be effective, especially if MRSA is suspected.
TY
Tyisha
2 years ago
I think Nafcillin could also be a good option for gram-positive coverage.
MA
Marti
2 years ago
Wouldn't Vancomycin IV and Piperacillin/Tazobactam be a better choice for MRSA coverage?
LA
Laura
2 years ago
I agree, starting with IV Doxycycline and Ceftazidime would cover a broad spectrum of bacteria.
CH
Charlie
2 years ago
I'm not sure, but I think Vancomycin IV alone could also be a good choice.
MI
Mindy
2 years ago
I agree with Muriel, those antibiotics would cover a broad spectrum of bacteria.
MU
Muriel
2 years ago
I think the most appropriate antibiotics would be Vancomycin IV and Piperacillin/Tazobactam.
AL
Alyce
2 years ago
Hmm, the patient is already taking cephalexin, so I'd go with Vancomycin IV and Piperacillin/Tazobactam to cover a broader spectrum of potential pathogens.
DO
Dominga
2 years ago
Yes, it's important to consider broad spectrum coverage in this case, especially with the elevated WBC count.
RY
Ryan
2 years ago
I agree, Vancomycin IV and Piperacillin/Tazobactam would be a good choice to cover both gram-positive and gram-negative organisms.