NABP NAPLEX Exam - Topic 1 Question 93 Discussion

Actual exam question for NABP's NAPLEX exam

Question #: 93
Topic #: 1

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?

AVancomycin IV and Piperacillin/Tazobactam

BIV Doxycycline and Ceftazidime

CNafcillin

DVancomycin IV.

ECeftriaxone

Show Suggested Answer

Suggested Answer: A

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

by Weldon at Sep 18, 2024, 04:38 PM

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Melvin

3 months ago

Surprised no one mentioned the cephalexin not working!

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Alison

3 months ago

Really? I thought Ceftriaxone would be more appropriate.

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Corrina

3 months ago

But what about Nafcillin? Isn’t that good for skin infections too?

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Donette

4 months ago

Definitely agree, especially with the fever and elevated WBC.

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Almeta

4 months ago

I think Vancomycin IV is a solid choice here.

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Deeanna

4 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.

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Lelia

4 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.

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Simona

4 months ago

I'm not entirely sure, but I feel like Piperacillin/Tazobactam is more for broader coverage, maybe not the best choice here?

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Dusti

5 months ago

I remember discussing skin infections in class, and I think Vancomycin is often used for MRSA coverage, especially with the redness and swelling.

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Alonso

5 months 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.

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Kaitlyn

5 months 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.

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Kara

5 months 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?

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Cristal

5 months 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.

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Margery

5 months 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.

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Delfina

1 year 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?

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Cecil

1 year ago

I would go with vancomycin IV and piperacillin/tazobactam for broader coverage.

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Lai

1 year ago

I think vancomycin IV would also be a good option to cover for MRSA.

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Suzi

1 year ago

I agree, nafcillin is a good choice for skin infections.

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Lenna

1 year ago

I would go with Vancomycin IV as well, it's a broad-spectrum antibiotic.

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Teddy

1 year ago

I think Vancomycin IV and Piperacillin/Tazobactam would be more appropriate in this case.

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Dottie

1 year ago

I agree, nafcillin is a good choice for skin and soft tissue infections.

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Delsie

1 year 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.

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Sharen

1 year ago

Vancomycin IV alone could also be effective, especially if MRSA is suspected.

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Tyisha

1 year ago

I think Nafcillin could also be a good option for gram-positive coverage.

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Marti

1 year ago

Wouldn't Vancomycin IV and Piperacillin/Tazobactam be a better choice for MRSA coverage?

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Laura

1 year ago

I agree, starting with IV Doxycycline and Ceftazidime would cover a broad spectrum of bacteria.

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Charlie

1 year ago

I'm not sure, but I think Vancomycin IV alone could also be a good choice.

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Mindy

1 year ago

I agree with Muriel, those antibiotics would cover a broad spectrum of bacteria.

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Muriel

1 year ago

I think the most appropriate antibiotics would be Vancomycin IV and Piperacillin/Tazobactam.

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Alyce

1 year 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.

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Dominga

1 year ago

Yes, it's important to consider broad spectrum coverage in this case, especially with the elevated WBC count.

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Ryan

1 year ago

I agree, Vancomycin IV and Piperacillin/Tazobactam would be a good choice to cover both gram-positive and gram-negative organisms.

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